Madrid – Polycystic ovary syndrome (PCOS), a frequently underdiagnosed endocrine and metabolic disorder, affects an estimated one in ten women globally. The condition, now comparable in prevalence to type 2 diabetes, can substantially impact a woman’s quality of life and long-term health, increasing risks for diabetes, cardiovascular disease, and reproductive challenges. A new report from Madrid’s Ramón y Cajal University Hospital details the condition’s complexities and current treatment options, as explained by Dr. Manuel Luque Ramírez.
– MENSHALENA/ ISTOCK – Archivo
MADRID, 16 Ene. (EDIZIONES) –
Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder affecting women of reproductive age, with a prevalence comparable to that of type 2 diabetes. The condition significantly impacts quality of life, yet remains widely underdiagnosed and often goes unrecognized. Understanding PCOS is crucial for improving women’s health outcomes and addressing a frequently overlooked condition.
Dr. Manuel Luque Ramírez, Head of the Diagnostic and Therapeutic Section of the Endocrinology and Nutrition Service at Ramón y Cajal University Hospital in Madrid, explains the condition and potential treatment options.
The primary characteristic of PCOS, according to Dr. Luque Ramírez, is a slight elevation in androgen levels – often referred to as “male hormones” – in women. Globally, approximately one in ten women experiences this hormonal imbalance.
The clinical manifestations of PCOS generally fall into three main categories:
1. Dermocosmetic Alterations: These include hirsutism, or excessive hair growth, in areas sensitive to hormones such as the face, torso, abdomen, back, thighs, and arms. Acne and alopecia (hair loss) can also occur, though the latter is less common. These physical changes can lead to significant emotional distress, including anxiety, depression, and social challenges.
2. Reproductive Alterations: Women with PCOS often experience irregular menstrual cycles, including more frequent periods, delayed periods, or cycles exceeding 35 days. Some may experience months without menstruation. Infrequent periods can lead to endometrial hyperplasia – a thickening of the uterine lining – which increases the risk of cancer. Additionally, menstrual irregularities can contribute to subfertility due to less frequent ovulation.
3. Metabolic Alterations: Women with PCOS tend to accumulate visceral fat, increasing their risk of prediabetes, diabetes, high blood pressure, fatty liver disease, and cardiovascular problems. They are also at higher risk for obstructive sleep apnea.
UNDERLYING CAUSES AND PREDISPOSITION
“Polycystic ovary syndrome is a complex disease with a genetic component, meaning there’s a genetic predisposition to developing it,” explains Dr. Luque Ramírez. “While excess weight can increase the risk, not all women with excess weight develop PCOS. For example, obesity can lead to increased insulin production, which in turn promotes androgen production in the ovaries, potentially triggering the syndrome in susceptible women.”
A 2018 review published in ‘Nature Reviews Endocrinology’, led by Dr. Escobar Morreale, also of Ramón y Cajal Hospital, suggests that PCOS is a “complex and polygenic disorder” with “strong epigenetic and environmental influences,” including diet and lifestyle factors.
Regarding the age of onset, Dr. Luque Ramírez notes that while there may be intrauterine and childhood factors that contribute to the development of PCOS, symptoms typically begin during post-puberty and adolescence.
He cautions that increased hair growth at this age doesn’t always indicate PCOS. “It’s important to be careful during this period because some hair growth is common and not always pathological. Menstrual irregularities are also common during post-puberty and adolescence, and complete maturation is needed to confirm a PCOS diagnosis.”
A HEALTHY LIFESTYLE IS ESSENTIAL
Dr. Luque Ramírez, Head of the Diagnostic and Therapeutic Section of the Endocrinology and Nutrition Service at Ramón y Cajal University Hospital in Madrid, emphasizes the importance of a healthy lifestyle – including a balanced Mediterranean diet, regular physical activity, and avoiding harmful habits like smoking – in managing PCOS, similar to other metabolic diseases.
“Specific treatment for hirsutism and other dermatological alterations, along with cosmetic measures, focuses on reducing or blocking excess circulating androgens using combined oral contraceptives with or without anti-androgens,” he adds.
Treatment for reproductive alterations depends on whether the patient desires pregnancy. “For women who wish to become pregnant, initial treatment involves weight loss if they are overweight, and monitoring ovulation. If pregnancy doesn’t occur with these measures, assisted reproductive technologies may be considered, such as letrozole, clomiphene citrate, gonadotropins, or in vitro fertilization.”
If pregnancy is not desired, treatment focuses on preventing endometrial hyperplasia in women with infrequent periods, which can be achieved with progestogens or oral contraceptives.
Regarding metabolic alterations, Dr. Luque Ramírez says treatment centers on prevention and early detection, again emphasizing the importance of a healthy lifestyle.
“We shouldn’t overlook the successful role of metabolic surgery in women with severe obesity, which restores fertility and menstrual cyclicity in most cases, reduces the risk of metabolic complications, and significantly improves dermocosmetic alterations, as well as decreasing circulating androgens, reversing the manifestations of the syndrome in most women,” concludes the endocrinologist at Ramón y Cajal Hospital in Madrid.
