How to treat polycystic ovary syndrome, endocrine disease that silently affects fertility

A hormonal condition that occurs during the reproductive period affects one in ten women. The exact cause of the occurrence of polycystic ovary syndrome (SOPC) is not yet fully known, but untreated, the pathology can give countless complications.

Polycystic ovary syndrome is considered to be the most common endocrine disorder in women of fertile age, on average, a woman in ten being affected worldwide, and in Romania, about 20% of women having this condition, diagnosed after presentation to the specialist doctor.

The causes that lead to the emergence of SOPC are not fully clarified until today, being involved both genetic factors and environmental factors that, most of the times, trigger the pathology. A predominant family history on the maternal line and certain genes have been shown to be involved in SOPC. Also, insulin resistance, too much insulin, inflammation and excess androgen hormone are factors that influence SOPC development.

“Affects women of all ages”

The most common symptoms in the case of polycystic ovary syndrome (SOPC) are irregular menstruation (menstruation at time greater than 35 days and their longer duration, with increased menstrual flow), persistent pelvic pain during ovulation and menstruation, a higher production of excessive hormones, Ovulation and, last but not least, difficulty in obtaining a task, which often constitutes an alarm and determines the presentation to the doctor.

The condition should be treated, otherwise it can determine major complications, such as infertility, abortions or premature birth, gestational diabetes, high blood sugar levels, values ​​outside triglycerides and cholesterol, food disorders, increased risk of cardiovascular disease, etc., to very serious conditions.

Gynecologist specialist Georgiana Gruia, a doctor at the Slatina County Emergency Hospital, explained for “Weekend Adevărul” that should be an alarm signal, when women in the doctor’s office arrive, from where and how the diagnosis and treatment start, but also why it is necessary that the problem is not neglected.

“It is an ovarian pathology that affects women of all ages, but we mainly discuss the woman in the fertile period. It is a pathology with which we are born, but which can be influenced later ”,
explains the doctor. Feeding of poor quality (for example, meat from birds raised into intensive system and brought to maturity in the short term) does not transform a normal ovary into a polycystic one, explains the doctor, in the case of a predisposition, both environmental factors, nutrition and lifestyle certainly influences.

Insulin resistance, a first factor

Because polycystic ovary syndrome involves both a hormonal and gynecological component, it is often necessary for specialists to treat the case together. “It is a pathology that we most correctly treat in a multidisciplinary team because, mainly, polycystic ovaries give a hormonal imbalance”says Dr. Gruia. This team means the gynecologist, the endocrinologist and the specialized physician in diabetes and nutrition diseases, depending on the case, because it can be a standalone pathology, which only affects the ovaries, but may be in combination with a thyroid dysfunction or with a pituitary dysfunction.

Hormonal dysfunction, especially if it is in combination with thyroid function (manifestations such as excessive, predominant in the lower abdomen, in the pubic area, on the neck, on the face), will be treated with the endocrinologist, and for the weight fluctuations, which also appear in the polycystic ovary syndrome, and will also need a specialized doctor in diabetes. nutrition. “The patient’s weight fluctuations are also treated with the diabetes doctor, in the idea that most develop insulin resistance. This can be found in control, when an excess weight is observed, and the doctor must know his food history: if he eats disorganized, what kind of food he prefers, etc. “. The excess is predominantly arranged in the lower abdomen, the hips are over -expressed and often stretch marks are observed. “A fairly high percentage presents the increased Homa index, which translates to insulin resistance. Later, additional investigations are done, but this is about the diabetes doctor and nutrition diseases ”, Dr. Gruia points out. Only after the patient is investigated in a multidisciplinary team and each specialist recommends treatment, the gynecologist will treat ovarian dysfunction.

First Stop: Gynecologist’s office

In most cases, patients first go to the gynecologist, accusing abundant flow, pelvic pain and irregular menstruation. “The normal menstrual cycle is defined between 24 to 32-33 days, in large lines. What comes sooner or over these 33 days clearly is irregular. Most of them are absence of menstruation for several months in a row and that worries them. That is why the tendency is to come to the gynecologist ”details the doctor.

In the case of adolescents, concern comes from mothers, who sometimes think about a task. “If we talk about the teenager who has not started his sex life, we do a transabdominal ultrasound first. The first time we start with a short anamnesis: when does menstruation come?, How did it come? At what age did it come?, If it was always irregular?, How many days?, What disturbed?, It hurts? It happens and ultrasound you can see them, not as affected both ovaries, ” the doctor states.

In order to establish what contributes more to the annoying symptoms, the genetic field or the lifestyle, the doctor may recommend performing the hormonal profile, which involves collecting blood samples, on 3-5 days of menstruation.
“Theoretically, it should be harvested three times during a menstrual cycle. The problem is that, considering that these investigations are not very settlement, you guide yourself after a sample, which costs about 600-700 lei, to harvest three times It is a considerable financial effort. All laboratories give a reference interval for the values ​​of each hormone according to the phases of the menstrual cycle we are in. Therefore, we always recommend that period, or, if a patient with recommended analyzes comes, should it be asked when menstruation was? What day were they harvested? It is very important, in order to be able to guide yourself according to values ​​and how it would be normal to grow. “says Dr. Gruia.

Analyzes of this type provide important clues to both the gynecologist and the endocrinologist, thus being identified the source of the hormonal imbalance.
“In order to be able to treat these polycystic ovaries, the endocrinological hormonal part, the thyroid function, the pituitary, which interests us the most. But the part of diabetes and nutrition diseases, these metabolism disorders are important to avoid weight fluctuations. ”

Infertility, the worst complication

If the polycystic ovary syndrome is not treated, the complications can be numerous, and some very serious. We speak primarily about irregular, painful, abundant menstruation, which causes discomfort and affects the patients.

The doctor mentions that although the first menstruation, in adolescence, may be irregular, if the problem persists for several months, investigations must be done. “The age at which the first menstruation is installed, appears even at 10-11 years. I even had a little girl who hadn’t turned 10. The incriminated factors are: food, environment, lifestyle. Indeed, the first ones can be irregular, one or two menstruation can come, then a break, until the still immature reproductive system is adjusted. If we exceed a six -month period, we ask ourselves a question. So I recommend the mothers to contact the endocrinologist in a first instance. Subsequently, after the endocrinological cause is excluded, the doctor guides the patient to gynecology if necessary ”, explains the doctor.

Also, this Patalogy can seriously affect fertility: “If in the woman in the fertile period, from 12 menstrual cycles we have 12 menstruation, theoretically 12 ovulations, of these 12, an average is 10 ovulatory cycles with good egg and two anovulatory cycles. That is, we have menstruation, but we do not have a follicle to release an egg for fertilization, capable of fertilizing. At the polycystic ovaries, depending on the severity, we lower this average. We are talking about 8-10 in a period of 12 months-12 ovulations-up to 5-6 ovulatory cycles in 12, in severe forms “.

It should be known that SOPC can also cause type II diabetes (over 50% of SOPC women develop diabetes up to 40), cardiovascular disease, and in some cases it can lead to endometrial cancer (due to irregular menstrual cycles).

More than drugs

Medicinal treatment to regulate menstruation and hormonal imbalances produced by this pathology are mainly based on the recommendation of combined (contraceptive) oral contraceptives in treatment schemes adapted to each case and the treatment of associated hormonal imbalances. These have the role of regulating menstruation and inducing the ovary “a memory” in order to regulate ovulation with shortening the number of days below 35 between menstruation and to correct associated symptoms (weight growth, excessive hair, pelvic pain, abundant menstrual flow).

“Polycystic ovary syndrome remains a complex pathology that can be controlled by maintaining a healthy lifestyle, optimal weight, limiting carbohydrate intake, avoiding sedentarism and consulting a specialist whenever the patient is experiencing symptoms that can hide hormonal imbalances, “ emphasizes the doctor. Therefore, in addition to the drug treatment, it is necessary to change the lifestyle in order to obtain the weight loss to the optimal weight related to height and age. It is recommended to avoid sedentary lifestyle, therefore, physical exercises or walking at least two or three times a week are mandatory to put in the program.