Polycystic ovary syndrome

Polycystic ovary syndrome is a condition that particularly affects young women. It is a fairly frequent syndrome that, specifically, affects 7 to 14% of the young female population and significantly affects their lives, from both a metabolic and hormonal and reproductive point of view. Polycystic ovary syndrome is basically characterized by: hyperandrogenism, which can give rise to hirsutism (a condition in which there is excessive growth of hair on the body) and acne; oligomenorrhea, i.e. a condition characterized by irregular and delayed menstrual cycles, absence of the menstrual cycle even for several months and short or excessively long menstrual cycles; a characteristic ultrasound appearance, characterized by the presence of microfollicles arranged mainly along the periphery of the ovary with a central  part known as the "stroma", responsible for androgen synthesis, which is particularly evident in the ovaries of affected women.

For the definition of polycystic ovary syndrome and its characteristics, reference can be made to the findings of the ESHRE (European Society of Human Reproduction and Embryology) group of experts, which met in Rotterdam in 2004. Specifically, polycystic ovary syndrome is correctly identified when the patient under examination has at least two of the three conditions previously mentioned, namely hyperandrogenism, oligomenorrhea and a characteristic ultrasound appearance of the ovary.

In recent years, a very interesting fact has been added to the purely gynecological aspect: it is a metabolic data that may or may not be present in girls affected by this syndrome. Specifically, it is hyperinsulinemia, or insulin resistance, which occurs mainly, but not only, in overweight women. Therefore, in making the diagnosis of this syndrome, it is necessary to evaluate not only the gynecological aspects already analyzed but also this metabolic element. If hyperinsulinemia is present, it should absolutely be treated as it could represent the antechamber of diabetes or hypertension.

As far as therapy is concerned, it differs according to the needs and characteristics of the patients. For example, if the patient were to be a strongly hyperandrogenic girl with a picture of significant hirsutism or significant acne, an antiandrogen can naturally be considered. Since there are different types of antiandrogens, it is advisable to consult with experts in the field to determine the most suitable therapy for the patient. On the other hand, if the patient simply wants a normal menstrual cycle, it is sufficient to administer a progestin or an estrogen-progestin every 40-45 days.

Finally, most of these women, not having a normal menstrual cycle, are affected by anovulation. They may, however, be looking for pregnancy and in this case you will simply have to induce ovulation. According to the World Health Organization (WHO), Clomiphene Citrate is the drug of first choice to induce ovulation, while, secondly, gonadotropins can be administered.