Polycystic ovaries is a very common abnormality of the ovaries. It has a genetic cause and the ovaries are presented at a larger size than normal with many small follicles.
According to the latest scientific data and to the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine decree in Rotterdam on 2003 and Amsterdam 2012, as well as the published studies in 2012 and 2014, there are two categories of polycystic ovaries:
- Simple polycystic ovaries (SPCO)
- Polycystic ovaries syndrome (PCOS)
Simple polycystic ovaries (SPCO)
SPCOs are confirmed by ultrasound and present around 11 follicles of diameter 2 – 9mm in each ovary. A mild increase in AMH (Αnti Müllerian Hormone) and androgens is also observed with or without obstructions in the cycle. They are presented in around 21-63% of women.
Polycystic ovarian syndrome (PCOS)
PCOS is confirmed by ultrasound check. Both ovaries present more than 23 follicles of 2-9mm diameter. Other symptoms include large increase in AMH, no or rare periods, subfertility, hyperandrogenism, hirsutism, and increased body weight. There is also increased chance of developing diabetes mellitus, hypertension and even malignancy. It is observed in around 5-10% of women of the reproductive age internationally. It is more common among women of 15 to 30 years old and the rate is decreased with age (33.3% in women younger than 33 years old, 14.7% in women between 30-34 years and 10.2% in women older than 35 years old).
Treatment of SPCO differs from that of PCOS. Women with SPCO usually present with an extended cycle of 30 to 35 days, acne and oily facial skin than may be combined with mild hirsutism. Administration of the contraceptive pill decreased androgen production from the ovaries, the length of the cycle is decreased to 28 days. Following three months of treatment with the contraceptive pill the acne, the oily skin and hirsutism are improved. In this way, women do not have to go through long-term skin treatments with cream and antibiotics.
An important number of women with polycystic ovaries, can get pregnant naturally. If this does not happen and if all other infertility factors are excluded (sperm, obstructed tubes), a course of clomiphene citrate for around three to four months can aid a high precentage of these women.
PCOS is also observed among young women. Initially it is treated with diabetes-specific medication that decrease insulin (metformin) aiding in weight reduction, especially if medication is combined with a balanced low-calory diet. With this procedure ovarian function and the periods may restart. The contraceptive pills may also be beneficial is the hirsutism, since they decrease the production of androgens by the ovaries. Pregnancy can be achieved with the aid of clomiphene citrate. If this is not successful then laparoscopic ovarian drilling may be performed. Another option is IVF, where a high success rate is observed among women with PCOS. However, special attention and care needs to be provided during ovarian stimulation to avoid hyperstimulation. Around 90-95% of women with PCOS can become pregnant, if there is no other cause for infertility.
The distinction between SPCO and PCOS was performed in order to reduce the stress among women and girls who after an ultrasound check show polycystic ovaries.