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We asked Dr. Krisztina Lukács about the characteristic symptoms of polycystic ovary syndrome (PCOS)

 

What does PCOS exactly mean?

The name - polycystic ovary syndrome comes from the fact that due to the excess male of hormones a thick capsule is formed on the surface of the ovaries and it prevents follicular rupture. Cysts develop from the residues of non-ruptured follicles and they result in polycystic ultrasound image of the ovaries. However not every cystic ovary means PCO syndrome and there is not always a polycistic ultrasound image in every PCOS. Diagnosis of the disease is based on the so called Rotterdam criteria, it can be set up if at least two of the three main symptoms exist: 1. irregular menses or disturbance in ovulation, 2. clinical symptoms or laboratory signs of male hormone predominance, 3. image of small cysts during gynaecological ultrasound examination arranged in the form of a beadwork below the ovary cortex.

What complaints are associated with this disease?

Although it is one of the most frequent hormonal and metabolic disorders, it is not easy to diagnose, because there are no specific symptoms which are typical and it is associated with different complaints in almost each age stage. There are however, very characteristic symptoms, such as quick weight gain, excess weight localized on the abdomen, increased desire for sweets, sudden fatigue after meals, tremor, oily and acne skin, increased growth of hair on the face and the body, hair loss, hair thinning and male pattern baldness. The most characteristic gynaecological symptoms include irregular periods or complete lack of periods, infertility and recurrent miscarriages. Unreasonable mood swings, nervousness and depression are frequent psychical symptoms. PCOS can be in the background of uncertain abdominal pains and also of sleeping disturbances. The symptoms can be mild or sometimes even severe.

Among whom it typically occurs?

Complaints usually start in adolescence, but due to the consumption of contraceptive pills symptoms frequently develop in the middle or end of the twenties.

What can be the cause of PCOS?

The cause of PCOS is unknown, but the role of genetic factors (inherited disposition) and of the lifestyle factors (over nutrition, sedentary lifestyle, stress) has been proved. The symptoms of the disease are caused by metabolic and hormonal disorders. Reduced insulin sensitivity (insulin resistance) is frequent, to contract this, pancreas excretes more insulin than usual for maintaining normal blood glucose level, however, this induces several other hormonal and metabolic changes. Due to the disorders of adipose tissues, adrenal glands and the ovary the production of androgen hormones (DHEA and testosterone) are increasing besides that the luteinizing hormone (LH) excretion is raised while progesterone or follicle stimulating hormone (FHS) secretion is reduced.

How to diagnose the disease?

The diagnosis of PCOS is usually set up by the gynaecologist and the physician-endocrinologist together. After questioning the complaints and symptoms a general medical examination comes including blood pressure measurement, waist and hip circumference measurement and determination of the body mass index. In the course of laboratory tests blood’s hormone levels are checked: besides the elevated testosterone, DHEA and oestrogen level we can see that the normal ratio of 1:1 of LH:FSH proportion shifts in favour of LH if the blood test was taken on 2nd-5th day of the menstrual cycle. Differences in blood fats are frequent, too. Insulin resistance can be proved with the so called sugar load test and determination of the HOMA-index. During the gynaecologic and vaginal ultrasound test the enlarged ovaries and follicles located as a beadwork inside and also thickened endometrium can be observed.

How could the symptoms be minimized?

According to our current knowledge PCOS cannot be completely cured, but the symptoms can be well managed and there are good possibilities for preventing the later complications (e.g. diabetes type 2, hypertonia, cardio- and vascular diseases). However the treatment must not be stopped after the complaints are eliminated, because the symptoms can be renewed. Hormonal medicines are available for reducing the symptoms for example the excess of male hormones. Skin problems can be relieved by dermatological treatments. In case of infertility caused by PCOS, several gynaecological interventions can be used(e.g. hormonal stimulation of the ovaries is possible). Treatment of insulin resistance is essential, namely the insulin sensitivity of the organism has to be restored. Changing the lifestyle is the key issue,so the regular physical exercise and adequate nutrition is vital. The purpose of the diet is to avoid the large fluctuations in blood sugar; this can be reached by decreasing the consumption of refined sugar and reducing carbohydrate content. In case of overweight the reduction of the body weight is also important – which also mean calorie restriction. In addition, metformin medicines used in type 2 diabetes can also be applied for reducing insulin resistance.

Dr. Krisztina Lukács

Dr. Krisztina Lukács
Head of the consultancy of internal medicine.

 

Phone number: +36(06)1-213-4222

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