Polycystic ovary syndrome

What the signs are

• Infrequent, irregular cycles or absent periods.
• Increased hair on the face or body (hirsutism), acne or thinning of the hair.
• Difficulty becoming pregnant because of irregular ovulation.
• Metabolic problems, including disorders of glycemia and weight gain.

Not every woman has all the signs and the condition can exist without overweight. The signs usually appear in puberty and may change after menopause.

What happens with the hormones

In PCOS there is a disturbance of the hypothalamic–pituitary–ovarian axis: increased secretion of luteinizing hormone and excess production of androgens (male hormones found in small amounts in every woman) interfere with maturation of the follicles and with ovulation. Insulin resistance and hyperinsulinemia, which also occur in lean women, reinforce androgen production. From this come infrequent cycles, increased hair and acne. Insulin resistance may contribute in some patients (see prediabetes), but it is not a diagnosis made from the appearance of the ovaries alone.

How the diagnosis is made

The doctor reviews the menstrual cycle, clinical signs and the necessary hormone tests; in adults the diagnosis is usually based on two of three criteria: irregular ovulation, clinical or biochemical signs of excess androgens, and a polycystic appearance on ultrasound, once other causes have been excluded. Ultrasound is used as appropriate. Exclusion of other conditions is required, such as thyroid disorders (hypothyroidism), hyperprolactinemia and some adrenal diseases. A polycystic appearance on ultrasound does not automatically mean PCOS. Criteria for adolescents differ from those for adults.

Why follow-up matters

PCOS is linked to a higher risk of type 2 diabetes, hypertension, dyslipidemia, fatty liver, sleep apnea, anxiety and depression and, when periods are absent for long, endometrial hyperplasia (thickening of the lining of the uterus). Glycemia, lipids and blood pressure (target below 130/80 mmHg, blood pressure 13 over 8) are assessed. Prolonged absence of periods requires a plan for care of the endometrium. If androgen signs appear very quickly, such as increased hair with a deepening voice, seek assessment without delay for other causes, for example androgen-producing tumors. Checks take place every 6 months to a year, or sooner when the doctor considers it reasonable.

How it is treated

Treatment is tailored to the goal: regulating the cycle, managing symptoms, metabolic control or achieving pregnancy. Nutrition and physical activity play a role even when weight loss is not needed, while in overweight a moderate weight loss can restore ovulation. Hormonal drugs (the combined pill, progestins), anti-androgens, metformin and ovulation induction (for example letrozole or clomifene) are used as indicated. Do not use hormones or fertility drugs without supervision. See also endocrine infertility.

Care at Tirana Polyclinic: we offer endocrinology and gynecology consultation, interpretation of tests and coordination of the hormonal and metabolic assessment.