Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a significant health condition affecting roughly one in ten women of reproductive age. Its underlying cause is a disruption in the egg development process that should normally occur regularly each month. Excess hair growth and fat accumulation around the waist are among the condition's most notable symptoms.

Polycystic Ovary Syndrome (PCOS) is a clinical condition in which the ovaries become filled with numerous small fluid-filled sacs (cysts) instead of normal ovarian tissue. The underlying issue in this condition is a disruption of the ovulation process that should occur regularly each month. Symptoms include hormonal changes, excess hair growth, and missed periods. All patients with this clinical diagnosis have numerous tiny cysts, each under one centimeter, in their ovaries. However, the symptoms and their severity can vary widely from person to person.

How does the condition present itself?

Irregular periods, increased hair growth, and oily, acne-prone skin are the most commonly observed findings in this condition. We see these symptoms, to varying degrees, in most of our patients.

Women with this condition may also experience increased fat accumulation around the waist. Insulin resistance (a form of pre-diabetes), high cholesterol, hypertension, and male-pattern hair loss are other, less common findings.

Particularly in severe cases, changes in physical appearance and fertility difficulties can lead to psychological symptoms, even extending to depression.

How significant a role does genetics play in this condition?

There is no single definitively established cause. Multiple factors should be investigated in the development of this condition; genetic inheritance may be just one of them.

Recently, more attention has been focused on the role of the hormone insulin.

In women with Polycystic Ovary Syndrome, insulin levels are often quite elevated, which also causes an increase in testosterone — often referred to as a male hormone.

The elevated levels of male hormones found in these patients are, in fact, the underlying cause behind most of the symptoms we mentioned — oily, acne-prone skin, excess hair growth, weight gain, and ovulation problems.

How does treatment proceed?

Since it is not possible to change the cystic structure of the ovary itself, treatment is generally directed at managing the condition's symptoms.

First and foremost, patients who are obese follow a weight management program until they reach a healthier weight.

For a significant number of women, the clinical picture improves with weight loss alone, and fertility issues resolve.

A diet that avoids refined, processed, and complex sugars, combined with an exercise program, is essential in treating this condition.

This lifestyle approach has been proven to have a positive effect on balancing hormones.

For women who are not considering pregnancy, the treatment we most commonly use is birth control pills.

With this treatment, periods become regular, male hormone levels decrease, and related symptoms such as acne resolve.

More recently, blood sugar-regulating medications have also been added to treatment, allowing elevated cholesterol and male hormone levels to be treated far more effectively.

If excess hair growth is the only symptom present, this can be treated with medications known as "anti-androgens."

It's important to remember that existing excess hair cannot be removed with medication — the goal of treatment is to prevent new hair growth.

Is surgical intervention an option for this condition?

In cases resistant to treatment, surgery may rarely be needed. A procedure known as "ovarian drilling" aims to reduce the cystic structure by creating tiny openings in the ovary.

This can help reduce male hormone levels and allow ovulation to return to normal. We cannot say this is definitively suitable for every patient — many factors determine whether this type of surgical intervention is necessary or possible.

Is this condition becoming more common in Turkey?

We know this health condition affects roughly one in ten women of reproductive age.

The reason we hear about it more often may be due to an increase in diagnosis rates compared to the past.

Obesity and poor nutrition are contributing to an increase in how often this condition is seen.

Is there anything that can be done to prevent it?

Birth control pills, while being taken, help prevent the formation of polycystic structures in the ovaries and hormonal irregularity.

However, these pills should not be used after age 35, particularly by smokers.

Healthy eating habits, avoiding smoking, and exercise can be considered non-medical preventive measures.

Is this condition related to ovarian cancer in any way?

Another important aspect of this condition is an imbalance between the female hormones estrogen and progesterone.

In what is medically referred to as "unopposed estrogen," the disruption in ovulation means progesterone is not present in sufficient quantities to counteract estrogen's adverse effects.

In individuals not receiving balancing hormone therapy, prolonged exposure to unopposed estrogen can medically lead to uterine hyperplasia and, in some cases, cancer over the long term.