Acne, hirsutism - beware of polycystic ovary syndrome

This is the 4154th article of Da Yi Xiao Hu

Adolescent women often have acne problems. Most women will consider seborrheic dermatitis and choose to see a dermatologist, but some women often have excessive hair growth, which is particularly embarrassing in the summer. Little do they know that it may be polycystic ovary syndrome that is to blame.

1. What is polycystic ovary syndrome

Polycystic ovary syndrome, abbreviated as PCOS, is a disease characterized by high androgen, infrequent ovulation or anovulation, and polycystic changes in the ovaries. It is a type of disease caused by endocrine and metabolic abnormalities, and its main manifestations are irregular menstruation, infertility and obesity.

What factors can cause polycystic ovary syndrome?

The cause of PCOS is still unclear, and its onset is mainly considered to be caused by the interaction of multiple gene abnormalities and some environmental factors. Genetic studies suggest that some PCOS patients inherit the trait in an autosomal dominant manner and have familial clustering, but no specific gene that induces PCOS has been found so far; long-term exposure to a high androgen environment and obesity can promote the development of PCOS.

3. In which age group does polycystic ovary syndrome usually occur?

Mainly affects women during puberty and childbearing years

4. What are the main endocrine and metabolic abnormalities of polycystic ovary syndrome?

1. Endocrine abnormalities

Luteinizing hormone (LH) is high, follicle-stimulating hormone (FSH) is low, the LH/FSH ratio increases, androgen is too high and estrogen is too much.

2. Metabolic abnormalities

Insulin resistance, high insulin levels.

5. What are the clinical manifestations of polycystic ovary syndrome?

1. Menstrual disorders

The main symptoms are infrequent menstruation, scanty menstruation or amenorrhea, and a few people may experience irregular bleeding.

2. Infertility

This type of patient may experience long-term anovulation, or the abnormal hormonal environment may cause abnormal endometrial receptivity or abnormal egg quality, leading to early embryonic developmental abnormalities or abnormal implantation, and even if pregnancy occurs, miscarriage is likely to occur.

3. Hirsutism and acne

PCOS patients have varying degrees of hirsutism, and their pubic hair is dense and distributed in a male pattern. Under the action of androgens, the sebaceous glands secrete vigorously, leading to acne.

4. Obesity

Most of them are abdominal obesity, with waist/hip circumference greater than or equal to 0.8, and 40%-60% of PCOS patients have a BMI (weight/height2) greater than or equal to 25kg/m2. Patients with abdominal obesity are prone to long-term complications such as metabolic abnormalities and cardiovascular diseases due to the accumulation of visceral fat.

5. Acanthosis nigricans

Localized skin lesions that are large or small, velvety, hyperkeratotic, gray-brown, and are often found in skin folds such as the back of the neck, underarms, vulva, and groin.

6. Risks during pregnancy

PCOS patients have a high miscarriage rate during pregnancy and are more likely to develop hypertension and diabetes during pregnancy, leading to increased risks during pregnancy and the perinatal period.

7. Emotional disorders

Women with PCOS often feel anxious and depressed due to obesity, acne, hirsutism, menstrual disorders, infertility, etc., which can lead to emotional disorders in the long run.

8. Long-term complications

PCOS patients may develop diabetes due to long-term insulin resistance; abnormal blood lipid metabolism can lead to atherosclerosis and cause coronary heart disease, hypertension, etc.; sustained relatively high estrogen levels can increase the incidence of endometrial cancer.

How to diagnose polycystic ovary syndrome

The diagnosis can be made when two of the following three conditions are met: oligomenorrhea or amenorrhea, hyperandrogenism, and ultrasound showing polycystic ovaries.

7. How to treat polycystic ovary syndrome

Some patients will be very nervous and at a loss when they hear that PCOS has so many short-term and long-term complications. In fact, PCOS has a systematic and mature treatment plan, but due to the large individual differences, it is necessary to develop personalized treatment plans for different patients. The main treatment principles are:

1. Adjust your lifestyle : control your weight, adjust your diet, increase exercise, and develop a good lifestyle

2. Adjust the menstrual cycle : You can choose short-acting contraceptives or progesterone in the second half of the cycle

**3. Treatment of hyperandrogenism: **Short-acting oral contraceptives

4. Treatment of insulin resistance : Metformin

5. Those who want to have children : ovulation induction treatment

Polycystic ovary syndrome often requires periodic drug treatment and long-term follow-up examinations. Many patients often miss medications or even interrupt treatment or follow-up due to busy work or personal factors. It is recommended that PCOS patients must adhere to treatment and regular follow-up examinations, and manage PCOS as a chronic disease to avoid or reduce the occurrence of long-term complications.

Author: Department of Gynecology, Huadong Hospital, Fudan University

Zhu LihongDeputy Chief Physician