What is it about ?
The ovaries not only produce large amounts of female hormone, but also a small amount of male hormone. This is perfectly normal. In girls and women who have multiple cysts on the ovaries, a phenomenon known as “polycystic ovary syndrome” (PCOS), the ovaries make too much of the male hormone. Often, women with PCOS have enlarged ovaries with the presence of cysts (a type of blister). It is not clear how these cysts develop, but they are benign anyway.
Women with PCOS usually have irregular periods, increased hair growth (male type), and fertility problems. Pregnancies are associated with a higher risk of miscarriage.
Twenty to 70% of women with PCOS are overweight. Women with PCOS are also more likely to have the following health problems at a later stage in their life, usually around or after menopause: type 2 diabetes (which can also appear earlier), cardiovascular disease, high blood pressure and cancer of the lining of the womb (endometrial cancer). Many of these problems are associated with being overweight and reduced insulin sensitivity. Early detection and treatment can reduce long-term consequences.
What is its frequency?
PCOS affects between 5 and 15% of women of childbearing age. PCOS causes increased health risks at different stages of a woman’s life.
How to recognize it?
If you have PCOS, you may have the following symptoms:
- ovulation and periods do not start or are irregular; sometimes you can go without your period for several months.
- it is impossible to predict if and when an egg will be released (ovulation) (again), so your fertile window can be difficult to determine.
- you can develop many buttons.
- you may have a lot of hair growth (including hair growth on the chin, breasts or lower abdomen).
- often you are overweight.
How is the diagnosis made?
The doctor will ask you questions and examine you. In this context, he will pay particular attention to the presence of male hair, acne and excess weight. He will then direct you to have a gynecological ultrasound. This exam makes it possible to visualize the multiple cysts on the ovaries. They will also give you a blood test to check your hormone levels.
The diagnosis of PCOS can be made if you have two of the following characteristics: menstrual disturbances, signs of hyperandrogenism (distribution of male-like hair growth or excess testosterone in the blood) and multiple cysts on the ovaries, visible on ultrasound. .
The doctor will rule out other possible causes, such as a thyroid condition. In women with PCOS, especially if they are overweight, they will also look for signs of diabetes or high blood pressure. To do this, he will measure the level of glucose (blood sugar) and fat in the blood, as well as blood pressure.
What can you do ?
The most important step you can take is to try to achieve a healthy weight. Weight loss regulates the menstrual cycle by restoring ovulation and significantly reduces the risk of miscarriage during the first weeks of pregnancy, as well as the risk of developing other problems during pregnancy.
Not knowing when you ovulate and when your period can be annoying. In this case, you never know if you are in the fertile period. It is especially upsetting when you are trying to get pregnant.
If you want to get pregnant, hormonal treatment (tablets or injections) can help to artificially induce ovulation and thus increase your chances of pregnancy. Losing weight improves the safety and effectiveness of treatments that induce ovulation.
If you don’t want to become pregnant, you can take the birth control pill (“the pill”) even if you don’t have your period. The pill often also helps fight pimples.
For a woman with PCOS, it is imperative to quit smoking, lose weight, and exercise more to reduce cardiovascular risk.
What can your doctor do?
If you do not have your period for long months, it may be helpful to have your period at least four times a year to shed the lining of the womb (endometrium), for long-term cancer prevention. of the endometrium. Most often, the pill is enough to trigger them. Oral contraceptive pills (eg, drospirenone, cyproterone, or desogestrel) restore the normal menstrual cycle. They can also help limit excess hair and pimples.
If the hyperpilosity remains problematic despite the pill, an anti-androgen (eg 50 mg cyproterone acetate for the first 10 days of the cycle) or spironolactone can be added to it.
Metformin is a medicine used in the treatment of type 2 diabetes. Recently, it has been found that some women with PCOS are only able to regulate sugar metabolism by producing a lot of insulin. However, high insulin levels can lead to an increase in testosterone production, and therefore disrupt ovulation. Metformin reduces the amount of insulin and seems particularly suitable for women who are overweight or have high insulin levels. The drug also has a slimming effect.
If you have a desire for pregnancy, several treatments / interventions are available to you: weight loss, tablets (clomiphene) or injections (gonadotropin) of hormones, exploratory surgery and metformin. Clomiphene citrate is the drug of choice. It is an oral antiestrogen that triggers ovulation. If treatment with clomiphene is unsuccessful, the next step is daily administration of subcutaneous (i.e. under the skin) injections of gonadotropins. You or your partner can learn how to give the injections. The cycle is then followed by ultrasound, which usually requires several appointments. The doctor may adjust the dose after the ultrasound.
Recent interventions include “laparoscopic ovarian drilling”. This treatment consists of exploratory surgery, performed under general anesthesia, during which several small superficial holes are drilled in the ovaries. This intervention changes the production of hormones in the ovary and restores ovulation. The cost of this treatment is significantly lower than that of gonadotropin therapy and the procedure is just as effective. It further reduces the risk of multiple pregnancy. The choice between the two treatments is made on a case-by-case basis.
If you are not yet pregnant after drug treatment, IVF (in vitro fertilization) may be considered.