OfElena Meli
All aspects of gynecological syndrome: implications for other disorders such as diabetes, cardiovascular diseases, sleep disorders and anxiety
It is forbidden to underestimate it polycystic ovary syndrome: when the diagnosis arrives it is necessary to take into account the reproductive health but also the metabolic, cardiovascular and dermatological health, the quality of sleep and the psychological well-being of the patients, because the disease has a overall impact on women’s health much greater than previously assumed.
A complex syndrome
These are the conclusions reached by the experts who during the last congress of theEuropean Society of Human Reproduction and Endocrinology (Eshre) have revised the international guidelines on the management of ovarian polycystosis, which must no longer be considered a gynecological condition with some repercussions on general health but rather, a complex syndrome of which ovarian cysts are only one of the aspects, in some ways not even the most relevant.
As Alberto Vaiarelli, secretary of the Italian Society of Fertility and Sterility (Sifes) and medical-scientific director of Genera Roma explains, «women with polycystic ovaries have hormonal alterations which pose a high cardiometabolic risk because for example they have high insulin resistance and glucose intolerance, elements which favor the onset of diabetes; in the youngest, gynecological problems related to reproduction prevail, but in those who are older, metabolic disorders become increasingly important.”
Hormonal balance to be re-established
The non-gynecological correlates of polycystic ovary syndrome are so many and have such a significant impact on health and quality of life that several experts are inclined to consider it first and foremost a endocrine-metabolic pathologyto be addressed by re-establishing a balance of female hormones and androgens: it is precisely the excess of testosterone, for example, contribute to acne, alopecia, hirsutism and weight gain. It is also essential to act on insulin resistance, which, as explained by Vittorio Unfer, gynecologist at UniCamillus in Rome, «is found in 30-40% of normal weight patients and in 80% of overweight or obese patients. To help them, inositols have also been studied for some time, natural molecules very similar to glucose which help make the tissues more sensitive to the action of insulin: in patients there is also an altered metabolism of inositols, therefore increase their intake with diet or supplements can help in some cases.”
The numbers
The risk of obesity increases by 63 percent and that of diabetes by 44 percentaccording to data collected on over 75 thousand women present in the UK Biobank, a large Anglo-Saxon database.
The polycystic ovary, which according to estimates concerns 5 to 18 percent of womenIn short, it is a complex condition: the classic symptoms, i.e. multiple ovarian cysts, high testosterone levels and ovulation and menstrual cycle disorders, are actually present all together in only one case out of two.
«This is the classic form of polycystic ovary, the easiest to diagnose», observes Vaiarelli. «Some, however, have cycles in which ovulation is normal, others mainly have hormonal and metabolic alterations. This is also why it is estimated that around 50 percent of women with polycystic ovary syndrome remain undiagnosed.”
Symptoms
Certain signs should make you suspicious: the overweight, hirsutism, acne, alopeciadecreased desire are quite common symptoms.
To arrive at the diagnosis you need a gynecological examination, an ultrasound to check for the presence of cysts, hormonal profile tests; then, as underlined in the update of the guidelines, a global approach is necessary. As the gynecologist Terhi Piltonen of the University of Oulu in Finland explained during the European conference, «it is necessary to deal with all the aspects affected by the syndrome, not just the gynecological ones: it is advisable to provide screening for diabetes, cardiovascular diseases, sleep disorders , anxiety and depression, all more frequent problems in these patients, who also need to maintain good psychological well-being and be careful not to develop eating disorders. It is equally important to consider the greater risk of endometrial cancer in pre-menopause.”
The theme of fertility
About one in five women with fertility problems have polycystic ovary syndrome. One of the most common correlates of this endocrine pathology is precisely the difficulty in having children but as the gynecologist Alberto Vaiarelli explains «paradoxically these women have a high ovarian reserve, i.e. many follicles and oocytes: by restoring a good endocrine and metabolic balance the patients can return to have normal ovulation and therefore become pregnant.” In younger women, reproductive disorders are more frequent and also more “burdensome” for the quality of life, also for this reason, as gynecologist Terhi Piltonen observes, “once polycystic ovaries have been diagnosed, the patient’s management must include a plan for reproductive health which includes the optimization of fertility with good weight control and the reduction of preconception risks. Furthermore, any pregnancies are at greater risk and therefore require closer monitoring.”
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