Diagnosis - Treatment
Polycystic ovaries can be diagnosed by ultrasound and by checking a woman’s hormone levels (blood tests) at the beginning of her cycle. It is important to remember that treating the symptoms (oily skin, acne or lack of ovulation) is not enough; one should treat PCO itself.
PCOS is easy to diagnose in some patients. These patients have irregular and unpredictable cycle, sometimes heavy bleeding, too. They are usually overweight with excessive facial or body hair due to high androgen levels. Some patients might have none of the above symptoms.
Diagnosis is confirmed by means of a vaginal ultrasound. Ovaries are enlarged and have many small cysts, usually in their outer edge.
As for the hormonal profile of these women, in severe cases, usually high levels of androgens (DHEA - S) and LH are detected. FSH is at normal levels. This FSH/LH ratio is characteristic in PCO. Many women with PCO Syndrome have high insulin levels, because they are resistant to insulin.
PCO causes are not clear. However, we do know for sure that the typical polycystic ovary occurs after a long period without ovulation. These women have high levels of androgens and LH, which further hinder ovulation. Obesity makes matters worse, as the fatty tissue secrets estrogens, which interrupt ovulation.
You can read here more about the way PCOS is diagnosed according to the consensus statement ofESHRE (EuropeanSocietyofHumanReproductionandEmbryology) andASRM (AmericanSocietyforReproductiveMedicine):
‘Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome (PCOS)’ – The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group
Human Reproduction 2004 19(1):41-47
PCO is treated either with medication or by surgery. The therapeutic approach depends on the symptoms each woman has and on her primary aim at the time e.g. to treat acne, infertility or other health problems. Treatment is determined following clinical (e.g. ultrasound) and lab tests (blood tests).
For women trying to conceive, the main treatment consists in ovulation induction, with or without medication.
Weight loss and physical exercise
For many patients, weight loss in itself is a sufficient treatment. The best strategy is to lose weight gradually, keeping a steady rate so that weight loss is permanent. Diets designed for extreme weight loss in a short period of time shock the metabolism and therefore are not effective. When you try to lose weight, you might need the help of a dietician.
Physical exercise always helps when you try to lose weight, as it reinforces sugar metabolism. Aerobic exercises such as walking, running or swimming are excellent choices.
Today we know that many patients with PCOS also have insulin resistance. Similarly to diabetics, they have high insulin levels, but their body does not respond to insulin. Women with insulin resistance are treated with anti-diabetic medication; this improves their hormonal balance and restores their ovulation.
In some cases, it is essential to treat PCOS by laparoscopy. During laparoscopy, the surgeon removes damaged ovarian tissue. Normal ovarian function is thus restored and ovulation occurs. Laparoscopy is necessary when all other treatments have failed.
After such a surgery, about 80% of patients have a normal cycle and 50% of them will conceive within 1 year without any additional medication or treatment. However, this operation, like any operation, might cause adhesions.