Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women.
Polycystic ovary syndrome (PCOS), a disease seen in women of reproductive age
usually manifests itself during puberty. Main ovulatory dysfunction
(ovulation disorder) and hyperandrogenism (excess of male hormones).
The complaints caused by PCOS (polycystic ovary syndrome), a disease
may appear in a spectrum. The findings observed in PCOS can be categorized under 4 headings
we can evaluate :

• Symptoms of hyperandrogenism (male pattern signs) (for example: hair growth, in medical language
  hirsutism, moderate-to-severe acne, oily skin, male pattern baldness)
• Menstrual irregularity (e.g., long menstrual intervals, absence or irregular menstruation)
  bleeding)
• Polycystic ovaries (can occur in one or both ovaries)
  Obesity and insulin resistance

Because of this broad clinical spectrum, many cases may not have all of these features, which is
Therefore, it can sometimes be difficult to diagnose PCOS. Diagnosed with PCOS (polycystic ovary syndrome)
patients are more likely to develop metabolic syndrome, type 2 diabetes, cardiovascular disease and
increased risk of endometrial cancer, increased hair growth, treatment-resistant
Any woman with acne, menstrual irregularities or obesity complaints of PCOS (polycystic ovary
syndrome) is important to keep in mind.

• Hirsutism : In women, male pattern hair growth is called hirsutism. Androgen hormone
  production or increased sensitivity to these hormones. On the face and body in women
  hair growth known as quince hair is normal, while in hirsutism, hair growth on the upper lip, chin, chest, belly
  hard, dark hair growth on the top, under the navel, upper arms, thighs, back and waist
  is observed. It may be due to polycystic ovary syndrome (PCOS) or other diseases.

ASSOCIATION OF POLYCYSTIC OVARY SYNDROME WITH INFERTILITY
WHAT IS IT?
In a normal menstrual cycle, about 15-20 eggs mature each month in a woman.
and usually 1 of them matures completely. This matured egg
It is excreted from the ovary, enters the tubes and combines with the sperm. Polycystic ovary syndrome (PCOS)
patients who cannot mature due to problems in the maturation process of the egg.
The eggs form a cystic structure and ovulation rarely occurs. Therefore, people with PCOS
women take longer to conceive.

WHAT CAUSES POLYCYSTIC OVARY SYNDROME?
The cause of PCOS is unknown. Studies have shown that both genetic and non-genetic
factors contribute to the development of the syndrome.
Although the mechanism is not fully understood, recent studies suggest that the syndrome
insulin resistance may play a role. Insulin has a similar effect to LH hormone
increases androgen release from the ovaries. Another possible PCOS mechanism is
androgen hormones (male hormones) produced defectively in the adrenal gland. These
androgen hormones produced in excessive amounts cause symptoms such as hair growth, acne and
prevents the maturation of eggs in the ovaries. In PCOS
leads to the formation of polycystic structure in the ovaries. Therefore, in PCOS
inability to ovulate (anovulation) and infertility (infertility) are seen and women with PCOS
40% are infertile due to ovulation disorders. Another important problem in PCOS is
excess androgen is converted to estrogen by the aromatase enzyme, resulting in an unmet estrogen
exposure. This increases the long-term risk of breast and uterine cancer in PCOS patients.
increases.

HOW IS POLYCYSTIC OVARY SYNDROME (PCOS) DIAGNOSED?
The Rotterdam diagnostic criteria are currently used as diagnostic criteria. According to these criteria
Chronic inability to ovulate (anovulation) and consequent menstrual irregularity, menstrual
inability to menstruate (amenorrhea) or prolonged menstrual cycles (oligomenorrhea)
Clinical or laboratory signs of hyperandrogenism (excess male hormone):
hair growth (hirsutism), male pattern hair loss, acne, increased testosterone DHEASO4,
androstenedione
Polycystic appearance with numerous small ovarian follicles in the ovaries on ultrasonography
In the presence of 2 of these criteria, PCOS can be diagnosed.
However, other endocrinologic diseases must be excluded when investigating PCOS (thyroid
diseases, Cushing’s syndrome, congenital adrenal hyperplasia, hyperprolactinemia, etc.).

LIFESTYLE CHANGES IN POLYCYSTIC OVARY SYNDROME (PCOS)
WHY IS IT IMPORTANT?
Lifestyle interventions (diet, exercise and behavioral interventions) and weight loss
A treatment that improves insulin resistance and hyperandrogenism in PCOS, restores ovulatory cycles
and improve metabolic risk. In polycystic ovary syndrome
Even a weight loss of around 5-10 percent can lead to an improvement in menstrual patterns and
decrease in the number of pregnancies. Therefore, all women with PCOS who want or do not want to become pregnant
We recommend diet and exercise to lose weight as a first step.
Lifestyle changes and diet are usually followed by birth control pills and
drug treatment with antidiabetic pills (metformin) is started. PCOS (polycystic ovary syndrome)
the course of treatment is determined by the patient’s desire to become pregnant.
Infertility (infertility) is treated with in vitro fertilization (IVF).

POLYCYSTIC OVARY SYNDROME (PCOS) IN WOMEN WHO DO NOT WANT PREGNANCY
TREATMENT

Weight loss (lifestyle change with sports and diet)
Birth Control Pills: regulate the menstrual cycle as well as birth control, reduce hair growth and
reduces hyperandrogenic manifestations such as acne, protects the uterus from high estrogen exposure.
Metformin : improves insulin resistance, as an aid in the regulation of menstrual cycles
may cause ovulation to occur again.
Antiandrogenic Drugs : Used to improve symptoms such as hair growth and acne.

POLYCYSTIC OVARY SYNDROME (PCOS) IN WOMEN WHO WANT TO GET PREGNANT
TREATMENT

Weight loss (lifestyle change through sports and diet)
Ovulation-inducing drugs (clomiphene citrate, letrozole, gonadotropin)
Metformin: used to support ovulation therapy, improves insulin resistance.
Laparoscopic ovarian drilling: Ovaries are cut with electrocautery or laser in 4-5 small
burned by drilling holes. Not responding to weight loss and ovulation stimulants
used in patients
IVF (in vitro fertilization) treatment: In vitro fertilization in PCOS patients with infertility problems
pregnancy is possible with treatment.

PROGRESSING IN PCOS (POLYCYSTIC OVARY SYNDROME) PATIENTS
WHICH PROBLEMS CAN BE SEEN AT OLDER AGES?
In patients with polycystic ovary syndrome (PCOS), metabolic syndrome, sleep apnea, endometrial
(uterine) cancer and depression problems are more common than other people.
Most people with polycystic ovary syndrome (PCOS) are overweight or obese. Both obesity
both polycystic ovary syndrome (PCOS) high blood pressure (hypertension), impaired blood
increases the risk of diabetes, low HDL (good cholesterol), high LDL (bad cholesterol). This picture
all called meyabolic syndrome. This results in polycystic ovary syndrome
(PCOS) patients have an increased risk of heart attack, diabetes and stroke in later years. For this reason
It is extremely important for overweight polycystic ovary syndrome (PCOS) patients to lose weight.
Sleep apnea is also a common condition in patients with overweight ovarian syndrome (PCOS).
In sleep apnea, there are intervals when breathing stops during sleep. Sleep apnea
can lead to many problems, such as poor quality of life and distraction.
Endometrial cancer is cancer of the inner wall of the uterus. It is also popularly known as uterine cancer.
known as polycystic. The endometrium tissue in the uterus grows and multiplies under the influence of estrogen, polycystic
ovarian syndrome (PCOS) patients also have increased estrogen due to ovulation problems and
can cause uncontrolled proliferation of endometrial tissue and as a result
increased risk of endometrial cancer.
Finally, depression and anxiety are also more common in patients with polycystic ovary syndrome (PCOS).
can be seen.