One of the many fertility problems affecting women is the Polycystic Ovary Syndrome or Polycystic Ovarian Syndrome (PCOS), also known as Stein-Leventhal Syndrome in honor of the two doctors who discovered it.
Although the causes behind the appearance of this syndrome are undetermined, it appears to be that there is a genetic predisposition.
Among women at reproductive age, 20 per cent present polycystic ovaries, of which 50 per cent are diagnosed with the polycystic ovary syndrome. This means that having polycystic ovaries does not necessarily mean you suffer from PCOS. PCOS should not be confused with polycystic ovaries (PCO).
Polycystic ovaries and PCOS
The polycystic ovary syndrome is due to metabolic causes, and shouldn’t be confused with polycystic ovaries or PCO, which are due to an alteration within the ovarian function, in which follicles are not fully mature and, therefore, they do not release the egg. Follicles then turn into a cyst within the ovarian cortex, which appears thickened in the ultrasound.
Many times, your period may be irregular but your ovary works well, and natural conception is likely to happen. If this is your case, this is NOT the syndrome.
Hormonal imbalance occurs with this syndrome: women have the so-called female sex hormones, estrogens and progesterone, but they also have androgen (typically the male sex hormone), although to a lesser extent.
With PCOS, women produce more androgen and their menstrual cycle does not come on a regular basis. Within the ovary, follicles do not mature and, therefore, eggs are not released, resulting then in cysts. Since follicles do not mature and eggs are not released, PCOS affects female fertility.
The polycystic ovary syndrome is diagnosed if two of the next three premises are met:
- Hyperandrogenism (a.k.a. hyperandrogenemia) symptoms due to an excessive production of male hormones: hair increase, alopecia…
- Polycystic ovary, thickened ovarian cortex, and ovarian cysts because the follicles are not releasing eggs.
- Very seldom menstrual cycles or periods throughout the year.
Polycystic ovary syndrome occurs because of insulin resistance: the body does not absorb glucose and, therefore, continues to produce insulin. The insulin hormone acts directly on the ovaries, affecting those female hormones which are responsible for follicular development and egg releasing. This prevents the menstrual cycle to come on a regular basis and affects fertility.
Women suffering from PCOS usually experience the following symptoms:
- Menstrual irregularities: oligomenorrhea (menstrual periods occurring at intervals of greater than 35 days) or amenorrhoea (absence of the menstrual period).
- Anovulatory infertility.
- Hormonal disorders: elevated testosterone, elevated LH hormone, elevated LH/FSH relationship, elevated δ4-androstendione (androgen), etc.
- Insulin resistance.
- Polycystic ovaries.
- Breast and uterine hypoplasia.
- Acanthosis nigricans: dark patches of skin which usually appear on the neck or the armpits.
In cases of predisposition to develop PCOS, changing your lifestyle is an essential step against it. Having a BMI-number below 25 and taking contraceptives and antidiabetic drugs is highly advisable, too. It is not only fundamental to avoid obesity but rather a sedentary lifestyle.
Women with polycystic ovary syndrome who do not ovulate on a regular basis are usually returned to normal via progesterone, aiding thus the second phase of the menstrual cycle, after ovulation.
Metformin, an antidiabetic drug, has been widely used for the desensitization of the ovaries towards excess insulin, this way promoting follicular development.