Hormonal Disorders in Women of Reproductive Age - Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a common chronic hormonal and primarily metabolic disorder, characterized mainly by menstrual irregularities (oligomenorrhea – anovulation), elevated androgen levels in the blood and/or increased hair growth (hirsutism). Insulin resistance is considered a key underlying factor contributing to these hormonal and metabolic disturbances.
Polycystic ovary syndrome (PCOS) affects 10–13% of women of reproductive age and has a genetic basis. However, it appears that approximately 70% of women worldwide are unaware that they have the syndrome. It is the most common cause of anovulation and, through this mechanism, can significantly affect fertility. PCOS may also continue to affect women beyond their reproductive years, increasing the risk of developing type 2 diabetes mellitus, obesity, and endometrial hyperplasia. There is currently no definitive cure for PCOS; however, lifestyle modifications (maintaining an ideal body weight and regular physical activity), as well as medications that improve insulin resistance (such as metformin), can help improve symptoms. Regarding fertility, restoration of ovulation when needed, along with assisted reproductive techniques, can provide very good outcomes.
Menstrual Disorders
Menstrual disorders are quite common, affecting approximately 14–25% of women of reproductive age. The category of menstrual disorders includes painful menstruation (dysmenorrhea), heavy menstrual bleeding (menorrhagia) (menorrhagia/hypermenorrhea), absence of menstruation (amenorrhea), which can be primary or secondary, prolonged intervals between menstrual periods (oligomenorrhea), short menstrual cycles or frequent menstruation (polymenorrhea), light or shortened menstrual bleeding (oligomenorrhea hypomenorrhea), severe physical and psychological symptoms before menstruation (premenstrual syndrome), irregular menstrual cycles (cycles that vary in frequency and duration).
The causes of these disorders vary and differ depending on the woman’s age. They may include hormonal disturbances (related to the secretion and metabolism of estrogen and progesterone, thyroid dysfunction, or abnormalities in prolactin secretion), polycystic ovary syndrome, endometriosis, severe stress, weight loss, poor nutrition, intense physical exercise, lifestyle factors (such as alcohol consumption), fibroids, polyps, ovarian cysts, pregnancy, and perimenopause/menopause.
Menopause
Menopause marks the end of a woman’s reproductive life and is associated with the cessation of ovarian function, resulting in a decline in circulating estrogen levels. Perimenopause is defined as the period that begins with the first menstrual irregularities and ends one year after the final menstrual period, when menopause is established. Perimenopause may last for several years and can affect a woman’s physical, psychological, cognitive, and social well-being. The average age of menopause is between 45 and 55 years.
In some women, menopause may occur earlier, before the age of 40 (premature ovarian insufficiency), while in others it may result from surgical procedures or medical treatments. The main symptoms of menopause include hot flashes, night sweats, sleep and concentration disturbances, irritability, anxiety, depression, fatigue, joint pain, headaches, weight gain and changes in fat distribution (particularly around the abdomen), vaginal dryness, pain during sexual intercourse, reduced libido, increased urinary frequency, and even urinary tract infections. As the proportion of women experiencing menopause continues to increase, there is growing scientific interest in improving women’s quality of life during this stage through the development of treatments and new therapeutic options that are increasingly being incorporated into clinical practice.