Mr. Vasilios Nikas, an Obstetrician-Gynecologist and scientific associate at LITO, explains polycystic ovary syndrome and how to treat it. Translated by Paul Antonopoulos.
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with a frequency ranging from 5-10%. It is diagnosed when there are irregular periods, excessive hair growth and many small cysts in the ovaries.
PCOS remains an enigmatic condition. Its pathophysiology is complex and results from interactions between genetic, epigenetic, ovarian dysfunction, endocrine, neuroendocrine, and metabolic changes, among other changes.
Insulin resistance is believed to be responsible for the hormonal and metabolic disturbances seen in the syndrome. PCOS has two phenotypes, overweight/obese and normal weight/thin, with the latter being the much less common form of the syndrome, with 20-50% of women with PCOS being normal weight or thin.
Diagnosis and treatment are more difficult in the small but significant percentage of patients with a normal body mass index (BMI, ≤25 kg/M2). These cases are called normal weight PCOS.
Other endocrine causes and genetic disorders with a similar clinical picture must be excluded in such cases before the diagnosis is made. There is consensus that PCOS is an exclusion diagnosis.
The syndrome must be diagnosed after conditions such as Cushing's syndrome, thyroid disorders, idiopathic hirsutism, and hyperprolactinemia have been ruled out.
About 80% of people with PCOS have BMI values above normal or high and show typical features, such as hyperandrogenism, polycystic ovaries on ultrasound imaging and insulin resistance. These individuals often go undiagnosed until they experience fertility problems as adults.
A smaller but distinct percentage of women with PCOS have a normal or low BMI and may or may not have symptoms, such as irregular periods or acne.
Obese people with PCOS suffer from more severe hormonal and metabolic disturbances compared to their normal-weight counterparts. Metabolic changes in lean women with PCOS relative to overweight women, as well as changes in levels of the peptide hormones adiponectin and ghrelin, have been investigated.
Lean women with PCOS had significantly greater insulin resistance compared to their BMI-matched counterparts without PCOS. However, the rate of IR (insulin resistance) was even higher in obese women with the syndrome.
Although hormonal and metabolic disturbances are also present in thin women with PCOS, the alterations are more severe in obese individuals.
Treatment of the syndrome
Weight loss is considered a first-line treatment in women with the obese phenotype of PCOS, but this is not considered in lean women with the syndrome. Caloric restrictions are unnecessary, as thin women do not need to lose weight.
In contrast, thin women with PCOS should aim to maintain a normal weight.
Lifestyle modifications with dietary interventions and regular physical activity (resistance training, e.g., weight lifting or bodyweight exercises, while running is not recommended) have shown improved insulin resistance and hyperandrogenism, among other benefits.
Psychological and emotional support is also essential, as thin women with PCOS are more likely to develop depression and anxiety problems. Thin people with PCOS should be encouraged to consume vegetables and fruits to ensure they have an adequate supply of various trace elements, vitamins and nutrients.
Metformin is an insulin-sensitizing agent. Compared to their obese counterparts, lean women with PCOS are more successful in restoring menstruation (55%) and ovulation (45%).
Administration of myoinositol (3 g/day) has a positive effect on lean women with PCOS. Treatment leads to a decrease in LH, androgens, CRP and insulin resistance. Hormonal profile and ovulation restored in women with PCOS.
Early diagnosis and personalised therapeutic intervention are necessary to improve the metabolic and endocrinological parameters of Polycystic Ovary Syndrome, both in overweight and normal-weight individuals.
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