Polycystic Ovary Syndrome (PCOS)

Poly cystic Ovary Syndrome (PCOS) is a heterogeneous endocrine disorder observed in women and one of the leading causes of anovulatory infertility. PCOS is characterized by features such as hyperandrogenism, insulin resistance, menstrual irregularities, infertility, hirsutism, and abdominal obesity. It was first reported in 1935 by Stein and Leventhal as a combination of polycystic ovaries and amenorrhea.

Pathophysiology

The pathophysiology of PCOS involves complex interaction disturbances among the central nervous system, pituitary gland, ovaries, adrenal glands, and other tissues. Key mechanisms include hyperandrogenism and insulin resistance. Hyperandrogenism is associated with increased luteinizing hormone (LH) levels and insulin resistance, along with components of metabolic syndrome.

Poly cystic Ovary Syndrome (Generated by Artificial Intelligence)

Clinical Features

Common clinical findings in patients with PCOS include:

• Menstrual irregularity (oligomenorrhea or amenorrhea)
• Hirsutism
• Acne
• Alopecia
• Recurrent pregnancy loss (particularly in the first trimester)
• Abdominal obesity
• Dyslipidemia, hypertension, and cardiovascular disease

Endocrinologically, levels of androgens, LH, estrogen, and prolactin (PRL) may be elevated.

Ultrasonographic Features

The polycystic ovary appearance is defined on ultrasound by the presence of 10 to 12 small follicles, 2 to 9 mm in diameter, located peripherally in the ovarian cortex. Ovarian stromal edema, increased volume (>10 ml), and increased tissue echogenicity may also be observed. The polycystic ovary appearance can be seen in up to 20-25% of healthy women and is not sufficient alone for a diagnosis of PCOS.

Ultrasonographic Morphology of Poly cystic Ovary Syndrome (Türkiye Klinikleri Gynecology Obstetrics–Special Topics)

Diagnostic Criteria

When diagnosing PCOS, other diseases that cause similar presentations must be excluded. Three different diagnostic criteria are outlined below.

National Institute of Health (NIH) Criteria

• Chronic anovulation
• Clinical and/or biochemical hyperandrogenism
• Exclusion of other etiological causes

Rotterdam Criteria (2003)

At least two of the following three criteria must be present:

• Oligo- or anovulation
• Clinical and/or biochemical hyperandrogenism
• Polycystic ovary morphology (ultrasonographic)

Exclusion of other causes is mandatory.

Androgen Excess Society (AES) Criteria (2006)

The AES criteria were developed to identify patients in whom androgen excess is the primary feature.

• Clinical and/or biochemical hyperandrogenism
• Ovarian dysfunction (oligo-anovulation and/or polycystic ovaries)
• Exclusion of other etiological causes

Metabolic and Endocrine Associations

Android-type obesity is common in PCOS. A significant proportion of women with PCOS are overweight or obese. Insulin resistance can occur independently of body mass index in PCOS. Increased adipose tissue is associated with hyperinsulinemia, impaired glucose tolerance, type 2 diabetes, and increased androgen production.

Treatment Approaches

Body Weight Management

Weight reduction and long-term weight control are established as key goals in PCOS management. A 5-10% reduction in body weight can restore ovulation and improve insulin sensitivity. Weight loss reduces hyperandrogenism and metabolic risk factors.

Nutritional Therapy

Nutritional goals include regulation of blood glucose, reduction of insulin resistance, and control of androgen levels.

• Carbohydrates: Low glycemic index carbohydrates are recommended. 55-60% of daily energy intake should come from carbohydrates.
• Proteins: 15-20% of energy intake should be derived from protein. High protein intake promotes satiety and may enhance insulin sensitivity.
• Fats: 25-30% of total energy should come from fats; saturated fat intake should be less than 10%. Consumption of omega-3 fatty acids should be increased due to their insulin-sensitizing effects. Trans fat intake should be avoided.
• Fiber: Vegetables, fruits, and whole grains are essential sources of dietary fiber.

Increasing meal frequency and establishing regular eating habits are important for controlling blood glucose levels.

Physical Activity

Regular moderate-intensity exercise (at least 30 minutes daily) plays a role in weight control and improving insulin sensitivity.

Pharmacological Treatment

Medical therapy can be applied based on endocrine and metabolic findings. However, pharmacological agents should be used in conjunction with nutritional and lifestyle modifications.

Multidisciplinary Approach

A multidisciplinary team including gynecologists, endocrinologists, dietitians, physiotherapists, and psychologists is recommended for the management of PCOS.

Research and Emerging Approaches

High-protein diets have demonstrated beneficial effects on weight loss, insulin resistance, and androgen levels in PCOS. Additionally, omega-3 fatty acid supplementation has shown positive effects on triglyceride levels and blood pressure. Low glycemic index diets have been reported to improve blood glucose control and menstrual regularity. However, further research is needed to determine optimal dietary component ratios and long-term effects.^【1】

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