Polycystic Ovary Syndrome
'Polycystic Ovary' is a disease characterized by multiple cysts arranged like pearls on the outer edge of the ovaries, and menstrual delays.
This disease is often exhausting for patients. Because while using hormone preparations, the periods come regularly, but when the hormone preparation is interrupted, the periods start to be delayed again. This situation creates hopelessness, insecurity and dissatisfaction in the patient and her/his relatives.
The feeling of 'I will never get better' starts to appear.
'Polycystic Ovary Syndrome' is a metabolic syndrome in which cysts in the ovary are accompanied by metabolic diseases.
- Clinical Findings
o Oligomenorrhea (few menstruation) or amenorrhea (no menstruation)
Obesity
o Subfertility & Infertility (no pregnancy despite not using protection for 1 year)
o Acne and oily skin
o Hirsutism (increase in hair growth where it should not be in women; nipples, inner sides of the legs, beard, mustache)
o Male pattern baldness
Biochemical Findings
Testosterone or androstenedione elevation
o Elevated LH and elevated LH/FSH ratio
o Low sex hormone binding globulin (SHBG)
o Impaired glucose tolerance
The etiology of polycystic ovary is not completely clear, but it has a genetic basis.
Patients with PCOS should be given detailed information about the diagnosis and possible effects of the disease. The subsequent treatment approach varies according to the typical patient group with and without symptoms:
The use of combined oral contraceptives is the most effective method to regulate menstruation. PCOS patients with oligomenorrhea or amenorrhea may be given combined oral contraceptives for menstrual regulation or progesterone-only treatment in the second half of the cycle.
For increased hair growth; if testosterone is high in hormone tests, drugs that lower testosterone levels should be given.
If there is no problem with hormones, laser hair treatment methods are frequently recommended.
Topical antibiotics may be useful in acne treatment. Combined oral contraceptives (COCs) are especially used for menstrual regulation and contraception and are also good for acne and increased hair growth.
The use of COCs containing cyproterone acetate (Diane-35), which has antiandrogenic activity, for 3 months for the treatment of acne and 6-9 months for the treatment of hair growth can treat these symptoms with menstrual regulation.
It is difficult for PCOS patients to lose weight, but it is a useful treatment approach in terms of reducing long-term cardiovascular risks, body image, menstrual pattern and fertility regulation. Referral to a dietitian and exercise advice are very useful.
In infertility caused by PCOS, ovarian stimulation with clomiphene citrate (clomiphene) is a very effective approach. However, simple weight loss is also dramatically effective in regulating ovulation.
Metformin use regulates fertility and corrects abnormal lipid levels in PCOS patients. The proposed mechanism is to reduce insulin resistance, thereby breaking the cycle of events leading to symptoms and physical manifestations of the disease. It is generally a treatment approach for women who are significantly overweight and can lose weight with dietary control and exercise.
Contraception in Polycystic Ovary Syndrome (Birth Control Methods)
Women with PCOS may ovulate in some cycles and not in others. Therefore, if pregnancy is not desired, effective contraception is necessary. This is usually cyclic contraception.
Women with PCOS have a significantly higher risk of developing type II diabetes. Annual glucosuria and random blood glucose screening and 3-monthly glucose averaging (hga1c) tests should be followed.
