Polycystic ovary syndrome (PCOS or Stein-Leventhal syndrome) is manifested by the presence of ovarian cysts. The dosage of anti-Müllerian hormone (AMH) as an alternative to ultrasound is now recommended in diagnosis.
Polycystic ovary syndrome (PCOS or Stein-Leventhal syndrome) affects approximately 10% of women according to’Inserm. It’s here leading cause of female infertility. PCOS is manifested by the presence of numerous cysts or small non-cancerous benign tumors within the ovaries. On August 17, 2023, from new recommendations have been published by an international consortium of over 3,000 professionals and led by the Australian University Monash. They revise the criteria for diagnostic PCOS and advocate Anti-Müllerian hormone (AMH) assay as an alternative to ultrasound. In PCOS, AMH is two to three times higher than normal. “It is interesting, because an accurate ultrasound with follicle count is not always available, even in France“commented the gynecologist and endocrinologist Catherine Azoulay in the Doctor’s Daily. On the other hand, when irregular menstrual cycles and hyperandrogenism are present, ultrasound or AMH are not necessary for diagnosis. “In adolescents, both hyperandrogenism and ovulatory dysfunction are needed but ultrasound and AMH testing are not recommended due to low specificity” reads the guidelines published on the Monash University website. What is PCOS? What are the symptoms ? What are the treatments? Can you get pregnant when you have polycystic ovaries?
Definition: what is polycystic ovary syndrome (PCOS)?
The term “polycystic” literally means “that contains many cysts”. Cysts are small pockets filled with air, gas, or fluid that can form on many parts of the body. We are talking about polycystic ovary syndrome when the ovaries increase in size due to the presence of several small cysts. This gynecological endocrine disease chronic of imprecise origin, but probably with a genetic and environmental component, mainly concerns young women.
What are the symptoms of PCOS?
Many symptoms are present in this syndrome which are expressed to different degrees in different women. Among the most marked, we observe a absence or disturbance of menstrual cycles (metrorrhagia), weight gain or even obesity, hirsutism, i.e. the excessive presence of hair (on the chest, stomach and face) and acne. In some cases it appears fertility disorders, going as far as sterility, linked in particular to anovulation, a consequence of the interruption of follicular maturation. Hair loss at the top of the skull and signs of virilization are also possible but rarer. In some cases dark spots on the skin of the neck, under the arms and in the groin area (inner thighs) called “acanthosis nigricans” may appear.
What Causes PCOS?
This pathology seems to be hormonal cause since a deficiency in luteinizing hormones and an excess of androgens, male hormones, are mostly found. There is a link between polycystic ovary syndrome and insulin resistance syndrome, a hormone secreted by the pancreas. It is thus responsible for diabetes when it is of poor quality or produced in insufficient quantities.
When to consult for PCOS?
Front of theacne, menstrual cycle disorders, excessive hair growth or difficulty conceiving, a consultation with the attending physician or gynecologist is necessary, as well as certain additional examinations (abdominal ultrasound, blood test) to seek the diagnosis of PCOS.
The diagnosis of polycystic ovary syndrome is usually made by combining the results of the interrogation and those of the complementary examinations. In particular, a blood test is carried out, which makes it possible to observe the levels of hormones, in particular the luteinizing hormone, or LH, which increases in a variable way. Androgens are also dosable and can be above normal. To establish the diagnosis of PCOS 2 of the 3 Rotterdam criteria must be met:
- hyperandrogenism clinical or biological (excess of androgens)
- egg dysfunction (irregular periods)
- ultrasound which shows the presence of cysts in the ovaries and the resulting increase in the volume of these organs
On August 17, 2023, new international guidelines were published by an international consortium of over 3,000 professionals and led by the Australian University Monash. They advocate Anti-Müllerian hormone (AMH) assay as an alternative to ultrasound. In PCOS, the AMH is two to three times higher than normal. On the other hand, when irregular menstrual cycles and hyperandrogenism are present, ultrasound or AMH are not necessary for diagnosis. “In teenageboth hyperandrogenism and ovulatory dysfunction are necessary but ultrasound and AMH assay are not recommended due to low specificityreads the guidelines published on the Monash University website. Indeed, multifollicular ovaries are common in teenage girls.
What are the treatments for PCOS?
To date, there is no cure for PCOS. However, a Drug treatment may be prescribed to regulate the menstrual cycle, and decrease the growth of hair and acne. The different options are discussed with the gynecologist:
- A contraceptive hormone therapy may be prescribed to correct hormonal imbalance by lowering testosterone levels (which will reduce acne and hair growth) and regularizing the menstrual cycle. It also reduces the risk of endometrial cancer (which is slightly higher in young women who do not ovulate regularly).
- There Metformin© is used to lower blood insulin levels, especially in patients with high insulin levels with pre-diabetes or diabetes. The two treatments Metformin© and contraceptive pill can be combined.
- THE acne treatment in the form of local creams, oral antibiotics and other drugs.
Solutions exist for excess hair which can quickly become complex. To avoid this, it is recommended to discuss with your gynecologist and dermatologist the possibility of bleaching the hair, or alternatively using waxing, hair removal creams, electrolysis or laser treatment For example.
What are the natural treatments for PCOS?
A healthy lifestyle and balanced diet combined with daily physical activity are the most important part of the treatment. Balancing insulin levels, and losing weight can reduce the risk of diabetes and some of the symptoms of PCOS. Accompaniment by a nutritionist doctor may be necessary.
Can you get pregnant with PCOS?
Due to ovulation problems, PCOS can be a cause of subfertility or infertility. Some women can get pregnant normally while others only ovulate 2 or 3 times a year, or not at all. The opinion of a gynecologist is necessary in case of difficulties in conceiving. Ovarian stimulation, ovarian drilling (surgical operation to restore spontaneous ovulation) or medically assisted procreation (PMA) can help.