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Polycystic Ovarian Syndrome, also known as Polycystic Ovarian Syndrome or Stein-Leventhal Syndrome (in honor of the doctors who described it for the first time), is a frequent endocrine dysfunction or disorder that affects approximately 10% of women of childbearing age.

This disease occurs mainly with anovulatory ovarian cycles (without ovulation), menstrual irregularity and increased synthesis of androgens (male sex hormones). Although it has been shown to be a multifactorial disease, the main cause that produces it has not yet been determined.

Signs and symptoms of Polycystic Ovary Syndrome

Polycystic Ovary Syndrome can manifest itself in a wide variety of ways, but it requires at least two of the following criteria:

1. Menstrual alterations: they are one of the main reasons for consultation of patients suffering from this syndrome, manifesting periods of menstruation spaced more than 35 days due to alterations in ovulation (oligoanovulation or chronic anovulation) since it is not possible to generate mature eggs that effectively complete the entire ovulatory cycle.
2. The presence by transvaginal ultrasound of an ovarian image (unilateral or bilateral): with multiple follicles (which must meet specific criteria of measurements in number and size) and an increased ovarian volume, thus showing a characteristic image of small follicles or "cysts" similar in size on the periphery of the ovary.
3. The presence of clinical or laboratory findings suggestive of increased androgen levels. The physical examination may reveal characteristics of masculinization secondary to the elevation of androgens (androstenedione and testosterone), such as the presence of facial hair or hair of a typically male distribution (hirsutism), baldness or androgenic alopecia.

There are other manifestations that could occur secondary to Polycystic Ovary Syndrome, such as:

• Infertility
• Acne, seborrhea and oily skin, due to increased levels of androgens.
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• Elevated insulin levels (hyperinsulinemia) and peripheral insulin resistance can be detected in almost 50% of patients.

Causes of Polycystic Ovarian Syndrome

Polycystic Ovary Syndrome is a multifactorial disease, and there may be one or more causes in the same patient. Among the causes of Polycystic Ovary Syndrome are:

1. Hereditary factors: because up to 50% of the mothers of patients with this diagnosis also have the diagnosis of polycystic ovary.
2. Hyperinsulinism: Elevated levels of insulin and resistance to this hormone may not only be a consequence but also a cause of the syndrome. When a resistance to the effect of insulin occurs, a compensatory rise in insulin levels is generated, which in turn decreases the concentrations of the sex hormone transporter globulin, stimulating greater production of androgens.
3. At the level of the hypothalamic - pituitary axis, greater activity and generation of pulses of gonadotropin-releasing hormone is generated, mainly increasing the levels of luteinizing hormone that secondarily elevates androgens, generating the clinical manifestations already referred to.

Treatment of Polycystic Ovary Syndrome

The treatment of Polycystic Ovary Syndrome should be individualized depending on the characteristics of each patient, taking into account various factors such as age, desire to conceive or not, the presence of infertility, body mass index, comorbidities such as Diabetes, Hypertension, among other. Within the treatment scheme are:

1. Diet and exercise: the mere fact of reducing a percentage of the body mass index in those patients with obesity or overweight, partly regulates menstrual disorders and anovulation with a good level of evidence. In addition, exercise stimulates the absorption of glucose in the muscle cells, which secondarily decreases insulin levels.
2. Use of Combined Oral Contraceptives or progestogens: in the case of patients who do not want to have children in the short term and who do not have contraindications for their use.
3. Use of insulin sensitizers: such as metformin.
4. Ovulation inducers such as clomiphene citrate: in infertile patients who are programmed for low complexity assisted reproductive techniques such as directed intercourse or artificial insemination.
5. Use of aromatase inhibitor drugs: such as Letrozole, to induce ovulation without the anti-estrogenic effects of clomiphene.
6. Gonadotropin use: also used as an ovulation inducer option in patients who do not respond favorably to clomiphene.
7. Ovarian drilling: it is a surgical intervention that is performed laparoscopically, in which several perforations are made on the affected ovary in order to restore normal ovulation. This surgery is indicated in patients with failures of the usual pharmacological treatment. However, its use is controversial, with consensus supporting medical treatment over surgical treatment.

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