Author: Rositsa Tashkova, Master of Molecular Biology and Microbiology
The World Health Organization (WHO) estimates that in 2012, 116 million women (3.4%) worldwide suffered from Polycystic Ovary Syndrome (PCOS). Worldwide, estimates of the prevalence of PCOS are highly variable, ranging from 2.2% to 26%. [ref. 1] It is estimated that in the United States alone, between 5% and 10% of women of childbearing potential have this problem. [ref. 2]
Women with polycystic ovaries have hormonal imbalances and metabolic problems that can affect their health. The condition is common in women of childbearing potential and may include symptoms such as irregular menstruation, acne, thinning hair and weight gain.
What is polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome is a common health problem caused by an imbalance of reproductive hormones.
Polycystic ovary syndrome can cause omission or irregular menstruation, which can lead to:
- Infertility (inability to get pregnant) - PCOS is one of the most common causes of infertility in women, but with proper medical intervention, a woman can still become pregnant - sometimes even without intervention.
- Development of cysts (small fluid-filled bags) in the ovaries.
Usually, a woman understands that she suffers from the syndrome when she visits her gynecologist after unsuccessful attempts to becomepregnant.
In addition, women with PCOS produce an excess of the female sex hormone estrogen. Although this does not contribute to the observed symptoms, in the long run this may prove to be a major risk factor for the development of uterinecancer. [ref. 4]
Some of the symptoms of polycystic ovary syndrome include:
- Irregular menstrual cycle. Women with the syndrome may miss their menstruation sporadically or have fewer menstrual cycles (less than eight per year). Or menstruation may occur every 21 days or more often. In some women with PCOS, menstruation completely stops.
- Too much hair on the face, chin or male type of hair. This is called hirsutism. Hirsutism affects up to 70% of women with venous ovaries.
- Acne on the face, chest and upper back.
- Thinning of hair or hair loss; male baldness.
- Weight gain or difficulty losing weight.
- Darkening of the skin ,especially on thefolds of the neck, in the groin and under the chest.
- Skin formationssimilar to warts. They are soft, with the color of the skin and appear in the armpits or neck area.
The exact cause of the development of ovarian cancer is unknown. Most experts believe that several factors, including genetics, play a role:
- High levels of androgens. Androgens are sometimes called "male hormones", although each woman's body normally synthesizes small amounts of them. Androgens control the development of male traits. Women with PCOS have more androgens than normal.
- High levels of insulin. Insulin is a hormone As a result, the levels of this hormone in the blood become higher than normal. Many women with PCOS also have insulin resistance, especially those who are overweight or obese, unhealthy eating habits, insufficient physical activity or have a family history of diabetes (usually type 2 diabetes).
How is the diagnosis made? In order to be diagnosed with polycystic ovary syndrome, it is necessary to exclude other causes of the patient's symptoms. The doctor will be interested in her medical history to date and will do a physical examination, as well as various studies:
- Physical examination. The doctor will ask about the body mass index (BM) and waist size, whether there is excess hair, acne or discolouration of the skin on the face, chest or back.
- Pelvic examination. The doctor may look for visible signs of increased levels of male hormones (e.g. enlarged clitoris) and check if the ovaries are enlarged or swollen.
- Ultrasound of the pelvis (sonogram). This test uses ultrasound waves to examine the ovaries for cysts and to check the endometrium (lining of the uterus).
- Blood tests. Blood tests check the levels of androgenic hormones. The doctor will also order a test for hormones associated with other common health problems that can be confused with polycystic ovary syndrome, such as thyroid disease.
If we are overweightor obese , the first and most important step is to make efforts to lose weight. Healthy eating habits and regular physical activity can help alleviate symptoms associated withpolycystic ovary syndrome.
Weight loss can help lower blood sugar levels,improve the way the body uses insulin, and normalize hormonelevels. Even 10% body weight loss can regulate the menstrual cycle and improve the chances of getting pregnant.
The relationship between weight and PCOS is related to the body's inability to use insulin correctly , which can lead to weightgain.
What is insulin resistance
Insulin is a hormone It helps glucose in the blood to enter the cells of muscle and fat tissue and of the liver, where it is used for energy. Glucose comes from the food we eat. The liver also produces glucose when needed, for example, when we are starving. When the blood sugar level rises after a meal, the pancreas releases insulin into theblood.
With insulin resistance, cells do not react normally to insulin and cannot easily absorb glucose from theblood.
If this does not happen, a prediabetic condition occurs. In this case, blood sugar levels are higher thannormal, but not high enough to diagnose diabetes.
Prediabetes are usually found in people who already have some insulin resistance or whose beta cells in the pancreas do not produce enough insulin to keep blood sugar within normal limits. Without enough insulin, additional glucose remains in the blood instead of entering the cells and being used for energy. Over time, type 2 diabetes may develop.
Researchers still do not fully understand the causes of insulin resistance and prediabetes, but believe that excess weight and lack of physical activity are also major factors in this case.
It is believed that obesity - especially too much fat in the abdomen and around organscalled visceral fat - is a major cause of insulin resistance. Waist circumference above 100 cm in men and over 89 cm in women is often associated with the onset of insulin resistance. This is true even if the body mass index (BM) falls within normal limits. [ref. 5]
Fat does not only serve to store energy. Research has shown that belly fat synthesizes hormones and other substances that can contribute to the onset of chronic or long-term inflammation in the body.
In turn, insufficient physical activity is also associated with insulin resistance and prediabetes. As already mentioned, regular physical activity leads to changes in the body that make it more able to maintain the balance of glucose levels in the blood.
What are the symptoms of insulin resistance and prediabetes
Insulin resistance and prediabetes usually have no symptoms . In some people with prediabetes, darkening of the skin is observed in the area of the armpit or neck at the back and side of the neck, a condition calledacanthosis nigricans.
What is the relationship between insulin resistance and PCOS
In general, insulin resistance and compensatory hyperinsulinemia (too high levels of insulin in the blood) affect about 65–70% of women with polycystic ovary syndrome, with 70–80% of obese women (BM> 30) and 20–25% of weak women (BM <25) exhibiting these characteristics. Some of the insulin resistance appears to be independent of obesity andis specifically associated with PCOS, with abnormalities of insulin action cell mechanismsand insulin receptor function documented. [ref. 6]
It seems that too high levels of insulin are an important factor in maintaining excessive levels of androgens in the blood , directly causing the excess productionof androgens from the flow cells, as well as as co-gonadotropin, amplifying the effect of the increased LH stimulus seen in most women with polycystic ovary syndrome.
Insulin resistance, compensatory hyperinsulinaemia and its effects have negative effects on both metabolic and reproductive health. Options for treating insulin resistance/hyperinsulinaemia include lifestyle changes, exercise, diet and weight loss or metformin treatment.
The main limitation of this therapy is the difficulty of keeping changes for an extended period of time, and unfortunately relapses occur.
Effects of polycystic ovary syndrome on fertility and pregnancy
Polycystic ovary syndrome can affect a woman's fertility in different ways.
Problems with ovulation are usually the main cause of infertility in those suffering from the syndrome. Ovulation may not occur for two reasons: due to an increase in testosterone production or because the follicles on the ovaries do not ripen.
Even if ovulation occurs, the imbalance in hormones can prevent the mucous membrane of the uterus from developing properly to allow implantation of the fertilized egg, which will prevent the onset of pregnancy.
Due to unbalanced hormones, ovulation and menstruation can be irregular. Unpredictable menstrual cycles can also make it difficult to get pregnant. [ref. 7]
- Gestational diabetes [ref. 9];
- Cesarean section;
- The baby can be born with more weight or spend more time in neonatology.
These complications are preventable under careful medical supervision, as well as with effort on the part of the woman with PCOS, who plans pregnancy: weight loss if he is overweight, and lowering blood sugar if it is too high.