Polycystic ovary syndrome is a common pathology among women of reproductive age and can affect the fertility of those who suffer from it.
It can have a family link, so that women from the same family have an increased risk of suffering from it compared to the general population.
The main signs that alert us to the possible existence of PCOS in a patient are alterations in the menstrual cycle (very long cycles or periods of absence of menstruation, called amenorrhea due to oligo or anovulatory cycles), excess body hair (or hirsutism) or other signs androgen excess in skin (hair loss, oily skin, acne …). In fact, PCOS is the most common cause of hyperandrogenism, but it is always necessary to rule out other pathologies that may have symptoms similar to polycystic ovary syndrome to establish the definitive diagnosis.
An increased body weight can also be associated with a tendency to insulin resistance in 60-80% of cases, which can lead to important long-term metabolic and cardiovascular alterations for patients.
At the ultrasound level, the diagnosis is based on the existence of enlarged ovaries, with multiple follicles arranged or not in the shape of a peripheral ring, hence the name “polycystic ovary”, what does not refer to real ovarian cysts.
However, there are women with sonographically polycystic ovaries who do not associate other symptoms and other women with an important clinical syndrome who do not present with an ultrasound image of polycystic ovaries. The Rotterdam criteria allow the diagnosis of PCOS when two of the following criteria are associated:- Hyperandrogenism- Oligo-anovulation- Polycystic-looking ovaries on ultrasound.
The origin of PCOS is very controversial but essentially three alterations are intertwined: an endocrine alteration (due to excess LH and androgens), a metabolic misbalance (due to insulin resistance and hyperinsulinism) and an alteration of ovarian function (with the consequent anovulation).
Thus, the main goal of treatment for patients with PCOS will be aimed at normalization of menstrual cycles by facilitating ovulation, as well as the correction of metabolic alterations secondary to insulin resistance and the treatment of hyperandrogenism.
In patients looking for pregnancy, it is essential to reestablish cycles, facilitating ovulation to allow pregnancy, but also correcting insulin resistance in order to improve reproductive prognosis and minimize complications such as early miscarriages, gestational diabetes and pre-eclampsia.