We’re sure that this is not the first time you hear this expression! But do you know exactly what it means to have polycystic ovaries? If the answer is no, don’t worry! In fact, there is a lot of confusion about this term. At first, it seems to indicate the presence of multiple cysts in the ovary. But this is not the case. Doctors use it when they detect a large number of follicles in the ovaries. But follicles are not cysts, but structures that contain eggs that have not yet matured. This is common in young women and, in principle, it should not be a cause for concern.

Dr Beatriz Álvaro, Responsible for the Polycystic Ovary Syndrome Unit

Dr Beatriz Álvaro, Responsible for the Polycystic Ovary Syndrome Unit

But you must be attentive, because an ovary with polycystic appearance can also be a symptom of ovarian dysfunction that is known by the name of the Polycystic Ovary Syndrome (PCOS). This syndrome requires medical attention, as it can affect the reproductive capacity and encourage the development of metabolic disorders such as diabetes or obesity. For this reason, Dexeus Mujer has created a specific Unit, whose goal is to address this problem from a multidisciplinary point of view.
In this post, Dr Beatriz Álvaro, responsible for this new Unit, explains how you can keep this problem under control.

In this post, Dr Beatriz Álvaro, responsible for this new Unit, explains how you can keep this problem under control.

 

What is exactly the PCOS and how many women are affected?

It is an ovarian dysfunction that may cause alterations at hormonal and metabolic level. The cause is not exactly known, although it is believed that there may be some genetic predisposition. In total, it is estimated to affect between 8 and 13% of the female population. But many of the women who have it don’t know it.

Why?

Because it is an underdiagnosed health problem, as the way that can manifest itself is very varied and sometimes it is difficult to make an early diagnosis. This is what happens with adolescents. It is considered that during the first eight years from the first period, there can be some irregularities in menstruation, and it is common to have acne, so we must give a certain margin of time before starting to put ‘tags’.

What symptoms can it cause?

They vary greatly from one woman to another. The most common are acne, lack of or irregular periods and hirsutism. It is also characterized by a high body mass index (BMI), tendency to gain weight and ovaries with polycystic appearance. But having ovaries with polycystic appearance does not mean that the cause is the PCOS, it could simply mean that they have a good ovarian reserve. For this reason, physicians should use this expression with some caution, because it can create confusion.

And how is it determined then, if you suffer from this syndrome or not?

In order to be able to confirm the diagnosis it is necessary to have at least two of these three conditions:

  1. Ovaries with polycystic appearance
  2. An androgens (male hormones) blood level higher than normal, or certain physical characteristics that are indicative of that androgens excess (hirsutism, acne…),
  3. Lack of period due to anovulation, or infrequent and irregular periods.

Why did Dexeus Mujer decide to create a specific Unit to treat this syndrome?

Because PCOS is a problem that deserves greater care than that it has been given until now and an approach that includes specific changes in life style (nutrition, exercise, etc.), since it has been demonstrated that those changes contribute to improve the syndrome and to prevent the development of other health problems which, in the long run, it can cause.

What kind of problems?

PCOS is associated with insulin resistance, so it can favour the development of diabetes and obesity. That is why it is very important that the control and medical follow-up of this syndrome should be made from a multi-disciplinary point of view, including experts in gynaecology, endocrinology and nutrition. It is also associated with an increased risk of cardiovascular health disorders and, in some cases, it can lead to fertility problems, so it may be necessary the intervention of an expert in reproductive medicine.

What percentage of women with PCOS have fertility problems?
In my experience, I can say that a 50% of patients I visit have a problem that could be related to this pathology (menstrual irregularities, hirsutism, acne…), and approximately half of them are patients who do not achieve to get pregnant.

And which is the solution in these cases? Is it necessary to resort to assisted reproduction techniques?

We must study each case. If it is a problem of anovulation, and there are no other factors of sterility (tubal factor or a male factor), it can be indicated a hormonal treatment to induce ovulation, and, depending on the results, we decide whether it is necessary to resort to in vitro fertilization.

More generally, what are the treatments for the disease?

The treatment must always be individualized. In general, the first option is to try to control the syndrome through the introduction of a series of guidelines in lifestyle (weight control, regular exercise, reducing the intake of sugar, etc.) Many times, these measures and a regular medical follow-up are enough. If there is no improvement, then a pharmacological treatment can be indicated.

Do you mean contraceptives…?
It depends. In some cases, the taking of contraceptives can help to reduce or eliminate the acne and hirsutism. However, they do not cure the syndrome, and in fact they may mask it, as some women realize they have it when they stop taking oral contraceptives because they want to become pregnant and find that their period don’t arrive or they begin to have acne or hair. Anyway, the taking of contraceptives can have a beneficial effect, since the lack of period that causes PCOS can favour the development of endometrial cancer in the long term, and with the intake of contraceptives that risk decreases.

Could pregnancy lead to favourable changes?

This is not a determining factor. But throughout life it is possible that the symptoms change and with age they can be smoother.

Then, does PCOS improve with menopause?

Some symptoms, but it is important to maintain control, as with menopause the risk of cardiovascular health problems increases. In fact, a 40% of women over the age of 40 with PCOS have what is called a metabolic syndrome that is characterized by high cholesterol, hypertension, and a high body mass index, three cardiovascular risk factors that is necessary to keep under control.

We cannot relax then…

No, but don’t be alarmed. With appropriate measures and under medical follow-up, we can maintain the PCOS under control and prevent the emergence of other health problems. The creation of this new Unit responds precisely to this goal.