Also called ovarian dystrophy, polycystic ovary syndrome affects between 5 and 10% of women. The leading cause of infertility in France, PCOS is linked to hormonal dysfunction.

Contrary to what its name might suggest, polycystic ovary syndrome is not characterized by the presence of multiple cysts in the ovaries. To understand this error, we must go back in time, more precisely to 1935, the year in which the syndrome was first described by doctors Irving Freiler Stein and Michael Leventhal. The disease is still sometimes called Stein-Leventhal syndrome. This publication (Stein I, Leventhal M, Amenorrhea associated with bilateral polycystic ovaries, Am J Obstet Gynecology) is the first report describing a series of patients, not isolated cases, with polycystic ovaries, hirsutism, and amenorrhea (absence of menses). It was a landmark in the history of medicine, but Stein and Leventhal had mistaken the numerous follicles present in the ovaries of these patients for cysts. Although the term is incorrect, it is still used.

1. What is PCOS? Definition

Ovarian dystrophy is a chronic syndrome related to hormonal dysfunction of cerebral and/or ovarian origin. This dysfunction leads to the abnormally high secretion of androgens by the ovaries. Secreted by the adrenal glands, androgens are so-called male hormones, since they participate in the development of male physical characteristics. But they are also secreted by the ovaries.

In the case of PCOS, this secretion is excessive, resulting in the production of testosterone. This disrupts the normal functioning of the ovaries and therefore ovulation. The ovaries, on the other hand, are perfectly normal, as are the eggs. In the absence of any other pathology, of course. But this hormonal imbalance complicates their functioning. PCOS can occur as early as adolescence or later in life without any real explanation.

2. Symptoms of Polycystic Ovarian Syndrome

Symptoms of ovarian dystrophy differ markedly from woman to woman. Some patients may be completely asymptomatic, while others have severe and varied symptoms. Ovarian dystrophy can be particularly debilitating for these women whose symptoms are not always limited to the gynecological sphere.

Symptoms related to the menstrual cycle

Women who suffer from PCOS have ovulation problems, which may be rare (called days ovulation) or even absent (anovulation), due to the inability of the follicles to mature. Cycles are irregular, sometimes very long, and often anarchic with amenorrhea that can last several months. Because of this disturbance of the menstrual cycle, SPOK causes infertility in almost half of the women who suffer from it.

The consequences of hyperandrogenism

The excess of male hormones, in particular testosterone, obviously has an impact on women's bodies and can cause numerous symptoms. In particular, excessive hair growth (hirsutism) can be observed both on the body and on the face. This hormonal imbalance can also cause acne on the face, back, and chest. It should be noted that the symptoms related to hyperandrogenism are increased by obesity. But PCOS itself can cause significant weight changes.

Metabolic disorders

Ovarian dystrophy can also be manifested by metabolic disorders. These women are more likely to be overweight and to suffer from hypertension. Polycystic ovary syndrome also predisposes to insulin resistance, for example. Because of their body's difficulty in managing carbohydrates, these women may have pre-diabetes or diabetes.

Skin symptoms

Acne is not the only dermatological symptom of SPOK. The insulin resistance we mentioned can cause a condition called acanthosis nigricans. This dermatosis causes the skin to become thicker and darker in certain areas of the body: the armpits, the back of the neck, and the skin folds. In dark-skinned individuals, the skin may take on a parchment-like appearance. This hyperinsulinemia can also cause acrochordons, which are tiny growths that are most often found in the armpits and neck.

Other symptoms related to ovarian dystrophy

PCOS can also cause many other symptoms. Although it is important to remember that not all of these symptoms are present in all women who are actually diagnosed. For example, some women may experience migraines, insomnia, hair loss, decreased libido, vaginal dryness, sleep apnea, anxiety, depressive symptoms.

3. Causes of PCOS

The causes of ovarian dystrophy are not clearly identified and remain poorly understood. Genetic mutations could be at the origin of the disease; about twenty genes have been identified but they are present in only 10% of PCOS cases. Family history is often found, and it is estimated that between 60 and 70% of daughters born to mothers with PCOS develop symptoms, although the transmission mechanism is unknown.

Environmental causes, including exposure to endocrine disruptors, are also suspected, but no definitive evidence exists today.

4. PCOS: How is the diagnosis made?

The symptoms we have listed can have other causes, so it is important to consult a doctor who can rule them out and confirm or not the diagnosis of PCOS. The diagnosis of PCOS is made in several stages and requires various tests to be carried out.

A blood test

The doctor prescribes a hormonal test which is performed between the 2nd and 5th day of the menstrual cycle. If menstruation is absent, it may be caused by a treatment. This blood test measures several hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones play an essential role in the ovarian cycle: FSH stimulates follicular maturation and the production of estrogen, LH causes ovulation. In PCOS, the production of these two hormones is disturbed and does not vary as it should during the cycle. This results in an inversion of the FSH/LH ratio.

In addition to these hormones, this test also measures androgens: the level of circulating testosterone, androstenedione (a steroid hormone), and dehydroepiandrosterone sulfate (DEHS). In ovarian dystrophy, androgens are elevated. The blood test also includes an hCG test (the pregnancy hormone), a carbohydrate and lipid test, and in some cases prolactin, TSH, and a 17-hydroxy progesterone test.

Pelvic ultrasound

Abdominal and pelvic ultrasound is also performed to diagnose PCOS, although it is not sufficient to make the diagnosis. However, the examination does reveal one of the characteristic features of ovarian dystrophy: the presence of numerous immature follicles in the ovaries. Normally, each ovary contains 5 to 10 follicles of about 5 mm at the beginning of each cycle. One of them will evolve and become a fertilizable oocyte. Either it is fertilized by a spermatozoon, which is the beginning of pregnancy, or it is not fertilized and is evacuated, which is the period. In the case of PCOS, the overproduction of androgens blocks follicular maturation: the follicles (at least 20 less than 9 mm in diameter) accumulate. Ultrasound can also show an enlarged ovary.

5. Polycystic ovary syndrome: how can it be treated?

Although there is no cure for polycystic ovary syndrome, the symptoms can be treated. For women who do not wish to become pregnant, this treatment begins with the use of an estrogen-progestin pill with an anti-androgenic action in order to act on acne, hirsutism, or hair loss. Hygienic and dietary measures must also be observed, including dietary management in case of overweight and regular physical activity. However, weight loss has no impact on the symptoms in women with a BMI within the limits. It is also important to regularly monitor cholesterol and blood sugar levels and to start diabetes treatment if necessary.

6. PCOS and pregnancy: the leading cause of infertility

Some women with PCOS get pregnant easily, but for those with symptoms, the path is usually more difficult. Ovulation must first be induced and regulated with medication (clomiphene citrate) or injections (exogenous gonadotropins). In case of failure and after several months of trying to achieve a pregnancy naturally, it is often necessary to resort to MAP (medically assisted reproduction).