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MORPHOLOGICAL AND FUNCTIONAL FEATURES OF POLYCYSTIC OVARIES
Mukhitdinova Khurshida Samikhovna
Asian International University.
https://doi.org/10.5281/zenodo.15059616
Polycystic ovarian syndrome (PCOS) is a chronic condition in which a woman does not
ovulate or rarely ovulates, i.e. a mature egg does not leave the ovary for fertilization by sperm.
Otherwise, this condition is called polycystic ovarian syndrome, or Stein—Leventhal
syndrome. It is accompanied by reproductive disorders (inability to conceive and have a child),
metabolic disorders and psychological problems.
PCOS is the most common endocrine disorder that occurs in 5-20% of girls of
childbearing age [3]. It is indicated by the presence of any two main criteria: excess of male sex
hormones produced in the ovaries — manifests itself in the form of external signs (seborrhea,
"male-type" hair loss, acne, hair loss) and/or laboratory increase in androgen levels; prolonged
non-occurrence of ovulation (oligoovulation) or its complete absence; distinctive polycystic
changes in the ovaries, detected by ultrasound [1][2].
There are two most significant theories of PCOS development:
1. Theory of disruption of hormone production regulating the ovaries in the hypothalamus
and pituitary gland. These areas of the brain are responsible for its neuroendocrine activity and
the work of the whole organism.
2. The theory of insulin resistance is a decrease in the sensitivity of div cells to insulin,
followed by a violation of glucose metabolism and its entry into cells [3][4].
Both theories explain the complaints and laboratory changes that occur in patients with
polycystic ovaries.
The contribution of genetic factors to the development of PCOS is also discussed. In
particular, we are talking about genes that are involved in the formation or action of male sex
hormones, the transmission of the insulin signal and metabolism, the formation of follicles in the
ovary and other processes [4][23]. For example, a woman has a 30-50% risk of developing
PCOS if her mother or sister has polycystic ovaries [3].
Symptoms of polycystic ovary
The signs of polycystic ovary disease include:
• irregular menstrual cycle;
• abnormal uterine bleeding;
• infertility;
• symptoms of hyperandrogenism — excess of male sex hormones;
• overweight or obese (div mass index of 25.0 or higher);
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• black acanthosis — dark brown patches in the skin folds of the neck, armpits, and groin
(an optional sign of insulin resistance) [5];
• Psychological and psychosexual disorders;
• eating disorders (overeating) [1].
An irregular menstrual cycle is understood to mean:
• cycle duration of more than 90 days in the first year after the onset of menarche — the
first menstruation;
• cycle duration is less than 21 days or more than 45 days from the 1st to the 2nd year
after the onset of menarche;
• cycle duration of less than 21 days or more than 35 days or less than 8 cycles per year in
women of childbearing age (i.e., from the 3rd year after menarche to menopause) is most often
observed;
• the initial absence of menstruation at the age of 15 (primary amenorrhea) or their
absence for more than three years from the onset of breast development (telarche) [1].
In 20% of women with polycystic ovaries, the menstrual cycle is not disrupted, while
ovulation does not occur. Therefore, it is wrong to judge the presence of ovulation only based on
the regularity of the cycle [5]. Abnormal uterine bleeding occurs when the thickened
endometrium (the inner layer of the uterus) is not completely and irregularly rejected. At the
same time, the bleeding becomes more abundant and prolonged.
Infertility, according to some literature data, is 15 times more common in women with
polycystic ovaries compared with women without this pathology [3]. However, in 70-75% of
cases, it is primary (if pregnancy has never occurred) and is associated with the presence of
cycles in which ovulation has not occurred [4].
The symptoms of an excess of male sex hormones include:
• seborrhea — increased sebum formation on the scalp, face, anterior surface of the chest,
back, shoulders;
• hirsutism — excessive growth of dark coarse hair in the upper lip, chin, chest, back and
abdomen, inner thighs;
• acne (acne) is a disease of the sebaceous glands of the skin associated with blockage of
their outlet ducts;
Androgen-dependent alopecia is a progressive hair loss that begins on the crown or
temples and spreads to the parietal and occipital regions.
• These changes in appearance, as well as excess weight, are quite difficult for women
and girls with polycystic ovaries to accept. Because of this, they often experience symptoms of
moderate to severe anxiety and depressive disorder [1].
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Pathogenesis of polycystic ovaries
Ovarian follicles are peculiar biological capsules containing eggs. The processes of their
maturation and further transformations are regulated by many hormones. The leading regulators
are follicle-stimulating and luteinizing hormones produced by the pituitary gland, FSH and LH.
• FSH regulates the growth and development of follicles along with maturing eggs,
promotes the formation of estradiol in the follicles, a female sex hormone (a type of estrogen),
which is formed from testosterone, the male sex hormone. The larger the size of the follicle, the
more estrogens it produces [4].
• Normally, in the middle of the menstrual cycle, under the influence of estradiol
accumulated in the follicles, the maximum release of FSH occurs along with a sharp increase in
LH levels. Due to these peaks, the largest mature (dominant) follicle ruptures and releases an
egg, potentially ready for fertilization. This process is called ovulation. Peak increases in LH and
FSH are very important for its adequate launch, rather than a long-term chronic increase in these
hormones. [3][4][6].
• Under the influence of the PH peak, the process of transformation of the accumulated
follicle into a yellow div, a temporary endocrine gland, is triggered. It produces progesterone—
a hormone necessary for the fixation of a fertilized egg in the uterine cavity. LH also stimulates
the formation of androgens, male sex hormones, in the ovary.
• If the egg is not fertilized by sperm, the corpus luteum gradually decreases and reduces
progesterone production. As a result, this leads to the onset of menstruation — the rejection of
the inner layer of the uterus (endometrium), which is not useful for attaching a fertilized egg.
• One of the reasons for the development of PCOS is the genetically programmed
excessive production of LH, occurring ahead of time, while maintaining low-normal levels of
FSH. The increased concentration of LH stimulates the excessive formation of male sex
hormones — testosterone and androstenedione. Their excess disrupts the development of
follicles, leading to their premature degradation (degeneration into a corpus luteum) and the
formation of small follicular cysts in their place, which can be detected during ultrasound.
• The absence of a dominant follicle leads to the inability to ovulate (hence infertility) and
the inability to form a corpus luteum, the source of progesterone production. Therefore, in the
second phase of the cycle, there is a low level of progesterone in the blood. This, in turn, is the
reason for the absence of endometrial rejection — the cessation of menstruation or a long delay
in its onset. The absence of rejection of the inner layer of the uterus can lead to its overgrowth,
i.e. endometrial hyperplasia. This disorder is a risk factor for cancer.
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An excess of androgens can to some extent be converted into estrogens (mainly not into
estradiol, but into estrone, another female sex hormone). Estrone further stimulates an increase in
LH. This is how this pathological process closes and self-sustains.
Another reason for the development and progression of PCOS is considered to be
genetically programmed disorders of the production and action of insulin with the formation of
insulin resistance — insufficient tissue response to its action.
Insulin is a hormone that regulates the metabolism of carbohydrates, as well as fats and
proteins. It has an anabolic (growth) effect on many organs and tissues. Due to a decrease in
tissue sensitivity to it, the effect of the hormone becomes insufficient, which may be
accompanied by an increase in blood glucose levels. In an attempt to lower sugar levels, insulin
production increases, i.e. excess insulin is detected in the blood when glucose levels are not low.
Insulin is able to stimulate the growth of follicle cells that produce androgens. In
addition, excess insulin in the liver reduces the production of the hormone globulin (SHBG).
Normally, it binds some of the male sex hormones, preventing them from exerting their
function. A decrease in the amount of SHBG leads to an increase in free testosterone in the
blood, which further enhances the manifestations of hyperandrogenism — acne, hirsutism,
alopecia, etc. [10].
Classification and stages of development of polycystic ovaries
The main criteria for polycystic ovaries include the absence of ovulation or its rare
occurrence, hyperandrogenism and polycystic ovarian changes [2]. Depending on them, PCOS is
classified into the following types::
• classic type — all three criteria are present (occurs in 46% of cases);
• ovulatory type — ovulation is preserved, while there is only clinical or laboratory
hyperandrogenism with signs of polycystic ovary on ultrasound (occurs in 23% of cases);
• nonandrogenic type — signs of hyperandrogenism are not observed, but there is no
ovulation and there are ultrasound characteristics of polycystic ovaries (occurs in 18% of cases);
• anovulatory type — there is no ovulation, there are signs of hyperandrogenism (it is less
common in 13% of cases) [6][11].
Depending on the complaints that come to the fore and related treatment approaches,
there are three types of PCOS:
• metabolic type, in which metabolic disorders predominate (type 2 diabetes mellitus,
overweight, impaired cholesterol metabolism);
• hyperandrogenic type, in which cosmetological problems associated with an excess of
male sex hormones (acne, increased hair loss, etc.) come to the fore;
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• reproductive type, in which the main complaints are problems of conception and
bearing a child [11].
Complications of polycystic ovary disease
PCOS leads to the following disorders:
1. Metabolic syndrome is a correctable disorder that combines obesity with two or more
criteria.:
2. increased blood glucose ≥ 5.6 mmol/l or the presence of type 2 diabetes mellitus;
3. high blood pressure (≥ 130/85 mmHg) or hypertension;
4. Blood triglyceride level ≥ 1.70 mmol/L;
5. Blood HDL cholesterol (high-density lipoproteins) < 1.3 mmol / L or treatment with
drugs to normalize blood lipids.
6. Gestational diabetes mellitus is diabetes that occurs during pregnancy.
7. Fatty liver hepatosis is an excessive accumulation of fat in the liver in people who do
not abuse alcohol, associated with insulin resistance.
8. Hypertension is a persistent increase in blood pressure.
9. Obstructive sleep apnea syndrome is the collapse of the respiratory tract with stopping
or weakening of breathing during sleep. It leads to the development of various metabolic and
vascular disorders. It is manifested by the presence of snoring, daytime sleepiness, fatigue, and
mood disorders [1].
10. Diseases of the cardiovascular system:
11. vascular atherosclerosis — deposition of cholesterol and other lipids in the walls of
the arteries;
12. Coronary artery disease is a partial or complete blockage of atherosclerotic plaques in
the arteries supplying blood to the heart.;
13. myocardial infarction — necrosis of the heart muscle due to acute blood flow
disorder;
14. stroke is an acute violation of cerebral circulation, etc. [10].
15. Increased blood clotting with the formation of blood clots, which can clog the lumen
of the vessels of various organs.
16. Oncological burden.
17. Endometrial hyperplasia is an overgrowth of the inner layer of the uterus. At the same
time, women with polycystic ovaries have an increased risk of developing endometrial cancer (2-
6 times), which often occurs before menopause. [1][4][12].
18. Depression, the main sign of which is a decrease in mood, self-esteem and the ability
to have fun.
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Therefore, patients with PCOS are recommended to be screened for anxiety and
depressive disorders. The Beck scale is the most convenient. Depending on the results, you may
need to consult a psychiatrist who will help you decide whether you need medication or
psychotherapeutic support.
The main cause of most of these complications is insulin resistance, which, in the case of
PCOS, is present in 95% of obese or overweight women, as well as in 75% of normal—weight
women [13]. It underlies the development of prediabetes, type 2 diabetes, obesity, hypertension
and hypercholesterolemia, which, in turn, lead to the development of cardiovascular diseases.
Thus, in the presence of insulin resistance, prediabetes can eventually develop in half,
and type 2 diabetes mellitus in a third of patients with polycystic ovaries [12]. Among other
things, insulin resistance in the case of PCOS is considered as a small trigger for the
development of Alzheimer's disease — senile dementia [12][14].
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