POLYCSYTIC OVARIAN  SYNDROME (PCOS)

It is found in approximately 15% of women in childbearing age. It is diagnosed by two of the following three criteria:

• Oligomenorrhea ( Infrequent menstruation) or amenorrhea(absence)

• Clinical or Laboratory findings and symptoms of elevated Testosterone levels (Hirsutism, acne, male pattern hair loss)

• 12 or more antral follicles with a diameter of 2-9 mm in one ovary

The main problem is deviations in testosterone level and metabolism. This is the most prominent in the ovarian tissue. Accompanying insulin resistance and changes in fat metabolism increase the risk of long-term cardiovascular disease. This is called Metabolic Syndrome. In this respect, PCOS is an important public health problem in terms of long-term results.

Treatment decision should be made according to the patient's complaints and clinical findings. A significant proportion of women with typical PCOS have excess weight. Lifestyle change, weight loss, proper nutrition program and exercise are the basis of managing the disease. In addition, the basic treatment principles are as follows;

• Menstrual irregularity and / or Hirsutism:  Loss of  15% of body weight usually helps for regular menstruation. . If this is not the case, Birth Control Pills may be the number one treatment option. In cases where insulin resistance is accompanied, we can start medications used in the treatment of Type 2 Diabetes such as Metformin.

• In cases where Hirsutism is the major complaint destruction of hair follicles  could  be considered several energy modalities (Laser Hair Removal). Birth Control Pills are also effective for hair growth, but this effect is observed as long as it is used. When the drug is discontinued, it usually returns to its original state

• Infertility: PCOS is the leading cause of  ovulation problems seen in inertile women. If there is weight excess, trying to give weight may help in some cases. Ovulation induction with oral agents such as Letrozole or Clomiphene Citrate achieves ovulation in 80% of casese. In patients with  insulin resistance, addition of Metformin to treatment positively affects the response. Gonadotropin therapy should be tried if ovulation and pregnancy are not achieved with oral treatments. If no results can be obtained, IVF should be performed

• Ovarian Drilling (Ovarian Diathermy): Drilling small holes on the surface of  the ovaries in cases that do not respond to first-line treatment . With the hormonal changes caused in the ovaries, we expect bothspontaneous  ovulation and better response to the following  treatment. This effect can continue for many years.  It is a surgical procesure and there are some doubts about long term results regarding prematüre ovarian failure. My personal experience is that Drilling is more effective in PCOS cases and it can be applied more frequently. The procedure is performed in a very short time. The patient is discharged on the same day. Short and long term risks in experienced hands are very low. It is important to use appropriate equipment and energy methods.