What Is Polycystic Ovary Syndrome, and How Is It Treated?

A 22-year-old woman presents with excessive body hair and irregular periods. She reports unexpectedly infrequent menstruation, only 5 or 6 times yearly. Her hair has begun growing black and coarse. Symptoms worsen with weight gain during university...

What Are Polycystic Ovaries?

Polycystic ovaries contain numerous cysts and consequently cause women to experience hormonal imbalance as a resulting condition.

The ovary is a female reproductive organ containing egg cells. Eggs do not mature before puberty; afterward, mature eggs are sent one by one toward the uterus. This continues until menopause.

The ovaries have 2 main functions:

• Normally, small sacs containing egg cells mature and rupture in each woman, releasing an egg.
• They secrete two female hormones called Folliculin and Lutein.

Many ovarian diseases may occur, from congenital structural defects to cancer.

A cystis a closed sac or capsule-like formation containing fat, a water-like fluid or gaseous material, commonly found in the body. Cysts develop within tissue and can occur in internal organs, on skin or anywhere else; they are generally benign. Some cause no symptoms, while others cause pain. Ovarian cysts are common in reproductive-age, generally young women and are mostly benign formations.

Ovarian cystsare uncommon before puberty, before menstruation starts, and after menopause because ovarian function begins at puberty and ends at menopause.

How Do Polycystic Ovaries Develop?

These small egg-containing sacs (follicles) should rupture regularly each month. If development is disrupted, they remain as cysts in the ovaries. Repetition increases the number of unruptured cystic structures, and accumulation of numerous small cysts produces Polycystic Ovary Disease . Incomplete ovulation increases cyst numbers; as these rise, the ovaries' delicate hormonal balance deteriorates further and disrupts the process more.

The most common disorders resulting from this cyst-related hormonal imbalance are;

• Excess androgen production,
• Elevated luteinizing hormone (LH)
• Reduced follicle-stimulating hormone (FSH)

The mechanisms of some changes are not fully understood. The ovaries in this condition secrete excessive androgens.

Androgens are hormones present in both sexes, with the most important role in male reproductive development and growth. The main androgen is testosterone, secreted by the testes in men. Increased androgens cause problems described shortly.  

- Related topic: What Is the Androgen Receptor? A Fundamental Molecule in Prostate Cancer Development

Risk Factors for Polycystic Ovary Syndrome

Although the cause of Polycystic Ovary Syndrome (PCOS) is not fully understood, genetic factors are involved. PCOS is more common in affected individuals' families. Irregular menstruation or diabetes among women in the family increases risk.

Polycystic Ovary Syndrome is characterized by excessive androgen secretion, disordered ovulation and structurally cystic ovaries.

Classic PCOS affects %6 to %10 of reproductive-age women and can cause substantial problems through androgen excess. Male-pattern body hair, excessive acne and weight gain may occur.

What Are the Symptoms of Polycystic Ovary Syndrome?

The most common manifestations are abnormal hair growth and irregular menstruation. Periods occur irregularly, with intervals shorter than 21 or longer than 35 days. General symptoms include;

• Excess hair growth on areas such as the chest, abdomen and back
• Hair thinning and baldness like men
• Irregular periods
• Acne and oily skin
• Weight gain, particularly around the abdomen
• Delayed conception or inability to conceive (infertility)
• Skin tags on the neck or armpits
• Dark or thick skin patches behind the neck, in the armpits or under the breasts

- Related topic: Information on Embryo Freezing and Infertility Treatment for Cancer Patients

What Happens If Polycystic Ovaries Are Untreated? – Other Possible Health Problems

Polycystic Ovary Syndrome is the most common cause of infertility related to ovulation problems. This multifactorial disorder also has various environmental influences, such as contributing to obesity. It is also associated with insulin resistance development, type 2 diabetes, high cholesterol, heart disorders and hypertension.

- Related topic: The Link Between Cancer and Diabetes Has Been Definitively Established

(Polycystic Ovaries) PCOS and Cancer Risk

Ovarian cysts generally cause no symptoms and are detected during routine gynecological examinations, making regular checkups important. Prolonged exposure to high estrogen in PCOS continuously stimulates endometrial (uterine) cell division, increasing uterine cancer risk by approximately 2,7-fold. Estrogen rises in PCOS while progesterone falls. Estrogen triggers new cell formation, while progesterone allows those cells to mature. The link with ovarian cancer is less clear, although some studies report increased ovarian cancer risk of approximately 2,5-fold.

An analysis of available studies compiled in 2020 found the PCOS–ovarian cancer relationship unclear overall, but identified an association with uterine cancer risk.

A Current Analysis of PCOS and Gynecological Cancer Risk

Cancer risk generally involves lifestyle, endocrine treatments, metabolic and dietary components, excess weight, physical activity, harmful habits and age. Among women with PCOS, gynecological cancerrisk remains unresolved, influenced by syndrome severity, specific treatments and lifestyle. Because PCOS etiopathology is still unclear, diagnostic criteria disputed, and endocrine and metabolic dysfunction extremely complex, few high-quality studies have yet established such a relationship.

PCOS is among the most common causes affecting hormonal disorders leading to female infertility. Infertility has also been associated with cancer, though links with breast cancer and ovarian cancer remain unclear.

- Related topic: Do Fertility Treatments and Technologies Increase Ovarian Cancer Risk?

Breast Cancer Risk

A rat-model study suggested a possible link between PCOS-like endocrine-metabolic changes and breast cancer. Another hypothesized similarities between problematic genes in PCOS and breast cancer-associated genes. Some studies emphasized that increased obesity in PCOS patients may relate to breast cancer risk.

However, an analysis of eight studies involving 45.470 PCOS participants confirmed that PCOS did not increase breast cancer risk.

Separate cohort studies in Denmark and Sweden likewise reported risk similar to the general population.  

Uterine Cancer Risk

LH overexpression is known in PCOS. LH receptors, the cell surface binding sites for LH, were highly expressed in the endometrium of PCOS patients with uterine cancer. On this basis, many studies show increased uterine cancer in women with PCOS.

Another study associated metformin treatment in uterine cancer patients with reduced overall mortality. Maintaining appropriate lifelong metabolic and endocrine control in PCOS patients was also found potentially to reduce uterine cancer risk.

Ovarian Cancer Risk

Ovarian cancer risk has been associated with reproductive-age hormonal changes and increased lifetime ovulation cycles. A lower number of menstrual cycles has been associated with greater carcinogenesis.

Recent studies noted common miRNA and mRMA features between women with irregular menstruation and women with ovarian cancer. DNA methylation and miRNAs were also abnormal in ovarian walls in PCOS, suggesting higher ovarian cancer risk in this population.

Data from a Swedish cohort showed an association between PCOS and ovarian cancer, while a Taiwanese study did not. Other recent studies also reported no relationship between menstrual cycles or PCOS and ovarian cancer. In summary, the relationship remains unclear.

In conclusion, PCOS remains mysterious because of its unclear etiopathology and debates about diagnosis, treatment and long-term outcomes. Its link with gynecological cancer risk is consequently unresolved because studies are insufficient and existing findings disputed. A comprehensive analysis of studies available through 2020 suggests no link with breast cancer, a possible increase in uterine cancer risk and no clear conclusion about ovarian cancer.

With few studies, some involving small patient numbers, understanding the potential risk between PCOS and gynecological cancers requires larger clinical studiesto establish the relationship.

How Is PCOS Diagnosed?

Medical history and symptoms are reviewed before diagnosis. A pelvic examination may follow a physical examination. Because some symptoms resemble other health problems, ultrasound and blood tests are used.

• Ultrasound: Ultrasound examines ovarian size and cysts. Endometrial thickness is also assessed.
• Blood tests: High androgen and other hormone levels are checked. Blood sugar is measured, and cholesterol and triglycerides may also be tested.

(Polycystic Ovaries) How Is PCOS Treated?

There are 2 basic treatment principles. Since the aim is to prevent incomplete ovulation, either ovulation should not begin or treatment should complete it.

• For the first approach, oral contraceptives, meaning birth control pills , can be used because they stop ovulation before follicle development and protect the uterus.
• The second approach uses particular medications to regulate the disturbed hormonal balance. These methods gradually reduce ovarian cysts.

If the woman wants children, contraceptive pills prevent this, so treatment is individualized.

Oral contraceptives play the main medication role, regulating menstrual cycles and hormonal balance. If there is no response after 6 months, adding spironolactone is recommended. Also, in situations causing thickening of the uterine liningor potentially cancerous formations, oral contraceptives are recommended; patients unable to tolerate them receive progesterone directly.

- Related topic: What Is Hormone Replacement Therapy? Which Women Should Use It and When?

Women wishing to conceive who are overweight or obese are initially encouraged to lose weight because this is thought to improve treatment, or weight loss is observed during treatment. Because links with diabetes have been established, an antidiabetic drug, metformin , may also be preferred in Polycystic Ovary Syndrome.

- Related topic: Losing Weight Reduces Proteins Involved in New Blood Vessel Formation in Cancer