Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects about 5 to 10 percent of women during their childbearing years. Typically, the ovaries contain multiple small cysts, which are often slightly enlarged. About 1 in 5 women have polycystic ovaries appearing on ultrasound scans but do not have the other features of this syndrome. These cysts do not require surgical removal. Polycystic ovaries make more male hormones (androgens) than do normal ovaries. The exact cause for PCOS is not known, but sometimes it is hereditary.
Hirsutism is a bothersome hyperandrogenic manifestation of PCOS that may require at least six months of treatment before improvement begins. According to a 2015 Cochrane review, the most effective first-line therapy for mild hirsutism is oral contraceptives.32 Spironolactone, 100 mg daily, and flutamide, 250 mg twice daily, are safe for patient use, but the evidence for their effectiveness is minimal.32 Other therapies include eflornithine (Vaniqa), electrolysis, or light-based therapies such as lasers and intense pulsed light. Any of these can be used as monotherapy in mild cases or as adjunctive therapy in more severe cases.33
There have been many studies on PCOS in the past several years; however, most are fairly small. Also, many studies examine medication effects on surrogate markers (e.g., androgen levels) rather than clinical outcomes (e.g., hirsutism). The study results are often conflicting, and in a recent systematic review, only 33 of 115 possible studies met basic inclusion criteria (e.g., randomized controlled trials), suggesting that many of the data in the literature may have methodologic flaws.1
Polycystic ovary syndrome is the most common endocrinopathy among reproductive-aged women in the United States, affecting approximately 7% of female patients. Although the pathophysiology of the syndrome is complex and there is no single defect from which it is known to result, it is hypothesized that insulin resistance is a key factor. Metabolic syndrome is twice as common in patients with polycystic ovary syndrome compared with the general population, and patients with polycystic ovary syndrome are four times more likely than the general population to develop type 2 diabetes mellitus. Patient presentation is variable, ranging from asymptomatic to having multiple gynecologic, dermatologic, or metabolic manifestations. Guidelines from the Endocrine Society recommend using the Rotterdam criteria for diagnosis, which mandate the presence of two of the following three findings—hyperandrogenism, ovulatory dysfunction, and polycystic ovaries—plus the exclusion of other diagnoses that could result in hyperandrogenism or ovulatory dysfunction. It is reasonable to delay evaluation for polycystic ovary syndrome in adolescent patients until two years after menarche. For this age group, it is also recommended that all three Rotterdam criteria be met before the diagnosis is made. Patients who have marked virilization or rapid onset of symptoms require immediate evaluation for a potential androgen-secreting tumor. Treatment of polycystic ovary syndrome is individualized based on the patient's presentation and desire for pregnancy. For patients who are overweight, weight loss is recommended. Clomiphene and letrozole are first-line medications for infertility. Metformin is the first-line medication for metabolic manifestations, such as hyperglycemia. Hormonal contraceptives are first-line therapy for irregular menses and dermatologic manifestations.
The prevalence of depression in women with polycystic ovary syndrome (PCOS) is high; a study has shown it to be four times that of women without PCOS. Therefore, systematic evaluation of the effectiveness and safety of antidepressants for women with PCOS is important. We found no evidence to support the use or non‐use of antidepressants in women with PCOS, with or without depression. Well‐designed and well‐conducted randomised controlled trials with double blinding should be conducted.
Los andrógenos son un tipo de hormona (mensajero químico del cuerpo); a menudo se denominan hormonas “masculinas”, pero el cuerpo de la mujer también produce y usa algunas de estas hormonas. Las niñas y las mujeres con PCOS generalmente tienen niveles más elevados de andrógenos de lo normal. Estas elevaciones pueden ocasionar ciertos cambios en el cuerpo como:
One strategy that may help some of you: Have a big breakfast. When a group of normal weight women with PCOS got a whopping half of their daily calories first thing in the morning, insulin levels dropped 8% and testosterone levels fell 50% in three months.13 And that’s not all. These women ovulated more frequently and had improved insulin sensitivity in comparison to another group of women in the study who more of their calories at dinner.13
Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be.