Introduction
The polycystic ovary, also known as polycystic ovary (PCO) or Stein-Leventhal syndrome, is a condition characterized by enlarged and polycystic ovaries - that is, filled with cysts of various sizes - and by three symptoms almost always present (triad):
- amenorrhea (absence of menstruation),
- hirsutism (increase in hair),
- obesity.
In some women there is also a familiarity with the syndrome.
The symptoms of polycystic ovary are due to a chronic anovulation situation, ie a constant absence of ovulation, associated with an increase in the production and secretion of androgenic hormones (hyperandrogenism) in varying quantities.
Causes
The most important cause of polycystic ovary is hyperandrogenism, which is responsible for hirsutism and, indirectly, for anovulation and cycle disorders.
The excess of androgens is due to a series of hormonal alterations that characterize the PCO and that are an increase in the levels of LH - which show wide oscillations in relation to an exaggerated and irregular secretion by the pituitary gland (which produces LH) - and the enhanced production of estrogen and androgen hormones by the ovary. In particular, it is precisely the irregular - and often exaggerated - secretion of LH that "hyperstimulates" the ovary to produce these hormones in abundance.
In polycystic ovary syndrome, the concentration of FSH, always produced by the pituitary gland, is instead reduced. The secretory variations of LH and FSH linked to an ovulatory menstrual cycle are also abolished.
In about 30% of affected patients there is also a moderate increase in prolactin, with values ​​approximately double compared to those observed in normal subjects.
Consequences
What causes hormonal changes in polycystic ovary syndrome?
The high quantities of androgens present in the circulation are converted into estrogens at the level of the peripheral tissues, in particular at the level of adipose tissue, rich in enzymes whose task is precisely this conversion. The excess released LH causes an increase in the volume of the ovary with hyperproduction of androgens, which increase the peripheral conversion processes of androgens into estrogens, perpetuating the vicious circle responsible for polycystic ovary syndrome.
The inadequate secretion of FSH and the high concentration of androgens in the ovaries, where follicle maturation takes place, cause its incomplete maturation. The incomplete maturation of numerous follicles, in turn, determines the formation of small cysts. The ovaries are generally, but not necessarily, enlarged. Rather more rarely the increase in prolactin may result in the secretion of milk from the nipples (galactorrhea).
Symptoms
To learn more: Symptoms of polycystic ovary
Ovarian polycystic disease is characterized by a marked variability in clinical manifestations. Therefore, the syndrome differs considerably from one patient to another, both because of the presence or not of certain symptoms, and because of their intensity and the hormonal alterations that can be detected with common laboratory tests. In a significant number of patients it turns out that some important clinical manifestations of this disease appeared already during puberty: the menarche (first menstruation) usually occurs at physiological age, but is immediately followed by menstrual irregularities. An excessive development of the hair system occurs immediately before or around the age of the menarche. An excess weight is present in a proportion of patients already before the menarche.
Menstrual cycle disorders are one of the symptoms of the polycystic ovary that most often lead the patient to consult the doctor: there may be anovulatory cycles, oligomenorrhea (few menstruation, "delaying cycles"), abnormal uterine bleeding, amenorrhea, infertility and alterations of basal temperature, which reflect failure to ovulate. At any time, due to a fluctuation in the level of estrogens, ovulation cycles may spontaneously occur. Among women with polycystic ovaries, hirsutism is almost constantly present, but is generally relatively mild. Acne is sometimes present, while only rarely we observe what are called virilization signs, which are hirsutism, receding hairline, forehead hairline recession, acne and increased sebum production (oily skin), increased masses muscle, low-pitched voice, increased volume of the clitoris and labia, increased sexual desire, increased breast volume and loss of the female silhouette. Obesity is present in less than half of patients with polycystic ovary syndrome.
