What happens with PCOS
Normally, each cycle, one dominant follicle matures in the ovary, from which an egg is released. With PCOS, follicles begin to grow, but none reach maturity: ovulation does not occur, and the follicles remain in the ovary, accumulating along its periphery.
At the same time, the level of male sex hormones - androgens - increases, which causes excess hair growth, acne and hair loss on the head. A significant proportion of women have insulin resistance: cells respond less well to insulin, its level increases, and excess insulin additionally stimulates the production of androgens.
It turns out to be a vicious circle: insulin resistance increases the production of androgens, androgens promote weight gain, and excess weight increases insulin resistance. This is why weight loss for PCOS works so effectively—it breaks the cycle.
Symptoms
- Irregular menstrual cycle: delays from several weeks to months
- Infrequent or absent periods
- Heavy bleeding after long delays
- Excessive hair growth on the face, chest, abdomen, back
- Acne, oily skin
- Male pattern scalp hair loss
- Excess weight, difficulty losing it, fat deposits in the abdominal area
- Dark velvety areas of skin on the neck, armpits, groin
- Lack of pregnancy with regular sexual activity
- Mood swings, anxiety
- Sometimes - normal weight and minimal external manifestations
How is the diagnosis made?
The diagnosis is made when at least two of the three signs are present and after excluding other diseases with a similar picture.
- Нарушение овуляции: нерегулярный цикл, редкие менструации или их отсутствие
- Клинические или лабораторные признаки избытка андрогенов: избыточное оволосение, акне либо повышенный уровень тестостерона
- Характерная картина яичников на УЗИ: множество мелких фолликулов и увеличенный объём яичника
Other causes must be excluded: thyroid disease, elevated prolactin, congenital dysfunction of the adrenal cortex, androgen-producing tumors, Cushing's syndrome. That is why the diagnosis is not made by ultrasound alone.
Survey
- Examination by a gynecologist with assessment of the degree of hair growth
- Ultrasound of the pelvic organs, preferably transvaginal, on days 3–5 of the cycle
- Total and free testosterone, SHBG, free androgen index
- LH, FSH, estradiol
- AMH - usually elevated in PCOS
- Prolactin, TSH - exclusion of other causes
- 17-hydroxyprogesterone - exclusion of congenital dysfunction of the adrenal cortex
- Fasting glucose, insulin, HOMA index, glucose tolerance test
- Glycated hemoglobin
- Lipid profile
- Assessment of blood pressure and body mass index
- Endometrial biopsy in case of prolonged absence of menstruation
What are the dangers of PCOS without treatment?
- Infertility due to lack of ovulation
- Endometrial hyperplasia and increased risk of endometrial cancer - due to prolonged absence of menstruation, the endometrium is not shed on time
- Diabetes mellitus type 2
- Metabolic syndrome, obesity, dyslipidemia
- Arterial hypertension and cardiovascular diseases
- Non-alcoholic fatty liver disease
- Obstructive sleep apnea syndrome
- Pregnancy complications: gestational diabetes, preeclampsia, miscarriage
- Anxiety and depressive disorders
Treatment
There is no universal scheme: treatment depends on whether the woman is planning a pregnancy right now, and on the prevailing problems.
- Reducing body weight by 5–10% is the most effective measure: many women regain regular cycles and ovulation
- Diet with limited fast carbohydrates, regular physical activity
- Drugs that increase insulin sensitivity - as prescribed by a doctor
- Combined hormonal contraceptives - in the absence of plans for pregnancy: regulate the cycle, reduce androgens, protect the endometrium, reduce acne and hair growth
- Progesterone preparations in courses - to ensure regular endometrial rejection
- Antiandrogen therapy for severe hair growth and acne
- Stimulation of ovulation when planning pregnancy
- Intrauterine insemination
- Laparoscopic drilling (cauterization) of the ovaries - if stimulation is ineffective; the effect is temporary, the amount of intervention should be minimal
- IVF if other methods are ineffective
- Cosmetological hair removal methods as an addition
Where to get examined in Tashkent
Ultrasound, hormonal and metabolic examinations are needed, and in case of infertility, ovulation stimulation and, if necessary, laparoscopy.
In Tashkent, examination and treatment for PCOS is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic, if necessary, together with an endocrinologist.
If you haven’t had menstruation for more than three months, don’t wait: long-term absence of endometrial rejection is not just an inconvenience, but a real risk for the uterine lining. Clinic contacts are below on the page.
