What is Polycystic Ovary Syndrome (PCOS), Symptoms, Treatment

Polycystic ovary syndrome is a health problem that commonly affects women of reproductive age. Hormonal changes may be at the basis of the syndrome. Androgen hormones specific to men are present at certain levels in women. However, excessive production of these hormones may cause some disorders. As a result, it may manifest itself in the form of changes in the skin and hair, cysts in the ovaries, along with disruption of the menstrual cycle. PCOS, whose main cause is not yet known, is one of the most common causes of infertility. However, there may be some risk factors that may predispose to the occurrence of polycystic ovary syndrome. Family history, lifestyle habits and some diseases are factors that can stimulate the development of PCOS. If polycystic ovary syndrome is not diagnosed early and treatment is not provided, it may cause long-term complications such as cardiovascular diseases and type 2 diabetes (1, 2).

What is Polycystic Ovary Syndrome (PCOS)?

PCOS, known as polycystic ovary syndrome, is a health problem characterized by the production of excessive androgen hormones from the ovaries, the female reproductive organs. Androgen hormones are male hormones and their excessive production in the ovaries can lead to some negative consequences. This hormone imbalance can often lead to reproductive, metabolic and psychological disorders in women. These disorders may include infertility, hyperandrogenism, insulin resistance and diabetes, cardiovascular diseases, depression and anxiety.

PCOS in women can occur at any time after puberty. Often women with polycystic ovary syndrome may not be aware of the condition. The risk of polycystic ovary syndrome may be high, especially in those with a family history of PCOS and in cases of obesity. It can usually manifest itself with menstrual irregularity. Additionally, ovarian cysts may be seen in PCOS patients. However, these symptoms may not always be observed (3).

What are the Causes of Polycystic Ovary Syndrome?

Although the exact cause of polycystic ovary syndrome is unknown, it can be said that some factors play a role in the development of the disease. Reasons that may affect the formation of PCOS may be:

• Excessive androgen hormone levels: Excessive production of androgen hormones from the ovaries can cause egg cells to fail to develop and be released from the follicles. In this case, ovulation cannot occur. Additionally, high male hormone levels can lead to hirsutism (excessive hair growth) and acne.
• Insulin resistance: Increase in the levels of insulin hormone secreted from the pancreas may cause excess production of androgens. As a result, high androgen levels can suppress ovulation. Insulin resistance can cause glucose in the body not to be used and blood sugar to rise.
• Low-grade inflammation: Leukocytes produce substances against injury, trauma, or infection, and this condition is called low-grade inflammation. Individuals with PCOS may be prone to low-grade inflammation.
• Genetics: Having a history of PCOS in family members may be a risk factor.

In addition, environmental factors such as poor nutritional conditions, physical inactivity, and toxins may also play a role in the formation of PCOS (1, 3, 4).

Who Gets Polycystic Ovary Syndrome?

Some risk factors may play a role in the development of polycystic ovary syndrome. Polycystic ovary syndrome is a common condition in women of reproductive age. Having PCOS in a mother or sister in the family may put the person at risk of developing PCOS himself. However, insulin resistance, especially characterized by the production of too much insulin, can predispose to the formation of PCOS. Obesity, which can be effective in the formation of insulin resistance, may be a risk factor for polycystic ovary syndrome. Therefore, improper nutrition and lack of physical activity can pave the way for obesity, insulin resistance and PCOS.

Long-term and low-grade infections may cause an increase in androgen hormones in the female body. High levels of androgens and inhibition of ovulation may occur during this period. Hormonal changes may occur in women exposed to environmental toxins and androgen hormones may be affected (5).

What are the symptoms of Polycystic Ovary Syndrome?

Symptoms of polycystic ovary syndrome may or may not be noticeable. However, signs and symptoms commonly seen in cases of PCOS may include:

• Irregular menstruation: Delay in menstruation, very frequent or infrequent menstruation, unpredictable menstrual bleeding and pain may occur. It may also occur as an absence of menstruation in some women.
• Hirsutism (Excessive hair growth): It is the condition of excessive hair growth on the face, chest, abdomen, arms and thighs.
• Obesity: It can be seen in approximately 40-80% of people with PCOS.
• Oily skin, pimples or acne
• Acanthosis nigricans: Dark and velvety skin patches on the neck, armpits, groin and under the breast.
• Hair loss: The hair of individuals with PCOS may become thinner and hair loss may occur.
• Cysts: Many and large follicular cysts may occur in the ovaries.
• Infertility: Blocking ovulation can prevent pregnancy. It is the most common symptom seen in PCOS cases.

Additionally, increased appetite and weight gain may be among other symptoms (3, 4, 6).

How is Polycystic Ovary Syndrome Diagnosed?

Diagnosing polycystic ovary syndrome can be complex or difficult. Criteria typically used to diagnose PCOS include:

1. Having irregular, heavy, long or short menstrual periods,
2. High androgen levels causing excessive hair growth, male pattern baldness and acne,
3. Numerous cysts and enlarged ovaries observed on ultrasound.

If at least two of these criteria are present, PCOS is diagnosed. However, cysts may not be observed in every patient with PCOS. In this context, some checks may be required to confirm the diagnosis of polycystic ovary syndrome. These controls:

• Control of BMI and blood pressure values,
• Medical history and medication use,
• family history,
• Physical examination of hair loss, excessive hair growth, dark skin spots and acne,
• Blood tests to check blood sugar and hormone levels,
• It may be in the form of a pelvic ultrasound to visualize the ovaries (1, 3).

Polycystic Ovary Syndrome Treatment

Treatment methods may vary when individuals with PCOS want or do not want to become pregnant. In general, changing lifestyle and habits, medications, and other treatments may be recommended alone or in combination. Treatment methods for PCOS patients who are not planning pregnancy may be as follows:

• Birth control methods: Methods such as birth control pills, injections, and intrauterine spiral can be used to regulate the menstrual cycle. This method can help prevent excessive hair growth and acne formation.
• Drugs that block androgens: Can be used to block the effectiveness of androgen hormones released in the ovaries. It can help prevent acne and excessive hair growth.
• Insulin sensitizers: Medicines used to treat diabetes, such as metformin, can help the body use insulin. By improving insulin resistance, menstrual cycles can become regular.
• Diet therapy: Diet therapy can be applied to prevent obesity, maintain body weight and improve insulin resistance.

Recommended treatments for PCOS patients planning pregnancy may include:

• Drugs that induce ovulation: Medicines such as clomiphene, letrozole and gonadotropin taken orally or by injection can induce ovulation.
• Surgery: It involves removing the tissues that produce androgen hormones from the body by surgery, which is rarely preferred.
• In vitro fertilization treatment: It is the process of fertilizing eggs and sperm in a laboratory environment when ovulation cannot be achieved with other treatments (3, 7).

What Should Nutrition Be Like in Polycystic Ovary Syndrome?

Polycystic ovary syndrome is a health problem that can develop in parallel with inflammation, insulin resistance and obesity. In this context, the consumption of some foods may need to be limited or eliminated. In cases of PCOS, it is recommended not to consume foods that can trigger inflammation, cause the development of cardiovascular diseases and insulin resistance, and lead to obesity. These foods may include:

• Fried foods containing trans fats (potato chips, corn chips, fried chicken and fish, French fries, etc.),
• Foods containing saturated fat, such as butter and margarine,
• Processed and packaged foods,
• Sugary drinks such as sodas,
• Granola, oatmeal and breakfast cereals that are high in sugar
• White bread, white rice, pasta, foods prepared with refined flour,
• Foods commonly used to alleviate obesity, insulin resistance and inflammation include:
• Fruits with low glycemic index (Blueberries, blackberries, raspberries, strawberries, melons, cherries, plums, apricots, oranges, tangerines, etc.),
• Non-starchy vegetables (broccoli, brussels sprouts, artichokes, asparagus, cabbage, cauliflower, cucumber, tomatoes, spinach, eggplant, mushrooms, onions, peppers, green leafy vegetables, zucchini, etc.),
• Small amounts of low-fat milk and dairy products,
• Fish rich in omega-3 fatty acids,
• Small amounts of red meat and poultry (chicken, turkey, etc.),
• Pumpkin and sunflower seeds, almonds, walnuts, sesame and poppy seeds,
• Whole grain products and legumes.

In addition to diet treatment, physical activity may be recommended (8, 9).

Polycystic Ovary Syndrome and Pregnancy

Pregnancy is possible in the presence of polycystic ovary syndrome. However, PCOS can lead to some complications during or after pregnancy. Most often, PCOS patients can get pregnant without requiring treatment, but in some cases, pregnancy can be difficult. Pregnancy complications that PCOS can cause may include:

• Low,
• Gestational diabetes (Gestational diabetes),
• Preeclampsia (Pregnancy poisoning),
• Premature birth,
• cesarean birth,
• High blood pressure caused by pregnancy

PCOS can have negative effects on both mother and baby health. Besides, it may not always pose a danger. With early diagnosis and treatment of PCOS, pregnancy can be easily overcome (10).

If you have suspicions and symptoms of PCOS, contact the relevant healthcare provider for early diagnosis and treatment opportunities.