PCO syndrome

Polycystic ovary syndrome (PCOS) is a disease characterized by hyperandrogenemia, ovarian dysfunction and polycystic ovarian morphology. The syndrome can cause significant metabolic disorders, thereby increasing the risk of diabetes mellitus and cardiovascular disease.

Insulin resistance is present in many women with PCOS, particularly those with hyperandrogenemia.

Aetiology

The contribution of the genetic background remains uncertain and there is no genetic test to use as a means of population control. There is no environmental agent or substance involved in the onset of the syndrome. Insulin resistance plays a central role in the etiology of insulin. Obesity is not a diagnostic criterion (given that 20% of women with PCOS is not obese), but strengthens the pathological phenomena of the syndrome.

Symptoms

Women with PCOS usually have menstrual disorders (from amenorrhea to menorrhagia) and infertility. For this reason, the focus is on ovulation induction therapies, as they increase the risk of ovarian hyperstimulation syndrome and multiple pregnancies.

Furthermore, women with PCOS have an increased risk of pregnancy complications, such as diabetes mellitus and hypertension. Dermatological disorders due to increased peripheral androgens, such as hirsutism and acne and, to a lesser extent, alopecia, are common results.

These women have been reported to have an increased risk of endometrial cancer through the independent risk factors that accompany the syndrome (obesity, diabetes, hypertension, chronic anovulatory cycles).

Differential diagnosis

  • Androgen producing Tumors

  • Therapies with androgens

  • Cushing syndrome

  • Thyroid disease

  • Congenital adrenal hyperplasia

Diagnosis

The history should focus on the onset and duration of various signs of hyperandrogenemia, the history of menstruation and the simultaneous intake of drugs, especially exogenous androgens.

  • Blood pressure

  • BMI

  • Adipose tissue distribution

  • Acne

  • Hirsutism

  • Alopecia

  • Acanthosis Nigricans

  • Free and total testosterone

  • TSH

  • Prolactin

  • 17OH progesterone

> 12 follicles of 2-9mm

PCOS and diabetes type 2

Studies have shown that women with PCOS have a 2 to 5 times greater risk of developing type 2 diabetes and therefore must be controlled with a load curve.

Therapy

Increased physical activity combined with proper nutrition reduces the risk of diabetes and these results are comparable or better than those of drugs. Weight loss improves the metabolic disorders that accompany PCOS. Limiting your daily calorie intake seems to be the key factor.

Pharmacological therapy

Metformin is used in conjunction with exercise and improves glucose tolerance. The most frequent side effects of metformin concern the gastrointestinal tract (diarrhea, nausea, vomiting, swelling, anorexia) and can be avoided by starting at a low dose and gradually increasing. The dose needed to treat PCOS is 1500-2000 mg a day in divided doses.

The first-line treatment for ovulation induction is always the anti-estrogen clomiphene citrate (Clomid). Otherwise, the second line of treatment consists of exogenous gonadotropins or laparoscopic ovarian perforation.

Clomiphene citrate

Pregnancy success rates at 6 months of treatment are reported at 20-40%. Half of women become pregnant by taking it at 50 mg a day, while another 20% reaches a pregnancy at a dose of 100 mg a day.

Gonadotrophins

They are used to induce ovulation in women with PCOS where Clomifene Cetate has failed. Low-dose gonadotropin therapy offers a high rate of ovulation.

Ovarian drilling

The value of laparoscopic ovarian perforation as the primary treatment of infertile women with PCOS is unclear and is therefore recommended as a second-line treatment. It does not appear to have any advantage over gonadotropin in the rate of pregnancy. However, it appears to have lower rates of multiple pregnancies in women who will be pregnant. Sometimes fertility after ovarian perforation may be temporary and further treatment with clomiphene or gonadotropins is required. The long-term effects of perforation on ovarian function are unknown. The effect of perforation on the metabolic disorders of PCOS is negligible.

Birth pills

Low-dose oral contraceptives are the most commonly used drugs to regulate the cycle and are best suited for long-term use. Generally, they provide their benefits through various mechanisms, including suppression of the pituitary LH, suppression of ovarian androgen production, and increased circulating SHBG. There are insufficient data to indicate which combination of estrogens / progestagens is more appropriate for the treatment of menstrual disorders in women with PCOS.