Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) affects nearly 25% of women during their childbearing years. Its main features can include cysts in the ovaries, high levels of androgens, lower levels of progesterone, excess hair growth on the face and body, acne, weight gain, and irregular or missing periods. Women with PCOS have fertility problems and a higher risk of pregnancy complications, such as pre-eclampsia, gestational diabetes, and miscarriage. However, many women don’t know they have it, because not all patients will develop all of PCOS’ symptoms, nor if they experience even one of the previous symptoms do they definitely have polycystic ovary syndrome.

To put it differently, PCOS affects women in so many ways (obesity, severe acne, abnormal hair growth, alopecia, menstrual irregularities, absence of monthly ovulation, fertility problems, and depression) that it’s good to be informed and consult your doctor at the first sign.

What is PCOS?

Polycystic ovary syndrome is a very common hormonal condition that affects how ovaries work. It usually starts in the late teens or early 20s and affects women’s daily lives in different ways. Some women struggle with fatigue, headaches, and mood swings because of hormonal imbalances. While others having excess androgen levels may deal with skin changes, hair thinning, or abnormal hair growth. Weight gain or difficulty losing weight can feel frustrating. Irregular menstrual cycles and cysts in the ovaries are also a leading cause of infertility.

PCOS usually presents with menstrual cycle disturbances in the form of oligomenorrhea or uterine bleeding. Why does this happen?

Every month, one follicle (the tiny fluid-filled sac that may develop on the ovaries) matures and releases an egg during ovulation. With PCOS, the follicles may not fully develop or release an egg. Instead, they can remain on the ovary, clustering in a pattern that looks like a string of pearls on an ultrasound, and none of them can reach a size that would trigger ovulation. A lack of ovulation causes thickening of the endometrium, which, when it “sheds”, results in heavy and prolonged bleeding.

Understanding the Etiology of PCOS

The exact cause of PCOS remains unknown.

Recent studies and research estimate that genes, insulin resistance, and increased levels of inflammation in people with PCOS have all been linked to excess androgen production.

Symptoms of PCOS

• Irregular or absent menstrual periods
• Infertility
• Obesity
• Too much androgen may result in unwanted facial or body hair (hirsutism).
• Thinning & loss of hair from the head (alopecia) and severe

How PCOS is diagnosed

Your doctor might ask you for symptoms like acne, excess face and body hair and weight gain.

• A pelvic exam can find cysts in the ovaries with ultrasound.
• Blood tests can check for higher levels of androgens (testosterone, androstenedione) and elevated insulin, cholesterol and triglyceride levels to evaluate your risk for heart disease and diabetes.

Treatment of PCOS

Because PCOS’s imbalance of male and female sex hormones affects many systems in the body, managing it usually requires a personalized approach.

• Weight loss medicine, diet, movement and exercise, sleep & rest, and stress management.
• Menstrual disorders. The contraceptive pill, progestogen tablets, or other hormonal methods of contraception may be recommended for a specific period of time to encourage regular monthly periods.
• To slow hair growth, eflornithine cream is often used. Esthetic treatments such as laser hair removal and electrolysis can also help remove unwanted hair.
• Acne treatment. Waxing and makeup are also recommended.
• Fertility problems. For women with PCOS who are trying to get pregnant, anti-estrogens (clomiphene) or gonadotropins may be recommended to stimulate ovulation, but this should always be done by specialized gynecologists and under close monitoring to avoid multiple pregnancies and the induction of Ovarian Hyperstimulation Syndrome.
• Reducing insulin and blood sugar levels in women with PCOS.

Long-term consequences of PCOS

• Patients with hyperinsulinemia are at risk of developing type 2 diabetes or gestational diabetes during pregnancy.
• Elevated androgens are implicated in the risk of developing arterial diseases.
• Patients with chronic anovulation are at a higher risk of endometrial hyperplasia and carcinoma.
• Overweight women with hyperinsulinemia have an increased risk of heart disease.

Our approach

Dr. Nikolaidis with decades of operating experience via laparoscopy, is highly skilled  in handling cases of PCOS. Let us inform you about your exact condition, carefully decide how to address it, and create a personalized exercise and nutrition program alongside your medication that will allow you to get pregnant (if you wish) or reduce any consequences and risks of PCOS, putting an end to your problem.