PCOS, polycystic ovarian syndrome, is a hormonal disease of both the ovaries and the hypothalamic-pituitary glands. For this reason, patients are followed by both a gynecologist and an endocrinologist. Contrary to what the name of this disease might suggest, PCOS does not cause cysts but is notably characterized by the presence of very numerous immature follicles in the ovaries.
PCOS: what are the symptoms and how to make the diagnosis?
The Rotterdam consensus is used to make the diagnosis of PCOS. It indicates that two criteria must be present among the following three: menstrual disorders (dysmenorrhea), hirsutism (acne, abnormal hair, alopecia), ultrasound abnormalities with the appearance of very numerous pseudocysts in the ovaries . “At the biological level we can also find an increase in testosterone, responsible for clinical hyperandrogenism, an LH/FSH ratio > 2.5, but also an AMH level > 6ng/ml which indicates a high ovarian reserve.”, explains Dr. Borges-Martins.
The diagnosis of the disease can be made at different ages of life. “In adolescence, because young girls do not have their periods or have very severe acne, in adult women because they have difficulty having a baby, or even much later in women who suddenly have acne or abnormal hair growth”, explains the endocrinologist.
The latter reminds us that there is no specific treatment for this disease, the causes and symptoms of which are varied. “We will therefore rather treat the symptoms of the disease than the disease itself. When it is not contraindicated, the pill is prescribed to put the ovaries at rest and calm the symptoms.”, explains Dr. Borges-Martins.
“PCOS is an ovarian and central disease. And the pill is not at all a comfort treatment, we will act on the ovaries indirectly so that they produce less male hormones”, she adds.
PCOS: how does the disease progress at menopause?
The question of the progression of the disease is obviously very important for women. “This is a question that young patients often ask me. Will I be peaceful at menopause?, observes the endocrinologist. The answer to this question is actually complex. At menopause, the ovaries stop functioning and therefore all symptoms related to hyperandrogenism disappear. But it is the metabolic and cardiovascular side which will take over. “We will see the appearance of diabetes, hypertension, excess weight but also liver disorders such as NASHfatty liver disease”, explains Dr. Borges-Martins. Later, around the age of 70, we also observe a slightly higher risk, of around 2%, of endometrial cancer in women suffering from PCOS.
PCOS at menopause: monitoring must absolutely be maintained
Given the metabolic risks, particular vigilance is required for these women at menopause. “At menopause, apart from mammograms to screen for breast cancer, women no longer go to the gynecologist. However, it is very important that they do so, especially after the age of 70”recalls the endocrinologist.
“It is also advisable to consult your doctor to carry out an annual biology in order to control blood sugar and lipid profile which in themselves, when pathological, constitute a cardiovascular risk factor. Liver tests must also be carried out to avoid ignoring NASH (‘fatty liver’), and finally check blood pressure.”, she adds.
Thanks to Dr Liliane Borges-Martins, endocrinologist.
Thanks to the association Asso’PCOS.