Dr Teksen Camlibel explains the effects of Polycystic Ovarian Syndrome
By Professor Dr Teksen Camlibel
Gynaecologist at Jinemed Health Centers
In women, there are follicle stimulating hormones (FSH) and luteinizing hormones (LH) secreted from the hypothalamus of the brain which enable the ovaries to function normally and women to ovulate. Of these hormones, FSH promotes the development of oocytes in ovary while LH helps oocytes mature and crack to provide pregnancy. FSH is always secreted more than LH.
In the opposite case, with higher LH value than FSH values, oocytes in the ovaries cannot crack. In this case, the oocytes in the ovary cumulate without cracking, and when oocytes are visualised with ultrasound, it is observed that tens of small oocytes fill up the ovary. This is called polycystic ovary (poly means many, cyst means vesicles filled with fluid which are oocytes in this case).
Menstrual periods of girls who have such hormonal order congenitally start in an irregular manner in adolescence. These children may be a bit overweight than normal and suffer from complaints such as puberty acne, oily skin, and hair loss more frequently. More hair growth may be observed on the facial area, around abdomen and chest. The reason for these conditions is the male hormone called testosterone secreted by oocytes that are unable to crack in the ovary and accumulate. This hormone is secreted more in patients with polycystic ovaries than in other girls, which causes masculine changes in the body.
We recommend that these children take medications to regulate menstrual periods, avoid gaining weight and take some special contraceptive pills to prevent hair loss or hair growth during their maidenhood. Otherwise, there may be irremediable disorders that leave marks on face and body.
PCOS has been linked to diabetes
It has been found in recent years that polycystic ovarian syndrome is carried on the same chromosome as diabetes, which means that these two diseases are interrelated, although remotely. It is therefore more likely that patients with polycystic ovaries develop diabetes, cardiovascular disease, high blood pressure, and high cholesterol throughout their lives. Such disorders are also more common in the families of these patients.
Polycystic ovary syndrome can be recognised not only as a hormonal problem in women but also an internal disease which may affect their lives. We particularly ask such individuals to have their check-up once a year and have tests such as diabetes and cholesterol.
When these patients reach the age of marriage or plan to have a child, they may require additional treatment as they cannot ovulate regularly. Since it is associated with diabetes as we mentioned before, in this case, certain medications that are prescribed for diabetes patients and lower the sugar level can regulate menstruation and enable ovulation in such individuals. First the patients need to be diagnosed when they consult the doctor to have a baby, which refers to specific visualization in ovaries, appearances such as oily face skin and body fat and acne formation, higher level of LH than FSH in blood on the third day of menstruation, and sometimes, higher testosterone in blood.
Patients with polycystic ovaries may sometimes respond severely to medications, which can lead to life-threatening problems such as overgrowth of the ovary, which we call hyperstimulation, and abdominal water retention.
Hence, the treatment of individuals with polycystic ovaries should be applied by specialist physicians so that the patients can have a child.
In individuals with polycystic ovaries, there is impairment in the quality of the cracked oocyte in question aside from enabling it to crack as a treatment. Therefore, when such couples are sometimes subjected to treatments such as IVF, they may have lower chances than normal individuals. Because oocyte quality and embryo quality may be lower.
A new surgical method called laparoscopic ovarian drilling is also used in people with polycystic ovaries. With this method, the abdomen is entered with a small pipe, which is called laparoscopy, and then, heat is applied with devices called cautery into ovaries, the oocyte is entered through the perforation of the oocyte shell membrane at several points, and there, damage is caused via heat by cautery. As LH hormone is secreted from the internal tissue of oocyte, this damage can lower the LH level in blood and sometimes cause natural ovulation and natural regularity in menstrual periods.
Some publications report that this procedure creates a chance of pregnancy up to 50 percent in polycystic ovary patients in the first year
After polycystic ovary patients become pregnant and give birth, living on a certain kind of contraceptive pill to regulate their menstruation between two deliveries is required both for their skin health and to have regular menstruation. These patients may need menstruation-regulating drugs until 40 years of age and even thereafter following the end of their pregnancy. Because polycystic ovarian disease lingers on.
Endometrial cancer (uterine cancer) is observed more frequently in the polycystic patients who have not been treated for long and menstruating irregularly. Because these patients do not ovulate, hence do lack the protective hormone called progesterone which is secreted after ovulation; therefore, estrogen, which leads to uterine cancer, prevails since it has not had any counterbalance, increasing the risk of cancer in uterine.
Such patients should be examined regularly in future and checked for cholesterol, high blood pressure and cardiovascular diseases. Since the daughters of these people may be suffering from polycystic ovarian syndrome, diagnoses, follow-up and treatments should be started consciously at an early age.
Due to being a disease observed in the society at a rate of ten to 20 percent, polycystic ovary syndrome has now become a disease more frequently observed, more easily recognized and treated by every gynecologist. When young girls have complaints about irregular menstruation, acne and oily skin, and hair growth, they should absolutely consult a gynecologist, and should be checked about this issue and start the treatment.
Humans are born and die with polycystic ovary syndrome. Hence, they need to be followed up by gynecologists and internists as a team during adolescence, pregnancy, and in the pre- and post-menopause period. After these follow-up and treatments, these patients can live a healthy, good life like other people.