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Sağ http://polycysticovary.net Tue, 13 Jul 2021 21:47:47 +0000 en-US hourly 1 https://wordpress.org/?v=5.8.1 Thyroid Gland Dysfunction and Polycystic Ovary Syndrome http://polycysticovary.net/thyroid-gland-dysfunction-and-polycystic-ovary-syndrome/ Mon, 10 Apr 2017 11:50:19 +0000 http://polycysticovary.net/?p=1237 Thyroid gland function should be investigated to diagnose polycystic ovary syndrome. Particularly, it is important in the differential diagnosis of women with group A and group B. Hashimoto’s thyroiditis is the most common disease which causes a decreased thyroid gland function (hypothyroidism) in women during reproductive period. Basically, hypothyroidism leads to less energy consumption in the body. Therefore, hypothyroidism causes weight gain and difficulty in losing weight. Additionally, hypothyroidism results in oligo-anovulation which is presented by long lasting and increased amount of menstrual bleeding.

Both hypothyroidism and polycystic ovary syndrome may be seen together in a woman. Usually, decreased energy consumption ,which leads to weight gain and obesity, causes presentation of symptoms and signs of women with polycystic ovary syndrome.

Hypothyrodism causes a decrese in production of shbg (sex hormone binding globulin), transport protein of male hormones (androgens), by liver. That’s why, thyroid function tests should be investigated in women who have androgens in normal limits when they have symptoms and signs of polycystic ovary syndrome.

Graves disease is the common disorder which increases the thyroid gland function (hyperthyroidism). Particularly, these women are not obese and have a difficulty in gaining weight. But, they may have long lasting and less amount of menstrual bleeding usually presenting spotting.

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Pregnancy Complications in Women with Polycystic Ovary Syndrome http://polycysticovary.net/pregnancy-in-polycystic-ovary-syndrome/ Mon, 10 Apr 2017 11:40:02 +0000 http://polycysticovary.net/?p=1233 Oligo-anovulation are diagnosed in approximately 20% of women who visit an infertility clinic. Particularly, 90% of these women who present oligo-anovulation are composed of group A and group B women with polycystic ovary syndrome. Group C women are usually ovulatory. However, a small number of women in group C may be anovulatory ,even they have regular periods.

Polycystic ovary syndrome is basically a genetic disorder which is usually expressed by changes in eating behaviour and life style. Therefore, being pregnant and giving a birth does not have any effect on signs and symptoms of polycystic ovary syndrome. Usually, same symptoms and signs reappear after giving birth.

Women with polycystic ovary syndrome are at increased risk for abortion (miscarriage), particularly early pregnancy loss. In addition, obesity and insulin resistance (hyperinsulinemia) are conditions which increase the risk of early pregnancy loss independently of polycystic ovary syndrome. Obese women with polycystic ovary syndrome who have insulin resistance have the highest risk of early pregnancy loss.

The risk of type 2 diabetes mellitus is already higher in women with polycystic ovary syndrome compared to normal population independently of obesity. But, particularly, obese women with polycystic ovary syndrome who have insulin resistance or glucose intolerance have the highest risk of gestational diabetes mellitus, when they have been pregnant. Thus, these women should begin to lose weight and be treated to decrease excessive weight and insulin resistance a few months before being pregnant. In addition, glucose intolerance and gestational diabetes should be carefully investigated during pregnancy of these women.

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Oral Contraceptives in Polycystic Ovary Syndrome http://polycysticovary.net/dogum-kontrol-hapi-kullanimi-ve-polikistik-over-sendromu-2/ Tue, 14 Mar 2017 01:25:56 +0000 http://polycysticovary.net/?p=847 Birth control pills (Oral contraceptives) should not be used in the treatment of polycystic ovary syndrome. Birth control pills, unfortunately, are frequently used in women with polycystic ovary syndrome, although they do not treat the basic problems in polycystic ovary syndrome.

DISADVANTAGES and RISKS ;

Long term use without taking an occasional break from birth control pills is not true in the treatment of polycystic ovary syndrome. Long term use  of birth control pills generally masks the actual problems such as polycystic ovary syndrome and early menopause. For this reason, women who have been using birth control pills for many years may have a risk to face irregular periods and not becoming pregnant when they stop taking birth control pills.

Birth control pills induced bleedings are not real periods. In a real period of a woman; a small sac called follicle containing an egg grows and then becomes a mature follicle in the ovary. Ovulation occurs when the mature follicle ruptures and the egg is released out. But, follicle containing an egg does not grow and ovulation does not occur while women are using birth control pills as well as in women with polycystic ovary syndrome.
Obese and overweight women with polycystic ovary syndrome using birth control pills have an increased risk of deep vein thrombosis, cellulitis, varicose veins, insulin resistance, gaining weight (water retention), psychiatric disorders like depression, pancreatitis, gallstones, cholecystitis and breast cancer.

Birth control pills particularly which are used for the treatment of polycystic ovary syndrome may cause death in women who are overweight or obese and have blood clotting disorders.
Hypothalamus and Hypophysis which are located in the brain send messages to ovaries to control the menstrual periods. Hypothalamic-hypophysial-ovarian axis usualy is not mature by 16 years of age. For this reason, use of birth control pills under the age of 16 may block the maturation of hypothalamic-hypophysial-ovarian axis.

There is a link between birth control pills use and breast cancer. The breast cancer risk is highest in the women who started using birth control pills as teenagers and who used birth control pills for longer years prior to first full time pregnancy.

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Subgroups of Polycystic Ovary Syndrome http://polycysticovary.net/polikistik-over-sendromunun-cesitleri-alt-gruplari/ Tue, 14 Mar 2017 01:17:55 +0000 http://polycysticovary.net/?p=841 Subgroups of polycystic ovary syndrome are defined by three criteria;

1-Status of male hormones

2-Egg growth and ovulation

3-Appearance of ovaries on ultrasound examination

The women with polycystic ovary syndrome are divided into three subgroups (A,B,C).The main characteristics and typical examples of these subgroups were described below;

GROUP-A

Group A is divided into two subgroups (A1, A2);

A1

– Symptoms of hyperandrogenism such as excessive male type hair growth, acne, oily skin, male type alopecia and /or increased blood levels of male hormones,

– Egg does not grow which causes cancellation of ovulation and periods or growth of egg slows down which causes delayed ovulation and periods,

– Appearance of polycystic ovaries on ultrasound examination

Example; She is 168 cm tall and weighs 85 kg, having increased hair growth on chin, neck, inner parts of thighs, periods every 2-3 months, increased blood levels of male hormones (testosterone, etc.), insulin resistance (+) and polycystic ovaries on ultrasound examination

A2

– Symptoms of hyperandrogenism such as excessive male type hair growth, acne, oily skin, male type alopecia and /or increased blood levels of male hormones,

– Egg does not grow which causes cancellation of ovulation and periods or growth of egg slows down which causes delayed ovulation and periods,

– Appearance of normal ovaries on ultrasound examination

Example; She is 165 cm tall and weighs 53 kg, having increased hair growth on abdomen, around nipple region, and between breasts, periods every 2-3 months,normal blood levels of male hormones (testosterone, etc.), insulin resistance (+) and normal ovaries on ultrasound examination

GROUP-B

– There are no symptoms of hyperandrogenism such as excessive male type hair growth, acne, oily skin, male type alopecia and /or increased blood levels of male hormones,

– Egg does not grow which causes cancellation of ovulation and periods or growth of egg slows down which causes delayed ovulation and periods,

– Appearance of polycystic ovaries on ultrasound examination

Example; She is 163 cm tall and weighs 82 kg, having no increase in hair growth, periods every 3-4 months, normal blood levels of male hormones (testosterone, etc.), insulin resistance (+) and polycystic ovaries on ultrasound examination

GROUP-C

– Symptoms of hyperandrogenism such as excessive male type hair growth, acne, oily skin, male type alopecia and /or increased blood levels of male hormones,

– Egg grows which results in ovulation and periods or growth of egg does not slow down which results in regular ovulation and periods,

– Appearance of polycystic ovaries on ultrasound examination

Example; She is 168 cm tall and weighs 54 kg, having increased hair growth on chin, back, shoulder, inner and outer parts of thighs, regular periods once every month, increased blood levels of male hormones (testosterone, etc.), insulin resistance (-) and polycystic ovaries on ultrasound examination

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Excessive Hair Growth in Women with Polycystic Ovary Syndrome http://polycysticovary.net/polikistik-over-sendromunda-tuylenme-artisi-ve-tedavisi/ Tue, 14 Mar 2017 00:30:08 +0000 http://polycysticovary.net/?p=810

Excessive growth of thick, dark and strong hairs on upper lip, chin, sideburn areas, neck, around the nipple region, between the breasts, abdomen, back, shoulders, inner and outer thighs and arms is a common symptom in women with polycystic ovary syndrome. An increase in production and efficacy of male hormones (testosterone, etc.) and a decrease in production of a substance called sex hormone binding globulin (SHBG)which neutralizes the male hormones by binding them in circulation causes light and thin hairs turn into dark and thick hairs.

This picture demonstrates  excessive hair growth on the neck area in a woman with polycystic ovary syndrome.

 

Insulin is a hormone produced in pancreas. Pancreas produces much more insulin than normal in women with insulin resistance. Hyperinsulinemia (increased insulin levels) causes excessive hair growth in women with polycystic ovary syndrome by two ways, including increased production of male hormones (testosterone, etc.) in ovaries and decreased production of binding substance (SHBG) in liver.

This picture demonstrates excessive hair growth on chin in a woman with polycystic ovary syndrome.

 

Body fat (adipose tissue) percentage is negatively correlated with sex hormone binding globulin (SHBG) levels. For this reason, overweight and obese women have low levels of SHBG. Low SHBG levels cause excessive hair growth in overweight or obese women with polycystic ovary syndrome because there is an increase in amount and efficacy of male hormones (testosterone, etc.) in these women. But, low levels ofSHBG do not cause excessive hair growth in overweight and obese women who do not have polycystic ovary syndrome because the levels and efficacy of male hormones (testosterone, etc.) are normal in these women.

This picture demonstrates excessive hair growth on the lower abdomen in a woman with polycystic ovary syndrome.

 

 Thyroid gland produces thyroid hormones. Hypothyroidism (decreased thyroid hormone levels) causes reduced energy use (low body temperature, etc.). Reduced energy use leads to fat storage in the body. Increased body fat (adipose tissue) percentage decreases production of binding substance (SHBG) of male hormones. For this reason, increased body fat storage causes excessive hair growth by increasing the efficacy of male hormones in women with polycystic ovary syndrome. Hypothyroidism can lead to excessive hair growth even in normal weight women with polycystic ovary syndrome if she has an increased body fat.

This picture demonstrates excessive hair growth on the forearm in a woman with polycystic ovary syndrome.

 

This picture demonstrates excessive hair growth on the sideburn area and neck in a woman with polycystic ovary syndrome.

 

Treatment; The primary principle of the treatment of excessive hair growth is to decrease the production and efficacy of male hormones (testosterone, etc.) and to increase the production of sex hormone binding globulin (SHBG) which neutralizes the male hormones. The treatment of insulin resistance by decreasing hyperinsulinemia is one of the treatment options which causes decreased production of male hormones (testosterone, etc.) in ovaries and increased production of binding substance (SHBG) in liver. Male hormones (testosterone, etc.) cause hair growth by binding receptors located on hair follicles in the skin. For this reason, medications that block the binding of male hormones to these receptors is another alternative for the treatment of excessive hair growth. An enzyme called 5-alpha reductase located on hair follicles in the skin converts male hormones (testosterone, etc.) to active forms (dihydrotestosterone, etc.) after male hormones bound to their receptors. Active forms (dihydrotestosterone, etc.) are much stronger forms of male hormones which cause hair growth. For this reason, medications that block the conversion of male hormones to active forms is another alternative for the treatment of excessive hair growth.  The treatment option for a person changes to the origin, distribution and severity of hair growth. Subgroups of polycystic ovary syndrome (A, B, C), obesity and insulin and sugar metabolism are also important factors determining the treatment options.

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Irregular Periods in Women with Polycystic Ovary Syndrome http://polycysticovary.net/polikistik-over-sendromunda-adet-duzensizligi-ve-tedavisi/ Tue, 14 Mar 2017 00:26:02 +0000 http://polycysticovary.net/?p=806  

Absent or delayed periods are common symptoms in women with polycystic ovary syndrome. These women usually have less than eight periods each year. Absence of periods causes thickening of inner lining of uterus (endometrium). These women with thickened inner lining of uterus may have bleedings which are long lasting, heavy and including dark coagulum. The women with thickened inner lining of uterus have also an increased risk of developing cancer in the inner lining of uterus.

The menstrual cycle is the time from the first day of a woman’s period to the first day of her next period (For example; 30 day cycle). The beginning of a woman’s period in the end of a menstrual cycle generally accepted as a sign of ovulation.

For example; a woman ovulates about 12 times a year if she gets periods once a month, a woman ovulates about 6 times a year if she gets periods every two months, a woman ovulates about two times a year if she gets periods every six months. But, the beginning of a period or having regular periods may not be a sign of ovulation in some women with polycystic ovary syndrome. For this reason, ovulation should be determined in these women with regular monthly periods having symptoms such as excessive hair growth, acne, male type hair loss or obesity. Ultrasound scan or some hormone tests should be done to know whether these women are ovulating or not.

This picture demonstrates an ultrasound image of polycystic ovary. The red arrow in the picture shows fluid filled small sacs containing eggs which surrounds the increased amount of white central area (stroma) of the ovary.

 

Figure-1 (below) shows the changes in blood levels of some hormones called FSH (Follicle Stimulating Hormone), LH (Luteinizing Hormone), Estradiol, and Progesterone during a menstrual cycle with ovulation. The changes in the production of these hormones during a menstrual cycle leads to growth of small sac with an egg and results in ovulation. The yellow line in figure-1 (below) illustrates the changes in the amount of FSH in a menstrual cycle. FSH leads to growing of a sac which contains egg starting from the first day of a menstrual cycle. The blue line in figure-1 (below) demonstrates the changes in the amount of estradiol. At the same time with the growing a sac containing egg, estradiol leads to thickening of inner lining of uterus (endometrium). The green line in figure-1 (below) illustrates the changes in the amount of LH in a menstrual cycle. The wall of a growing sac with egg ruptures and egg is released from the ovary, 36 hours after the highest level of LH in the menstrual cycle. The release of an egg from the ovary is known as ovulation. Pregnancy can occur if an egg which is released from the ovary (ovulation) meets with a sperm. Otherwise, menstrual bleeding usually will begin about 14 days after ovulation if the egg does not meet with a sperm.

The red line in figure-1 (below) illustrates the changes in the amount of progesterone in a menstrual cycle. Progesterone reaches its highest level 7 days after ovulation in a menstrual cycle. Progesterone levels can be measured by a blood test to determine whether ovulation has occurred or not. Menstrual bleeding usually will begin about 7 days after the progesterone reaches its highest level in a menstrual cycle. The menstrual cycle shown in figure-1 (below) lasting 28 days ends when menstrual bleeding begins 7 days after the progesterone has reached its highest level. The all events happening in a menstrual cycle repeats themself every 28 days in a women with regular menstrual cycles.

Figure-2 (below) shows that there is no change in blood levels of FSH, LH, Estradiol, and Progesterone throughout a menstrual cycle without ovulation (anovulation). For this reason, the small sac with an egg does not grow and the egg is not released from the ovary which is shown in figure-2 (below). Pregnancy does not occurin women with anovulation because there is no egg released from the ovary to meet with a sperm and also menstrual bleeding will not happen in these women.

The small sac containing an egg does not grow or grows slowly which causes lack of ovulation and periods or delayed ovulation and periods in some women with polycystic ovary syndrome (Group A and B) that is shown in the left side of blue arrow in figure-2. However, there is no problem in the right side of blue arrow (figure-1) in women with polycystic ovary syndrome. That’s why, menstrual bleeding of a woman will begin about 14 days after ovulation whether she has polycystic ovary syndrome or not. For example; if the sac containing an egg grows and therefore ovulation occurs in 14 days, intervals between periods will be (14+14): 28 days. If the sac containing an egg grows and therefore ovulation occurs in 60 days, intervals between periods will be(60+14): 74 days. If the sac containing an egg grows and therefore ovulation occurs in 180 days, intervals between periods will be (180+14): 194 days.

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