Irregular menstruation, weight gain, excessive body hair, acne... Polycystic ovary syndrome cannot be ignored

In the past two days, the hot search about "Women with polycystic ovary syndrome will experience acne breakouts" has caused a lot of controversy.

Some netizens believe that "polycystic ovary syndrome" is not a fatal disease and the media is just selling anxiety.

Image source: Weibo screenshot

However, some people have come forward to say that the hormone imbalance caused by polycystic ovary syndrome can cause increased body hair, facial acne, and even lead to female infertility.

Image source: Weibo screenshot

With such polarized reviews, are they really talking about the same disease? Or is it that the disease varies from person to person, and different people will have different symptoms?

Polycystic ovary syndrome

In fact, there are indeed many cognitive misunderstandings about the four words "polycystic ovary".

The "polycystic" condition that many people mention as "having no effect" mostly refers to the polycystic ovary changes (PCOM) on the physical examination form.

Every adult woman has more than 300,000 primordial follicles in her ovaries. In each menstrual cycle, the number of follicles with a diameter of 2 to 9 mm is usually no more than 10. Women who are diagnosed with polycystic ovaries have more than 12 large follicles in their ovaries.

However, polycystic ovarian changes are only a sign detected by ultrasound examinations, and do not necessarily mean a disease. They can also occur under normal circumstances. About 20% to 30% of women in China will see this result in their physical examination reports. As for its impact, it is not necessarily that great. Many women may not have this sign if they are tested again after six months.

The "polycystic" disease that can cause symptoms such as infertility and increased body hair is actually scientifically called polycystic ovary syndrome (PCOS), an extremely complex disease caused by endocrine and metabolic abnormalities. Common symptoms include amenorrhea, hirsutism, acne, infertility, obesity, etc. About 4% to 18% of women of childbearing age will be affected by it.

Some people may wonder: The names of "polycystic ovary" and "polycystic ovary syndrome" are so similar, and there seems to be a strong causal relationship between them. Does this mean that if you are diagnosed with polycystic ovary, you may develop polycystic ovary syndrome?

Don't be anxious, you may have been misled by the vague and sweeping name of "polycystic ovary syndrome."

Copyright images in the gallery. Reprinting and using them may lead to copyright disputes.

As early as 1712 in Italy, doctors detected symptoms of polycystic ovary changes in some patients through ultrasound, but it was not until the middle of the 20th century that the disease was systematically studied. In 1960, because one of the common characteristics of some female patients was bilateral ovarian cystic enlargement, scholars officially named it "polycystic ovary syndrome", which is still used today.

But in fact, the direct correlation between the four words "polycystic ovary syndrome" and "polycystic ovary" is smaller than many people think.

A study showed that even if a woman has both ovaries removed, some symptoms of PCOS may still occur. At the same time, there is also data mentioning that less than half of women diagnosed with PCOS are found to have polycystic changes in their ovaries.

The diagnosis of PCOS is very strict

In fact, the causes and symptoms of PCOS have been under discussion. Some scholars believe that endocrine disorders caused by excessive androgen are the main cause of PCOS, and its alias "hyperandrogenic anovulation syndrome" may better summarize its symptoms - after all, this disease is not only related to the ovaries. In recent years, a new theory has also emerged: insulin resistance is also included in the core manifestations.

Amidst all the different opinions, one thing is certain: once you have PCOS, it will be with you for life and it cannot be cured, only alleviated.

Since it is a syndrome, it means that it is not an independent disease, but includes a series of symptoms. At present, the diagnostic methods around the world are different. China adopts the 2003 Rotterdam PCOS International Diagnostic Criteria:

Infrequent or no ovulation

Clinical manifestations of hyperandrogenism and/or hyperandrogenism

Polycystic ovary: ≥12 follicles with a diameter of 2 to 9 mm in one or both ovaries and/or ovarian volume ≥10 ml

PCOS can only be diagnosed if at least 2 of the above 3 conditions are met and other causes of hyperandrogenism are excluded: congenital adrenal hyperplasia, Cushing's syndrome, androgen-secreting tumors, etc. Most Asian guidelines believe that infrequent ovulation or anovulation are necessary conditions for Asian women to be diagnosed with PCOS, and the other two manifestations can be diagnosed as long as one is met.

If a woman has menstrual abnormalities and polycystic ovarian changes or increased androgen are found in the test results, further diagnosis can be made.

Polycystic ovary syndrome should not be underestimated

Although the root cause of PCOS is still being explored, some of the symptoms it causes are relatively fixed.

1. Abnormal ovulation

In the female reproductive system, there is a HPO axis with a clear division of labor: hypothalamus-pituitary-ovary. They affect the development of follicles and the discharge of menstrual blood during each menstrual period by secreting, synthesizing, and regulating hormones. Among them, the hypothalamus is responsible for secreting gonadotropins, allowing the primordial follicles to develop normally, eventually grow into a mature egg and be discharged. However, patients with PCOS often have excessive androgens or insulin resistance in their bodies, which affects the normal work of the hypothalamus and leads to abnormal ovulation.

2. Menstrual disorders

Menstrual disorders in women with PCOS are usually manifested as oligomenorrhea (menstrual cycles between 35 days and 6 months) and amenorrhea (no menstruation for more than 6 months), and in some cases, frequent menstruation. In short, most are not within the normal range of 21 to 35 days.

Copyright images in the gallery. Reprinting and using them may lead to copyright disputes.

Menstruation is the periodic shedding and bleeding of the endometrium that accompanies the cyclical changes of the ovaries. Estrogen and progesterone play an important role in the source of menstrual blood - the endometrium. It is the follicle and the corpus luteum formed on the follicle wall after the egg is released that release these two hormones.

Patients with polycystic ovary syndrome often have abnormal ovulation, which leads to abnormal release of estrogen and progesterone, and prevents normal menstruation.

3. Hirsutism and acne

Normally, women's bodies also secrete some androgens, but the androgen secretion in patients with polycystic ovary syndrome will far exceed the normal level. Under the action of androgens, the sebaceous glands secrete too vigorously, which will lead to characteristics similar to frequent acne.

Copyright images in the gallery. Reprinting and using them may lead to copyright disputes.

4. Obesity

The easiest way to determine whether a person is overweight is to calculate the body mass index (BMI): BMI = weight (kg) / height (m2). The normal range of BMI is 18.5-24. If BMI ≥ 24, it can be commonly understood as overweight or obese.

Patients with polycystic ovary syndrome usually suffer from insulin resistance and elevated androgen levels. Insulin is responsible for sugar metabolism and fat metabolism. Once resistance occurs, it will lead to metabolic disorders, while androgen contributes to fat accumulation. Both together lead to obesity.

Copyright images in the gallery. Reprinting and using them may lead to copyright disputes.

Conversely, obesity may also aggravate insulin resistance, affecting women's ovulation and menstruation, thus forming a vicious cycle. Of course, not all PCOS patients have insulin resistance and obesity. Clinically, it is also common to see "thin PCOS" women. Whether they are PCOS patients or not still needs to be judged by the relevant diagnostic criteria. It cannot be concluded that PCOS exists based on whether they are obese.

Active treatment of polycystic ovary syndrome

At present, although there is no cure, clinical practice generally advocates a comprehensive treatment approach with lifestyle adjustment as the main method and drug treatment as the auxiliary method to improve the symptoms of women with PCOS. For example, under the guidance of a doctor, women can control their weight, improve their work and rest schedule and diet, and strengthen their exercise.

At the same time, since PCOS may cause a series of symptoms, it is best to conduct a comprehensive examination, identify the cause, and choose lifestyle adjustments and symptomatic treatments based on individual circumstances, so as to reduce endometrial lesions, maintain female health, and protect and promote fertility.

Copyright images in the gallery. Reprinting and using them may lead to copyright disputes.

The most important thing is to establish a correct understanding of it. Whether it is the recent controversy about "Is polycystic ovary serious?" or the popular saying of "polycystic ovary syndrome is just the ovaries starting to protect themselves" spread by marketing accounts some time ago, they are all limited to a too single understanding of polycystic ovary syndrome. This frivolous attitude is not conducive to its real diagnosis and treatment.

References

[1] Diamanti-KandarakisE,KandarakisH,LegroRS(August2006)."TheroleofgenesandenvironmentintheetiologyofPCOS".Endocrine.30(1):19–26.

[2]MortadaR,WilliamsT(August2015)."MetabolicSyndrome:PolycysticOvarySyndrome".FPEssentials(Review).435:30–42.

[3]LeoV,MusacchioMC,CappelliV,MassaroMG,MorganteG,PetragliaF(July2016)."Genetic,hormonalandmetabolicaspectsofPCOS:anupdate".ReproductiveBiologyandEndocrinology(Review).14(1):38.

[4]DunaifA, FauserBC(November2013)."RenamingPCOS--atwo-statesolution".TheJournalofClinicalEndocrinologyandMetabolism.98(11):4325–4328.

[5]KollmannM,MartinsWP,Raine-FenningN(2014)."Termsandthresholdsfortheultrasoundevaluationoftheovariesinwomenwithhyperandrogenicanovulation".HumanReproductionUpdate.20(3):463–464.

[6]SteinIF,CohenMR,ElsonRE.Resultsofbilateralovarianwedgeresec-tionin47casesofsterility.AmJObstetGynecol.1948;58:267–273.

[7]VallisneriA,1721.CitedinInslerV,LunesfeldB.Polycysticovariandis-ease:Achallengeandcontroversy.GynecolEndocrinol.1990;4:51-69.

[8]Chereau,Achilles.MemoirespourServiral'EtudedesMaladiesdes

Ovaries.Paris:Fortin,Masson&Cie;1844.

[9]Paulina M. Merino; Claudio Villarroel; Cristián Jesam; Patricia López; Ethel Codner

ORCIDlogo.NewDiagnosticCriteriaofPolycysticOvarianMorphologyforAdolescents:ImpactonPrevalenceandHormonalProfile.HormResPaediatr(2017)88(6):401–407.

This article is a work of Science Popularization China-Starry Sky Project

Produced by: Science Popularization Department of China Association for Science and Technology

Producer: China Science and Technology Press Co., Ltd., Beijing Zhongke Xinghe Culture Media Co., Ltd.

Author: Li Mi, popular science creator

Reviewer: Lan Yibing, deputy chief physician, Department of Obstetrics and Gynecology, Zhejiang University School of Medicine