Having ovarian cysts is not the same as having polycystic ovary syndrome (PCOS)

Everyone knows someone whose menstrual cycles are irregular , that 28 days is a myth. In addition, many of those with irregular cycles, often longer than usual, also have acne and even more body hair growth than usual (hirsutism) . Is it normal to have these signs and symptoms or is it something to worry about? In this article we are going to talk about the most frequent cause of chronic anovulation and hyperandrogenism in women of childbearing age, polycystic ovary syndrome (PCOS) .

Indeed, among women of reproductive age (approximately 15-49 years), 2-6% of the female sex is affected by PCOS worldwide, and this proportion is gradually increasing. If it were just longer periods and some hair, it wouldn’t be a problem. Unfortunately, PCOS contributes to infertility in 60-70% of fertile women who want to conceive.

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic ovary syndrome is characterized by excessive production of androgens in the ovaries. Androgens are male hormones, like testosterone or androstenedione. Just as estrogens exist in small amounts in males, androgens also exist in small amounts in women. In their usual measure they are beneficial and an essential part of the balance of many processes in the body. However, excess production can be a problem, leading to irregular and infrequent periods, as well as promoting hirsutism, ie male-pattern hair growth , especially on the face.

Interestingly, when these people have an ultrasound, it is common to find small fluid-filled cysts or “follicles” along the surface of the ovary. This can hinder the ovulation process, contributing to irregular periods. Hormonal imbalance , due to excess androgens, causes unwanted growth of body and facial hair.

What are the signs and symptoms of polycystic ovary syndrome?

As we mentioned, the most frequent symptoms of polycystic ovary syndrome are irregular menstrual cycles or lack of periods directly due to anovulation, the appearance of unwanted hair on the body (especially on the face, chest, back and abdomen ), androgenetic alopecia (a type of baldness common in men), thinning hair, and acne .

Other possible associated symptoms, more non-specific, are mood swings, darkened areas of the skin on the neck, under the breasts and in the armpit, skin tags, obesity (mainly around the belly) and pelvic pain. Finally, but not always , large ovaries with cysts or follicles may be seen on ultrasound.

What are the causes of PCOS?

The underlying cause of PCOS is still unclear , although we do know that it has a genetic predisposition. If your mother or sister has PCOS, you are at higher risk for it.

As we are seeing, PCOS is a very heterogeneous syndrome and, in addition to the signs and symptoms mentioned, we know that it is frequently associated with metabolic alterations. That is, women with insulin resistance, diabetes, high blood pressure, obesity, among others, are more likely to develop PCOS.

How is PCOS diagnosed?

Your specialist in Family and Community Medicine or your gynecologist will ask you about your symptoms, how long you have been dealing with them, how they have affected your lifestyle and your previous medical history, if any. In addition to the pertinent physical examination and scrutiny of your previous medical history, the diagnosis requires meeting 2 of 3 criteria (Rotterdam criteria):

• Clinical symptoms of hyperandrogenism (acne, hirsutism,…) and/or laboratory tests (elevated testosterone, androstenedione, DHEA-S, LH/FSH ratio >2).
• Oligo/anovulation.
• Finding of polycystic ovaries on ultrasound, with a minimal number of follicles and/or ovaries markedly enlarged.

What are the treatment options for polycystic ovary syndrome?

PCOS is treatable. Your treatment depends on your age, the number of children, whether you are diabetic or not, the severity of your symptoms and your general health. The treatment of PCOS is given as follows:

Treatment for women who want to conceive:

For married, fertile women who want to conceive and become pregnant, treatment plans include lifestyle changes and medications.

• Lifestyle changes include changes in diet and physical activity. A healthy diet and exercise help you lose weight . Exercise helps combat symptoms caused by insulin resistance and excess body fat. Healthy diets lower blood sugar levels. By far, weight loss is the most effective treatment .
• Medical treatment may include drugs to induce ovulation and metformin which can help treat insulin resistance.

Treatment plans for women who do not want to conceive:

Single people and those who do not want to become pregnant are treated primarily with combined oral contraceptive pills, metformin, and lifestyle changes.

• Combined oral contraceptives (COCs) help regulate your hormones, reduce levels of male hormones, and control acne.
• Cyproterone acetate and depilatories help in hirsutism. Today, laser treatment is all the rage to get rid of unwanted hair.
• Antidiabetic medications such as metformin lower blood sugar and androgen levels, aiding in ovulation induction.

What are the complications of PCOS?

Women with PCOS are more likely to develop diabetes mellitus, heart disease, high blood pressure, infertility, and endometrial cancer. On the contrary, it turns out that PCOS is a protective factor against ovarian cancer, that is, people with this disease suffer less from this other type of cancer.

Having ovarian cysts is NOT PCOS.

Now that you know what polycystic ovary syndrome is, it is worth mentioning that only having cysts in the ovaries is not enough for the diagnosis of this condition. Let us remember that 2 of the 3 aforementioned Rotterdam criteria are necessary and, therefore, a person could suffer from PCOS without objectifying the cysts or, on the other hand, objectify cysts without fulfilling other criteria. This is very relevant because polycystic ovaries are not directly related to the development of cysts. Actually, we are talking about an alteration in the disposition of the follicles (anatomical-functional structures that are part of the ovaries).

Trying to be as clear and direct as possible: polycystic ovaries have a gynecological origin, and PCOS have an endocrinological origin (hormonal, as we have seen, androgenic), which implies a fundamental difference, since the treatments are different. In essence, they are different processes with different treatments, which sometimes only share a common characteristic. Furthermore, most cases of polycystic ovaries are asymptomatic and do not require treatment.

Polycystic ovaries also do not present as many problematic relationships as PCOS. In the case of polycystic ovaries, for example, fertility is not affected.

References:

polycystic ovaries vs. Polycystic ovary syndrome (PCOS). (2020). Ruber International Hospital. https://www.unidaddelamujer.es/ovaries-poliquisticos-versus-sindrome-de-los-ovarios-poliquisticos-sop/

PCOS (Polycystic Ovary Syndrome) and Diabetes (2020). CDC: Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/pcos.html

Polycystic Ovary Syndrome (PCOS). (s.f.). Johns Hopkins medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos

Polycystic ovary syndrome (PCOS) (2020). Mayo Clinic https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

Polycystic ovary syndrome (PCOS) (2017). WebMD. https://www.webmd.com/women/what-is-pcos