Polycystic ovary syndrome: an integrated approach to treatment

Natalya Chekalskaya , endocrinologist at the LegeArtis beauty clinic (Ukraine, Kiev)

What is PCOS?

Polycystic ovary syndrome (PCOS), also known as Stein-Leventhal syndrome or sclerocystic ovary disease , is an endocrine (hormonal) disorder in which the ovaries are enlarged and contain many small fluid-filled sacs. PCOS is a fairly common disease. Polycystic disease occurs when the ovaries overproduce male hormones (androgens), which are normally produced in very small quantities.

During each menstrual cycle, many small follicles (vesicles) form in the ovaries, from which an egg can later be released. Normally, in the middle of the menstrual cycle during ovulation (follicle rupture), one egg leaves one of the follicles (of an ovary), and the other follicles overripe and stop working. With PCOS, the egg does not mature and ovulation does not occur. The follicles do not rupture, but fill with fluid and turn into cysts. Accordingly, the ovaries can increase in size, becoming 2–5 times larger than normal.

Women with PCOS often exhibit masculine characteristics, such as excess facial and body hair growth, acne, bald spots, and abdominal fat deposits (fat deposited around the waist).

Doctors estimate that this disease affects about 5–10% of all women who have not yet gone through menopause. It is one of the main causes of infertility. In addition, many women do not know that they are sick.

Etiopathogenesis of the syndrome

There is still no consensus among doctors about the causes of PCOS. However, it is known that this disease is associated with the insensitivity of body tissues to insulin (a hormone involved in regulating blood sugar levels). Recent research suggests that the body of women with PCOS cannot process insulin properly, and its levels in the blood become so high that the ovaries respond to it by overproducing male sex hormones.

Symptoms of the disease can appear at any age. They can develop during puberty, and then the menstrual period may be delayed or not occur at all. Girls may be overweight and have male-pattern hair growth, such as on the chest and face. Menstrual irregularities or heavy menstrual bleeding may also occur.

Symptoms may vary slightly from woman to woman, although it is common to experience some or all of the following symptoms:

• oligomenorrhea, amenorrhea - irregular, rare menstruation or complete absence of menstruation; those menstruation that does occur may be pathologically scanty or, on the contrary, excessively abundant, as well as painful;
• infertility, usually the result of chronic anovulation or oligoovulation (complete absence of ovulation, or ovulation does not occur in every cycle);
• increased blood levels of androgens (male hormones), especially free fractions of testosterone, androstenedione and dehydroepiandrosterone sulfate, which causes hirsutism (excessive hair growth on the face, chest and abdomen) and sometimes masculinization;
• central obesity - “spider-shaped” or “apple-shaped” obesity of the male type, in which the bulk of adipose tissue is concentrated in the lower abdomen and abdominal cavity;
• androgenic alopecia (significant male-pattern baldness or hair loss with receding hairline on the sides of the forehead, above the forehead line, on the crown, occurring due to hormonal imbalance);
• acne, oily skin, seborrhea;
• acanthosis (dark pigment spots on the skin, from light beige to dark brown or black);
• acrochordons (skin folds) - formations consisting of dense horny masses;
• stretch marks (stretch marks) on the skin of the abdomen, usually as a consequence of rapid weight gain;
• long periods of symptoms resembling those of premenstrual syndrome (swelling, mood swings, pain in the lower abdomen, lower back pain, pain or swelling of the mammary glands);
• night apnea - stopping breathing during sleep, leading to frequent awakenings of the patient at night;
• depression, dysphoria (irritability, nervousness, aggressiveness), often drowsiness, lethargy, apathy, complaints of “fog in the head.”

PCOS is visible on ultrasound, although not always. In 20% of women (who have not yet gone through menopause) who do not have symptoms of polycystic disease as such, polycystic ovaries are detected during ultrasound examination.

In addition, PCOS may be accompanied by symptoms of diabetes, increased urination, vaginal thrush (candidiasis), or chronic skin infections.

Recommendations for patients

Your doctor may recommend a specific diet to try to normalize your insulin levels and keep your cholesterol levels normal. Losing weight and staying in good physical shape is also very important - these measures alone help some women with PCOS. Reducing body weight against the background of a reduction diet leads to normalization of carbohydrate and fat metabolism. The diet involves reducing the total calorie content of food to 2,000 kcal per day, of which 52% comes from carbohydrates, 16% from proteins and 32% from fats, and saturated fats should make up no more than 1/3 of the total amount of fat. An important component of the diet is limiting spicy and salty foods and liquids. A very good effect is observed when practicing fasting days; fasting is not recommended due to protein consumption during the process of gluconeogenesis. Increasing physical activity is an important component not only for normalizing body weight, but also for increasing the sensitivity of muscle tissue to insulin. The most important thing is to convince the patient of the need to normalize body weight as the first stage in the treatment of PCOS.

Treatment by an endocrinologist

An endocrinologist should evaluate symptoms based on the medical record and general examination. If you suspect PCOS, your doctor will order the appropriate tests to confirm it and rule out other possible diseases.
Necessary examination: ultrasound examination (will show the general appearance of the ovaries), blood tests - general levels of sex hormones, insulin, glucose, cholesterol.

Medicines. To treat PCOS, your doctor may prescribe progestogen (a synthetic version of the female sex hormone progesterone) or birth control to induce regular menstrual cycles.
Some low-concentration contraceptives commonly available on the market contain estrogen and a small amount of the antiandrogen (a substance that blocks the effects of male sex hormones) cyproterone acetate. These substances help to effectively control excess hair growth and acne. Another antiandrogen, such as spironolactone, which acts in a similar way, may also be used. Excessive hair growth can be treated simultaneously with medications and hair removal treatments. It is important that the doctor choose the optimal method.

Isotretinoin is used in cases of severe acne. This drug reduces the amount of sebaceous secretions of the skin and reduces the number of skin glands that produce them. Due to the presence of side effects, this medication can only be prescribed by a special doctor. It is contraindicated for pregnant women and those planning pregnancy, as there is a danger of harming the baby.
Medicines, such as metformin, may also be prescribed to help the body properly use the insulin it produces. These medications help reduce body weight and lower blood pressure in patients with PCOS, and sometimes help restore the menstrual cycle and control excess hair growth caused by increased testosterone levels.
Using all these drugs, a woman must understand that their effect does not appear immediately.

Cosmetological correction

It is necessary to understand that if medications aimed at reducing hair growth are ineffective, the cosmetologist may suggest using other methods, such as laser hair removal, waxing or electrolysis. An important component in an integrated approach to solving the problem of PCOS are body care procedures aimed at general detoxification of the body, lymphatic drainage, and improvement of microcirculation, including for home care. Remember that peelings, normalization of the lipid layer, hardware cosmetology will have a visible aesthetic effect, provided that these activities are carried out regularly.

Of course, only an endocrinologist can prescribe hormonal treatment to a woman after a thorough examination, but in no case a cosmetologist - this can lead to irreparable consequences. But it is simply necessary to recommend contacting a specialist in case of such problems.

This problem cannot be solved unilaterally; an integrated approach of a team of doctors and cosmetologists, a unified examination algorithm, integration of the efforts of different specialists in order to preserve the quality of life, continuity in the work of specialists, and principles of individual therapy are required. And, of course, we should not forget that a woman’s quality of life is determined not only by her state of health, but also largely depends on her appearance and the condition of her skin, which largely determine her psycho-emotional well-being.

First published: KOSMETIK international journal, No. 2 (36), 2009