Marie did not have any menstruation for 6 months, Anne, for several years. Marie is 28 years old, she is a victim of hirsutism (a hyperpilosity, especially at the level of the ventral line). Anne, 27, had episodes too when she is rather hairless. She also has weight problems.

Chronic fatigue, acne in the back, mood swings, glucose intolerance, pre-diabetes, probable difficulties to have children, presence of numerous follicles on the ovaries ... So many symptoms, very different according to the women, the syndrome polycystic ovaries (PCOS, PCOS in English). Anne and Marie are both affected and both face difficulties in their medical follow-up.

And for good reason. In France, there are only three specialists in the syndrome. Professor Michel Pugeat, an endocrinologist in Bron (69), has worked his entire career on the latter and was part of the 2003 consensus of Rotterdam that attempted to define the PCOS. It enlightens us on this pathology *.

What is polycystic ovary syndrome?

Polycystic ovary syndrome is difficult to understand. The specialists initially thought that it was a genetic disease. The Médigène project , which ends in 2016, should also shed light on the genetic issue around the PCOS.

The syndrome was identified in the 1930s by two surgeons: Stein and Leventhal - who also gave their name. They found ovaries larger than normal and operated on them, observing follicles there, and confusing them with cysts. These follicles are very active in the production of androgens but do not lead to ovulation and do not produce estrogen. This disrupts the menstrual cycle, and thus ovulation.

"This syndrome is difficult for women to live because it deeply attacks femininity," explains Professor Michel Pugeat. It is declared either at puberty, after pregnancy or following a cessation of the contraceptive pill.

The symptoms that must alert

Professor Michel Pugeat wants to reassure women: "PCOS is completely reversible. That's why we talk about a syndrome and not an illness. As can be seen from the testimonials of Anne and Marie, the symptoms are numerous and it is difficult to diagnose PCOS. This was the goal of the Rotterdam Consensus, which retained three signs:

• An irregular or absent menstrual cycle: this is known as amenorrhea (there is no more ovulation, therefore no rules)
• Clinical signs of androgen excess (often leading to increased hair growth or hirsutism), or increased circulating testosterone levels
• The discovery, during an endo-vaginal ultrasound scan, of about twenty micro-follicles, which have the effect of increasing the surface of the ovary

The Rotterdam Consensus considers that there is polycystic ovary syndrome when two of these three signs are united. When a woman has all three criteria, it is a severe form of PCOS. There are 4 "phonetypes", 4 combinations of the syndrome. The most severe of these phonetypes is often accompanied by pre-diabetes, then weight gain and diabetes.

PCOS: what are the consequences for the body and health?

Women with polycystic ovary syndrome are faced with many changes in their intimacy, with the ovaries producing too much testosterone.

The rules disappear, the hair develops with a male topology (especially on the ventral line) - it is hirsutism. However, Professor Pugeat reassures: "With the syndrome, we talk about a testosterone production increased by 30%, but we remain very far from the values ​​of a man, who produces ten times more. There is no risk of virilization, where the voice, the musculature and the clitoris would be modified ... "

Acne is also a symptom, as is chronic fatigue, increased cholesterol and the risk of diabetes. If women with polycystic ovary syndrome have more difficulty getting pregnant, it is hypo-fertility, never infertility. Pr Pugeat reassures: "In reality, most women get pregnant without difficulty, they are accompanied and stimulated. "

A pathology that heals

The first stage of treatment is to regularize the menstrual cycle. "When there is a desire for pregnancy, we give progesterone to restore cycles," says Pr Pugeat. Then, when the patient is pregnant, one is very attentive to the metabolism because it is more likely to develop a gestational diabetes. "

To combat hair, there are treatments that rest the ovaries: we give for it a pill - usually 2nd generation, or anti-androgenic treatments. These are long-term protocols. Professor Pugeat regrets that there is no real consensus in Europe about the treatments to be given, nor good communication about polycystic ovary syndrome.

This is also what Marie and Anne noticed. Marie, who has - in addition - a problem of intolerance to hormones, finds herself unable to take the pill. If his gynecologist already speaks to him about PMA, Professor Pugeat has a more reassuring speech and does not exclude a natural pregnancy.

For her part, Anne was entitled to hormone treatment, but home, the most serious symptom is obesity. This syndrome transformed her physically, but also mentally: "My relatives told me that for about 6 months, they did not recognize me anymore, I was still angry, I got angry with a lot of people at that time , without really knowing why. Marie also has episodes of mood swings. Both have a history of cholesterol in their family ...

The importance of a healthy lifestyle to roll back PCOS

Polycystic ovarian syndrome affects between one in six women and one in twelve women in Europe. If the disease is endocrine, the metabolic "background" is also very important: a woman whose family is affected by diabetes, obesity or hypercholesterol will be more likely to be affected.

A healthy lifestyle and a balanced diet can reduce the onset of the syndrome, said Professor Michel Pugeat, who wants to reassure all women about the reversibility of the PCOS. Nevertheless, it is now necessary to inform about this syndrome, so that all Anne and Marie can get a real follow-up and answers to consider their future as a woman, and eventually as a mother.

* Thanks to Professor Michel Pugeat for his explanations, thanks to Anne and Marie for their testimony.