Polycystic ovary syndrome – SOPQ

Also called the Stein-Leventhal Syndrome, the SOPQ is among the most frequent endocrinological problems in fertile aged women.

This endocrinological and metabolic alteration affects between 6 to 10% of fertile aged women. The main characteristic is an excess of male hormones (Hyperandrogenic) and a high problem of glucose metabolism (hyperinsulinemia). Even if there is a certain number of asymptomatic women, the majority of them show the following symptoms:

  • Anovulation: lack of menstruation or irregular menstruation (oligomenorrhea)
  • Obesity
  • Excessive hair growth (hirsutism)
  • Acne
  • Greasy skin

The diagnostic criteria include HYPERANDROGENISM (clinic or biochemical), ANOVULATION and the ULTRASOUND ASPECT of ovaries (increase in volume and multiple images of follicles of less than 10 mm from the ovary cortex).

The short term problems may include:

  • Hyperandrogenism syndromes such as acne, hirsutism and greasy skin. We then recommend adopting hygiene-dietetic measures (loss of weight and exercise), gestagenic contraceptives or anti-androgen contraceptives or dermatological treatments against hirsutism.
  • Menstrual irregularity. In this case, we will also recommend hygiene-dietetic measures (loss of weight and exercise). It is also recommended to use gestagenic and anti-androgen contraceptives.
  • Sub-fertility-sterility (by anovulation). As in the above cases: a hygiene-dietetic treatment with reduction in caloric ingestion and increase in daily physical exercise (particularly for obese patients) will increase the spontaneous fertility, and the response to different reproduction treatments. The fertility treatment using medicines that reduce the level of insulin (for patients suffering from hyperinsulinemia), such as metformin, which reduces the level of androgens while improves the response to ovulation.
  • Clomiphene Citrate: its administration during the first days of the cycle enables an ovulation in 75-80% of the cases with patients subjected to a infertility treatment, even if only half leads to a pregnancy. 75% of pregnancy is however obtained in the first 3 months.
  • Gonadotropin: it is more efficient than the Clomiphene Citrate in the reproduction treatment, but there is a higher risk of complications. The dose depends on an individual basis to prevent an exaggerated response. If the mono-follicle development associated to planned sexual relations or to the Artificial Insemination does not lead to a pregnancy, if there is a male factor or an associated tube, or if a multiple follicle development is produced, other assisted reproduction techniques should be used, such as In Vitro Fertilization (FIV).
  • Laparoscopic ovarian drilling: the opening of “windows” in the ovarian cortex reduces the concentration of androgens and triggers a spontaneous ovulation within months of the intervention.

Treatment complications:

  • Artificial Insemination: increase in the rate of multiple pregnancy.
  • In Vitro Fertilization: increase in the cancellation of the fertility treatment, ovary hyper-stimulation syndrome risk and reduction in the fertilization rate.

The long term problems of the Polycystic Ovary Syndrome include an increase in cardiovascular and cerebrovascular risks: obesity, arterial hypertension, intolerance to glucose and Mellitus Diabetes of type 2, increase in the rate of cholesterol, etc.). Hygienic and dietetic measures will decrease their impact (diet, exercise).

Last Update: 11/09/2014
References:
– Stein I, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935; 29: 181-91.
The Rotterdam ESHRE/ASRM- sponsored PCOS Consensus Workshop Group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).Hum Reprod 2004;19: 41–47.
– SEF Sociedad Española de Fertilidad. Síndrome del Ovario Poliquístico
2ª edición.2012. Editorial Médica Panamericana
– Clinical Gynecologic Endocrinology and Infertility 7th ed: Leon Speroff, Robert H. Glass, Nathan G. Kase, 2006 Lippincott Williams & Wilkins