Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is the most common metabolic disorder observed in young and middle-aged women. It can affect approximately 1 in 5 women in the general population. It was first described by Irving Freiler Stein and Michael Leo Leventhal in 1935. The term “polycystic” refers to the presence of multiple cysts.

In most cases of polycystic ovary syndrome (not all), numerous small cysts are observed in the ovaries. These cysts, although different from normal ovarian cysts, are small in size. The main symptoms include oligomenorrhea (infrequent menstrual periods), amenorrhea (absence of menstrual periods), anovulation (irregular ovulation), elevated androgen hormones, excessive hair growth (hirsutism), acne, and obesity.

Ovarian Enlargement

In 80% of patients with Polycystic Ovary Syndrome (PCOS), ultrasound examination reveals ovarian enlargement, thickening of the ovarian capsule, stromal expansion, and multiple small cysts (more than 10-12) just beneath the ovarian capsule. However, the presence of these findings does not always indicate the presence of polycystic ovary syndrome, as similar findings can be observed in 23% of normal women on ultrasound examination.

Among patients presenting with infertility and ovulation disorders, 80% are diagnosed with PCOS.

Treatment of Polycystic Ovary Syndrome

The goals of treatment include achieving normal body weight through diet, exercise, and lifestyle changes, reducing androgen hormone levels and hirsutism, and promoting pregnancy if desired. Additionally, women with PCOS are exposed to continuous estrogen hormone due to chronic anovulation (ovulation disorder), which increases the risk of endometrial cancer. Therefore, one of the treatment objectives is to prevent this. In overweight patients, weight loss through diet and exercise can restore ovulation function and normalize menstrual cycles, increasing the chance of pregnancy. For patients who do not desire pregnancy, commonly used treatment options include oral contraceptives and progesterone hormones. To reduce excessive hair growth in these patients, oral contraceptives, cyproterone acetate, flutamide, finasteride, and other medications may be used. Metformin, a medication used for diabetes, can be used in these patients due to its ability to reduce androgen production and its positive effects on ovulation, especially in patients desiring pregnancy. In patients desiring pregnancy, ovulation-inducing medications are used. Typically, treatment starts with clomiphene citrate and if there is no response, more potent medications are utilized. In cases where pregnancy cannot be achieved with all treatment modalities, in vitro fertilization (IVF) is considered as an option.