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Polycystic Ovary : Definition, Causes, Symptoms, Diagnosis and Treatment

Friday, August 17th 2012. | Disease, Hybrid Health, Women Health

Polycystic Ovary Definition

The polycystic ovary syndrome (PCOS) involves a disturbance of normal functioning of the ovaries with metabolic abnormalities (insulin resistance in particular).

The polycystic ovary syndrome (PCOS) is very common, it affects 5 to 10% of women. Typically it is diagnosed at an obese woman or having problems of hair, which has long cycles capricious and difficult to have a child, but other combinations of signs are possible.

The diagnosis requires that certain diagnoses have been removed (adrenal hyperplasia, androgen-secreting tumors, Cushing’s syndrome) and at least two of the following three criteria are present (definition established by the Consensus of Rotterdam in 2003) :

  • Trace and / or anovulation;
  • Clinical hyperandrogenism and / or biological;
  • Ultrasound appearance of polycystic ovaries.

Besides the correction of infertility and excess hair growth type male, the treatment is important to prevent the development of diabetes or cardiovascular complications.

Many clues suggest it might be a genetic origin but all efforts failed to isolate a single gene responsible. This is most probably a complex multigenic disease.

Polycystic Ovary

Polycystic Ovary (img thanks to mountnittany.org)

Polycystic Ovary Causes

All the mysteries of polycystic ovary syndrome have not been drilled

Today we lean towards a pathological mechanism in the ovaries.

Women with PCOS have ovaries that, under the influence of LH, androgens convert better precursors to testosterone (male hormone) than normal women. Hence hyperandrogenism. However, there are also mechanisms involving the brain center responsible for producing the hormone gonadotrophin-liberating (the oscillator arched) in the hypothalamus (GnRH).

This production is normally done at a certain frequency balancing the production of LH and FSH from the pituitary but, when it is too fast, the synthesis of LH is favored over the synthesis of FSH. Hyperinsulinism is observed in the polycystic ovary syndrome contributes, also, to hyperandrogenism. It inhibits the production by the liver of SHBG, which binds the protein in the blood testosterone.Now this is the free fraction of testosterone that is active, so the fewer of SHBG and the male hormone occurs.

This is what explains why women with PCOS may have a total testosterone (free testosterone + testosterone bound to SHBG) normal or slightly increased despite signs of virilization: pilosity in areas “masculine” clitoral hypertrophy, etc..However, pubertal development is otherwise normal.

Finally the hyper-androgenicity could stimulate the start of growth of primordial follicles stored by the ovaries. On the one hand, they are therefore too numerous to grow and, secondly, there is no selection of a dominant follicle would prevent ovulation.

Hyperinsulinism not only enhances hyperandrogenism, it is also used in the metabolic syndrome that associates a set of disturbances increase cardiovascular risk. The metabolic syndrome is twice as common in women with polycystic ovary syndrome.

Polycystic Ovary Symptoms

Bleeding is the first sign.

 Lack of ovulation (oligo-ovulation) is manifested by less than 8 menstrual cycles (oligomenorrhea) or a year long cycles (35-45 days), and if the lack of ovulation is total (anovulation) , is no longer at all periods (amenorrhea). It also happens that one has the impression of having regular cycles when in reality there is no ovulation.

No one realizes that if we made a temperature curve because there is no thermal shift in the assumed time of ovulation.

The hyperandrogenism is especially marked by hirsutism that is to say, the excessive growth of hair in areas usually male: face (above the lip, chin), chest (between the breasts, in the back), stomach (especially between the navel and the pubis), buttocks, insides of thighs …

This is not the same as the excessive growth of hair in areas “feminine” (hypertrichosis). Acne is possible, but not necessarily specific to hyperandrogenism.

Obesity is common in cases of polycystic ovary syndrome (more than one in three women). Waist circumference is often greater than 88 cm due to the increase in visceral fat associated with insulin resistance.

Polycystic Ovary Diagnosis

Hormone assays enable the diagnosis

The hyperandrogenism can be confirmed by hormonal assays (biological hyperandrogenism), but the increase in free testosterone was not found in all patients with polycystic ovary syndrome.

Other assays are designed to exclude the diagnosis of disease which may falsely suggest a polycystic ovary syndrome: adrenal hyperplasia, androgen-secreting tumors, Cushing’s syndrome.

The ultrasound shows the presence in an ovary (or both) of at least twelve follicles measuring 2 and 9 mm in diameter, and / or ovarian volume greater than 10 mm.

The endovaginal ultrasound (= the probe is inserted into the vagina) must be conducted between 3 th and 5 th day of the cycle in the presence of regular cycles (or 3 to 5 days after uterine bleeding induced by progestin if spanioménorrhée is severe) and in the absence of taking the pill.

Polycystic Ovary Treatment

The treatment involves the prescription of hormones to measures of lifestyle.

The lifestyle changes are essential (physical activity, diet …). Weight loss is a fundamental part of treatment. Indeed, a loss of 5 to 10% of body weight is sufficient to restore ovarian function in 55 to 100% of patients within six months! Weight loss reduces androgen levels, insulin and increase SHBG.

The menstrual disorders may require the prescription of sequential progestin to reduce the risk of endometrial cancer that would expose the isolated action of estrogen. The same effect can be obtained with a prescription of combined oral. However, the benefit-risk hormone should be evaluated because of the increased metabolic risk in patients already at increased risk.

Hirsutism and acne are treated with anti-androgen or estrogen and progestin). Are preferred progestins with no androgenic effects (type and norgestimate, desogestrel). However, the metabolic risk is increased in women with polycystic ovary syndrome should carefully weigh the risk-benefit of these treatments.

Infertility requires specialized care for women wishing to become pregnant.

Polycystic Ovary Consequences

The consequences are numerous.

The polycystic ovary syndrome is not only responsible for ovulation disorders (infertility), it also causes metabolic disturbances that affect overall health:

Polycystic Ovary Specially Concern

Obstetrics and Gynecology

Gynecology and obstetrics includes many disciplines, all dedicated to the health and well-being of women outside of pregnancy (gynecology) or during pregnancy and childbirth (obstetrics).

This is a surgical specialty, but in France, some gynecologists do not operate and do not give birth. In this case, they are called medical gynecologists.

Gynecology is divided into several branches. Obstetrics is monitoring the course of pregnancy and childbirth.

Gynecology itself is to the diagnosis and treatment of diseases of the genital and breast cancer (disease of the uterus, ovary, breast, sexually transmitted disease), gynecological cancer screening by Pap mammograms and in collaboration with radiologists, the management of infertility treatment, birth control (contraception or abortion) and the treatment of menopausal disorders.

Senology, for diseases of the breast is a specialty that is part of gynecology. The pelvipérinéologie is a division of gynecologic surgery for the treatment of pelvic floor disorders.

Polycystic Ovary References:

Torre A., Fernandez H. The polycystic ovary syndrome, Journal of Obstetrics Gynecology and Reproductive Biology 36 (2007) 423-446.

Revised 2003 consensus on diagnostic Criteria and Long-term Health Risks related to polycystic ovary syndrome,Human Reproduction, Vol.19, No.1, pp.41-47, 2004.

Duranteau L. Amenorrhea of the adolescent, EMC (Elsevier, Paris), Pediatrics, 4-107, B-20, 2011.

Theron-Gerard L., Cédrin-Durnerin I., J.-N. Hugues, Recommendations for the diagnosis and monitoring of the polycystic ovary syndrome, EMC (Elsevier, Paris), Gynecology, 145-A-10, 2008 .

George P., C. Ortelli, imaging of infertility of ovarian origin,Journal of Radiology 2009, 90, 10: 1339-1340.

 

 

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