What is polycystic ovarian disease?

polycysticWhat is ovarian disease?

Polycystic ovarian disease (PCOS) is the most common hormonal disorder seen in women of reproductive age. It shows transition with the effect of multiple genetic factors, and if there is PCOS in the family, the risk increases. If a first-degree relative (mother, sister) has PCOS, 20-40% of people have PCOS. In the United States, it affects 5%-10% of women of reproductive age in the population. In a study we conducted with a budget of 100 thousand dollars as Hacettepe PCOS Study Group (it is the first and only study in our country), we determined the prevalence of PCOS in our country at a very high rate of 19%.

Diagnosis

In the diagnosis, the patient is examined, USG is performed, and the degree of hair growth is determined by the Ferriman-Gallwey measurement. Male hormones are detected in the blood. (Total testosterone, free testosterone, SHBG, DHEA-S). Prolactin and TSH values ​​are requested.

According to the Rotterdam criteria:

  • Delayed or absent periods (infrequent or no ovulation)
  • Increased hair growth (on the face, between the breasts, around the navel, on the upper arms, back, upper legs) or high male hormones in the laboratory
  • Observation of 12 and larger cysts with a diameter of 2-9 mm in a single ovary in ultrasonographic examination

If at least 2 of these 3 items are present, the diagnosis of PCOS is made.

Normal and polycystic ovaries shown

Concomitant conditions

  • About half of patients with polycystic ovarian disease are overweight.
  • Predisposition to gain weight, inability to lose weight
  • Oily skin, acne, male pattern hair loss can be observed.
  • increase in hair growth
  • There may be a situation where pregnancy does not occur because ovulation is infrequent or absent.
  • Pregnant women have a higher risk of miscarriage.
  • Thickening of the uterus (endometrial hyperplasia) and may be a risk factor for intrauterine cancer
  • Depression (26-40%), anxiety-anxiety disorder (11.6%), overeating (23.3%), and not enjoying life are observed more frequently.
  • The risk of pregnancy poisoning (preeclampsia), pregnancy-induced high blood pressure, gestational diabetes and preterm labor is increased.
  • Babies of PCOS patients have a higher need for postnatal intensive care compared to normal babies. Perinatal morbidity is higher (even after correcting for multiple pregnancy effect).
  • The rate of multiple pregnancy due to ovulation treatment is also high.
  • Regardless of weight, 40% of PCOS patients have hidden sugar. 10% have overt diabetes. The rate of hidden sugar is 90% in overweight PCOS patients. In a recent study (joint result of 35 studies), overt diabetes mellitus increased 4 times and latent diabetes mellitus 2.5 times in women with PCOS. For this reason, when the diagnosis is made and every 2 years, it should be checked whether overt diabetes or latent diabetes develops with a sugar load test (75 grams of sugar load).
  • 70% of PCOS patients have elevated blood fats. It is high in 24-40% of LDL fat, which is known as bad fat, which is the oil that blocks the arteries. HDL fat, known as the good fat, has decreased.
  • Metabolic syndrome is seen in 33-47% of PCOS patients, which is 2-3 times higher than normal.
  • PCOS patients have a higher incidence of cardiovascular diseases. In a study we have done, we found that a substance called CD40, which increases the risk of cardiovascular diseases, is higher in patients with PCOS. With this study, we received the 1st prize for the best article at the 2008 3rd National Reproductive Endocrinology and Infertility Congress.
  • Although there are studies stating that the risk of ovarian cancer and breast cancer is high, it has not been fully demonstrated. Closer screening for breast and ovarian cancer is currently not recommended.
Treatment

Rather than a single treatment option, treatment for complaints is more appropriate.

Vaginal bleeding without ovulation

It develops secondary to excess estrogen due to not ovulating. Due to the low level of progesterone, the lining of the uterus is thick and very fragile. Prolonged vaginal bleeding may occur. Since pathological thickening of the intrauterine layer can be seen in women over 35 years of age (endometrial hyperplasia with or without atypia, there is at least a 1% chance of transforming into uterine cancer), it is necessary to perform an intrauterine sampling. If hysteroscopy is possible, it should be performed with hysteroscopy. In women under 35 years of age, sampling is generally not required.

If there is no problem in intrauterine sampling, combined birth control pills, cyclic or continuous progesterone therapy to stop vaginal bleeding (Medroxyprogesterone acetate 5-10 mg/day or norethindrone acetate 2.5-10 mg/day or micronized progesterone 200 mg 2-3 times/day) can be given.

In appropriate cases, intrauterine devices containing progesterone (Mirena) can be inserted.

increase in hair growth

The treatment of increased hair growth is explained in detail in the section on hair growth. Click for detailed information.

Prevention from type 2 diabetes

Weight loss, diet and exercise effectively reduce the incidence of diabetes. If necessary, metformin 2-2.5 mg/day can be added to the treatment. Metformin is actually a sugar-lowering drug. It can help in weight loss as it also cuts the appetite.

Protection against cardiovascular disease

Author

663751
prof. Dr. Ibrahim ESINLER

Gynecology and Obstetrics

This article was added on 29.09.2011. 411times read.

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