PCOS: definition, diagnose and treatment

September is the awareness month for polycystic-ovarian syndrome (PCOS), the most common ovulatory disorder with 6 to 13% of US women going through this syndrome.

The term polycystic ovaries is somewhat confusing since it is not about cysts on the ovary, but rather how the ovaries look. With PCO, there is a greater number of small follicles compared to normal ovaries.

What are the symptoms of PCOS?

The most common symptom of PCOS is increased male hormone or androgen levels. This can cause acne, greasy skin, increased and unwanted body hair growth, and accelerated hair loss in the scalp. Irregular ovulation and subsequently irregular menstrual cycles. Other possible symptoms: weight gain, difficulties getting pregnant, an increased risk of diabetes and high blood sugar, high blood pressure, and emotional challenges such as depression or anxiety

How to diagnose PCOS?

The so-called “Rotterdam criteria” are the symptoms used by doctors to diagnose a patient with PCOS. The patient must have at least 2 out of 3 of the following symptoms:

• Irregular period or complete absence of ovulation and infrequent or absent ovulation. The gynecologist finds out whether the criterion of cycle disorders applies

• The level of male hormones in the blood is elevated and/or increased hair growth/acne. A physical examination clarifies the external symptoms

• The ovaries are surrounded or enlarged by more than 12 small cysts with a diameter of 2-9 mm that string together like pearls. A vaginal ultrasound examination shows the condition of the ovaries. Is very important to mention that the ultrasound should not be used as a diagnostic tool of PCOS in women with a gynecological age of less than 8 years, this means that the woman has less than 8 years after her first menstruation.

Why is it important to learn more about PCOS?

As mentionedbefore, PCOS is the most common hormonal disorder in pre-menopausal women. Nevertheless, it is an underdiagnosed and therefore undertreated condition that increases the risk of several diseases such as diabetes mellitus type 2, cardiovascular disease, and metabolic syndrome. The treatment is individualized and may involve a combination of lifestyle changes, supplements, and pharmacological intervention.

PCOS treatment

The treatment of PCOS is challenging since the symptoms are heterogenous within patients. According to the guidelines for the assessment and management of polycystic ovary syndrome of 2018, oral contraceptive pills are the first-line pharmacological management for menstrual irregularity and high androgen levels. Nevertheless, good management of the condition with individualized lifestyle interventions can be archived, avoiding the side effects that come with the chronic intake of oral contraceptive pills.

Regarding the nutritional recommendations, an optimal “diet” for PCOS is not established yet. The dietary changes should be tailored according to the patient’s food preferences and avoiding very severe restrictions and unbalanced diets, following the general population recommendations of healthy eating. Modifying the glycaemic index, anti-inflammatory foods, and intuitive eating are some of the eating plans that have shown a positive impact in fertility and metabolic parameters. Is very important to screen eating disorders in patients with PCOS, since it is more frequent in this population. The exercise recommendations for the prevention of weight gain and maintenance of health in adults is a minimum of 150 min/week of moderate-intensity physical activity or 75 min/week of vigorous intensities or an equivalent combination of both. Muscle-strengthening activities should be included on 2 non-consecutive days/week.

Reference: Teede et al., 2018. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Monash University, Melbourne Australia. Ajmal N, Zeib Khan S, Shaikh R. >Polycystic ovary syndrome (PCOS) and genetic predisposition: A review article. Eur J Obstet Gynecol Reprod Biol X 2019. doi: 10.1016/j.eurox.2019.100060 PCOS nutrition center. PCOS training course for registred dietitan nutritionist. Module 1 understanding and treating PCOS.