Sexual organ diseases are a prevalent issue today affecting women of all ages. The high frequency of gynecological pathologies is particularly characteristic during reproductive age, and there is currently a trend towards its rapid increase. One of the main factors contributing to the development of gynecological diseases is hormonal imbalance.
Polycystic Ovary Syndrome (PCOS) is an endocrinopathy characterized by disruptions in the reproductive and endocrine functions of the ovaries due to hormonal imbalance. Malfunctions in many metabolic and hormonal processes in the female body are accompanied by hyperandrogenism (elevated levels of male sex hormones), menstrual cycle disturbances, and cystic changes in the ovaries. Therefore, PCOS can have serious consequences for both fertility and women’s overall health. It is important to understand the nature, causes, and treatment methods for this condition.
Prevalence of PCOS and Its Impact on Women’s Health
Although PCOS is recognized as one of the most common endocrinopathies significantly affecting women’s health, the exact etiology and pathogenesis of the disease remain incompletely understood. This poses significant challenges for effective diagnosis and targeted therapy of this syndrome.
Experts from the Centers for Disease Control and Prevention (CDC) note that PCOS can develop in women of any race, ethnicity, and age (from puberty to menopause). According to the World Health Organization (WHO), the prevalence of PCOS in women of reproductive age ranges from 8% to 13%, with up to 70% of cases going undiagnosed. Thus, a significant proportion of patients may not even suspect they have this pathology.
Imbalances in sex hormones and the menstrual cycle, along with the development of small follicles that cannot mature into dominant ones, lead to ovulation disorders and can complicate the onset of pregnancy. Therefore, among the main consequences of PCOS, issues with conception are highlighted. Approximately 80% of women facing infertility due to lack of ovulation are affected by PCOS.
Additionally, PCOS is associated with anovulation, bilateral enlargement of the ovaries, hirsutism (excessive hair growth in a male pattern) with concomitant hyperandrogenism, and obesity, significantly impacting the quality of life of patients. Since reproductive system disorders due to PCOS are accompanied by dysfunction in almost all organs and systems of the female body, this pathology represents a multisystemic issue. Therefore, resolving it requires a comprehensive approach involving various specialists such as gynecologists, reproductive specialists, endocrinologists, dermatologists, dietitians, cardiologists, psychiatrists, psychologists, and others.
Causes of Polycystic Ovary Syndrome (PCOS)
PCOS is a complex multifactorial disease, the exact causes of which are still not fully understood. However, a number of factors known to underlie PCOS have been identified by specialists from the Mayo Clinic:
- Genetic and hereditary factors;
- Excessive androgen production;
- Insulin resistance.
Let’s delve deeper into each factor.
Genetic predisposition plays a significant role in the pathogenesis of PCOS, accounting for up to 80% of cases. Women with a family history of PCOS have a significantly increased likelihood of developing the condition. Currently, over 1,000 candidate genes are known to influence the synthesis of around 500 proteins responsible for PCOS manifestations.
Additionally, women with type 2 diabetes, obesity, and cardiovascular diseases in their family history are at higher risk of developing PCOS.
Moreover, PCOS is rooted in pathogenetic mechanisms such as hyperandrogenism and insulin resistance, which form a pathological cycle. Elevated levels of androgens contribute to the development of obesity and insulin resistance. In turn, insulin resistance leads to decreased glucose utilization in the body, resulting in compensatory hyperinsulinemia, which is an important link in the pathogenesis of hyperandrogenism. Insulin resistance is present in the majority of women with PCOS.
Among other possible causes of PCOS, experts also cite previously experienced severe inflammatory and infectious pathologies of the urogenital system, diseases of the adrenal and thyroid glands, endometriosis, disturbances in metabolic processes in the body, autoimmune disorders. The development of PCOS can be influenced by stressful situations, improper lifestyle habits (smoking, unhealthy eating habits, lack of physical activity), low socioeconomic status, and external factors.
These factors often interact with each other, and the course of PCOS can vary uniquely in each woman. Therefore, understanding these factors allows for timely diagnosis and the selection of optimal treatment strategies to prevent complications and improve the quality of life for the patient.
Main Symptoms and Signs of Polycystic Ovary Syndrome (PCOS)
The symptoms of PCOS are individual and often varied. Sometimes they occur suddenly and change over time. The most common symptoms and signs that may indicate the development of PCOS include:
- Menstrual cycle disturbances: irregularity or complete absence, scanty/heavy periods, intermenstrual bleeding from the genital tract (abnormal uterine bleeding).
- Infertility (due to anovulation): in the case of PCOS, it is primarily primary infertility, meaning the woman has not had pregnancies before seeking help.
- Acne, hirsutism, alopecia as manifestations of hyperandrogenism: androgens specifically determine the type and distribution of hair growth on the head and body.
Additional possible signs of PCOS:
- Excessive weight or obesity.
- Pain in the lower abdomen and pelvic area.
- Fibrocystic breast disease.
- Hyperpigmentation of the skin under the armpits, on the back of the neck, under the chin, in the groin area.
- Stretch marks, skin swelling.
- Seborrhea.
- Change in body shape towards a male type.
- Difficulty conceiving.
The manifestations of PCOS are often hidden and quite dangerous for the patient. They can include metabolic disorders, type 2 diabetes, dyslipidemia, depressive disorders with extensive psychological symptoms. Therefore, diagnosing PCOS requires the involvement of specialists from various fields and correction of identified disorders.
Consequences of PCOS for Reproductive Health
PCOS can have a significant negative impact on the health of patients in the future—both physically and psychologically. Hormonal imbalance and ovarian dysfunction contribute to difficulties with conception in many women of reproductive age. Successfully achieving pregnancy for women with PCOS poses a risk for developing complications. For instance, pregnant women may experience increased rates of type 2 diabetes, hypertension, and preeclampsia. These conditions often lead to premature labor and newborn health issues.
Moreover, pregnancy in women with PCOS may increase the risk of miscarriage and premature births. Therefore, experts worldwide recommend mandatory and thorough monitoring of pregnant women with PCOS. With correctly chosen and timely treatment, as well as hormonal balance adjustment, the likelihood of giving birth to a healthy child significantly increases.
Infertility is the most adverse consequence of PCOS. However, with adequate therapy, the chances for a woman to conceive and carry a fetus to term remain high.
Diagnosis and Treatment of Polycystic Ovary Syndrome (PCOS)
PCOS diagnosis is established when any two of the following criteria are present: oligo- and/or anovulation, hyperandrogenism (clinical and/or biochemical), and polycystic ovaries confirmed by ultrasound or anti-Mullerian hormone analysis.
Diagnosing PCOS can be complex. Difficulties may arise because the ovaries, adrenal glands, hypothalamus, and pituitary gland are closely interconnected functionally, and impairment in any of these areas affects the others and the reproductive system as a whole. Consequently, identifying the primary cause of PCOS can be challenging. Therefore, this necessitates a series of clinical, laboratory, and instrumental investigations.
Key diagnostic methods include:
- Gathering patient complaints and medical history, gynecological examination, and physical examination to identify signs of hyperandrogenism and other characteristic symptoms of PCOS.
- Laboratory tests: complete blood count, biochemical analysis, hormone level determination (such as LH, FSH, TSH, prolactin, estradiol, testosterone, progesterone, insulin, etc.).
- Instrumental diagnostics: pelvic ultrasound, dynamic folliculometry.
- Analysis of urogenital secretions.
- Additional examinations as needed: thyroid ultrasound, adrenal glands.
Additionally, it is important to conduct differential diagnosis to exclude pathologies that may have symptoms similar to PCOS, such as hypothyroidism, hyperprolactinemia, metabolic syndrome, or type 2 diabetes, and to identify pathogenetic mechanisms. This is necessary to establish a clear diagnosis of PCOS and choose further treatment strategies.
The treatment of PCOS is comprehensive and based on examination results, disease stage, age, metabolic disorders, complications, and the woman’s reproductive plans. Treatment methods depend on the goals and objectives determined by the physician in consultation with the patient.
Potential treatment goals include:
- Normalization of menstrual cycle, hormonal profile, and metabolic disorders.
- Reduction of symptoms associated with elevated androgens.
- Restoration of fertility (probability of conception).
- Weight reduction.
- Overcoming insulin resistance.
- Prevention of cardiovascular complications.
- Treatment of associated diseases.
The European Society of Endocrinology (ESE) and other global scientific communities emphasize that PCOS treatment should primarily include lifestyle management, especially in cases of excess weight. This involves adopting healthy eating habits and adequate physical activity to normalize body weight and hormonal levels.
The main methods of PCOS treatment include hormonal therapy, medications that increase peripheral tissue sensitivity to insulin, and stimulate ovulation. Effective pharmacological therapy, including metformin and combined oral contraceptives, is a preferred strategy for treating this syndrome. Additionally, the use of inositols to correct metabolic indicators, stimulate ovulation, and reduce manifestations of hirsutism/hyperandrogenism in the context of PCOS is also advisable.
It should be noted that properly selected modern hormone therapy can normalize the menstrual cycle, prevent the development of hyperplastic processes and endometrial cancer, reduce the degree of hirsutism, improve the condition of the skin and hair, and also promote the preservation of reproductive function in women with PCOS.
In cases where drug therapy is ineffective and/or there are persistent ovulation disorders, surgical treatment—ovarian laparoscopy—is applied.
Complications Due to Untimely Therapy
Untimely initiation or cessation of therapy can lead to the progression of PCOS symptoms and associated diseases. Complications that may threaten patients include type 2 diabetes, metabolic syndrome, obesity, hypertension, dyslipidemia, venous thrombosis, heart attack, and stroke. Women with PCOS have more than twice the likelihood of developing atypical hyperplasia and endometrial cancer. Additionally, there may be occurrences of sleep apnea, psychological, and emotional issues. Specifically, there is a high risk of a pathological course of pregnancy and infertility.
Furthermore, recent data has linked PCOS with a decline in cognitive function. It has been shown that women with PCOS exhibit poorer memory and cognitive skills, as well as minor changes in the brain during reproductive age. As noted by Professor K. Sherif, the mechanism of accelerated cognitive aging processes stems from metabolic anomalies associated with PCOS, which impact not only blood vessels and the heart but also the brain.
With proper management of patients with PCOS and adherence to physician recommendations, most long-term health risks can be mitigated.
Impact of Lifestyle on PCOS
There are significant benefits to maintaining a healthy lifestyle for women with PCOS. An international expert group on PCOS management recommends healthy eating and/or adequate physical activity, cognitive-behavioral interventions, or combined approaches as the primary treatment strategy for PCOS. Pharmacological methods are not always effective. Lifestyle correction contributes to weight reduction, regulation of menstrual function, and reduction of hyperandrogenism symptoms in PCOS patients. Moreover, the role of a healthy lifestyle in alleviating insulin resistance associated with many adverse outcomes in PCOS is well-established.
Prevention, Control, and Patient Support for PCOS
Preventive measures should aim to reduce the risk of PCOS development and its complications, as well as improve overall patient health. Recommendations from experts for PCOS prevention and control include:
- Weight normalization (especially in cases of obesity).
- Balanced diet (vegetables, fruits, whole grains, lean protein products, milk, cheese, or yogurt).
- Regular moderate-intensity physical exercise (approximately 150 minutes per week).
- Smoking cessation and moderate alcohol consumption.
- Hormonal balance monitoring.
- Early detection and treatment of metabolic disorders.
- Timely treatment of inflammatory and infectious diseases.
- Stress management (through meditation, deep breathing exercises, yoga).
- Adequate 7-9 hours of nightly sleep.
- Regular consultations with a gynecologist and endocrinologist to monitor PCOS symptoms and overall health aspects.
Additionally, it is crucial to enhance women’s awareness of modern approaches to diagnosing and treating PCOS, provide support, and promote patient self-management of the condition.
Conclusions
Polycystic ovary syndrome significantly impacts various aspects of patients’ lives. However, most women with this condition can lead full lives through lifestyle changes, proper care, and appropriate pharmacotherapy. Such a comprehensive approach will prevent the development of metabolic, cardiovascular, and psychosocial complications associated with PCOS in the long term. Additionally, women can restore their menstrual cycle, achieve reproductive goals, and improve overall health.