Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOs) is a common disorder of the endocrine system that affects the reproductive system (particularly ovaries) of a female. Polycystic ovary syndrome (PCOs) is a common disorder of the endocrine system that affects the reproductive system (particularly ovaries) of a female. It is characterized by elevated blood androgen (male hormones) in females. This hormonal imbalance leads to irregular monthly cycles, excessive hair growth on the skin, acne, and infertility.

The exact cause of PCOs is still unknown. Early diagnosis and effective treatment along with weight loss may reduce the risks of long term complications such as infertility, type 2 diabetes, and heart diseases.

Polycystic Ovaries

Polycystic ovaries contain a large number of harmless follicles (size 8mm or larger) in one or both ovaries. Follicles are small sac-like structures within ovaries in which ova develop and one is released in each cycle at ovulation. In PCOS, follicles are unable to release an egg and ovulation is inhibited.

Almost one in every five women is a victim of PCOS and half of them are asymptomatic! 

Who Is at the Risk of PCOs?

Approximately 5-10% of women between the age of 15 to 44 (childbearing age) are a victim of PCOS. Since, most women are diagnosed with PCOS in their 20s and 30s, they have problems getting pregnant. However, PCOS can occur at any age after puberty.

Women of all races and ethnicities are prone to the disease. The risk factors are greater for obese individuals.

Signs and Symptoms

Common signs and symptoms of PCOS include:

  1. Menstrual disorders: PCOs lead to oligomenorrhea ( less than the normal number of monthly cycles), or amenorrhea (complete absence), both types of disorders may occur in the same individual.
  2. Infertility which results from chronic anovulation (absence of ovulation)
  3. High level of masculine hormones (hyperandrogenism): Common signs are acne, hypermenorrhea, hirsutism (male pattern of hair growth on chin or chest), androgenic alopecia (hair thinning or diffused hair loss) and hyperandrogenemia.
  4. Metabolic disorder: It appears as a tendency towards central obesity and other symptoms associated with insulin resistance, increased appetite and an inclination towards fatty foods such as chips, burgers, pizza, fries etc.

Other common symptoms include skin tags, acne, oily skin, dandruff, hair loss, male pattern balding, pelvic pain, high level of triglycerides in the blood, skin tags and infertility.

Asian women are less likely to develop hirsutism than other ethnic backgrounds. PCOS increases the tendency towards central obesity but there are conflicting facts about whether visceral or subcutaneous abdominal fat is increased, unchanged or decreased in women.

Causes of Polycystic Ovary Syndrome

It is a heterogeneous disorder with uncertain causes, but there is some evidence that it is a genetic disorder which comes from familial clustering of cases, greater incidence in monozygotic compared with dizygotic twins and heritability of endocrine and metabolic features of PCOS. Some clinical evidence indicates that exposure to higher than normal levels of androgens and anti-Mullerian hormone (AMH) in fetal life increases the risk of developing PCOS.

Diagnostic Tests

There is not a single specific test to detect the presence of PCOS but the condition can be diagnosed by medical history, physical exams (including pelvic exam) and blood tests to check levels of different hormones, cholesterol, and glucose.

A transvaginal ultrasound is also advised to observe the uterus and ovary closely.

Treatment of PCOS

The primary treatment aims at improving lifestyle and eating habits. Aims of treatment can be classified as follows:

•    Lowering the insulin resistance level

•    Treatment of hirsutism and acne

•    Restoration of normal reproductive activity and monthly cycles

•    Prevention of endometrial hyperplasia

•    To reduce the risk factors of endometrial cancer

•    Restoration of fertility

There is no specific treatment or cure for PCOS; weight loss, balanced diet and exercise can make the symptoms better.

Surgical Treatment

If fertility medications are ineffective, a simple surgical procedure called laparoscopic ovarian drilling (LOD) is recommended. It involves the use of heat or laser technology to destroy the defective tissues in the ovaries that are producing androgens such as testosterone.

General interventions for weight management and insulin resistance can be beneficial in the treatment of the disease. PCOS is known to cause significant emotional distress and may lead to depression, so appropriate psychological support is required.

Diet

Since PCOS is associated with weight gain or obesity, successful weight loss is the most effective way to restore normal ovulation but patients find it difficult to achieve or sustain normal body weight. A low carb-diet with a large intake of fruits, vegetables, and whole grains is helpful in disease management.

Medications

The prescribed medicines commonly include oral contraceptives and metformin. Oral contraceptives reduce the tendency of hirsutism caused by high testosterone and help in the regulation of normal menstrual cycles. However it becomes difficult for a PCOS patient to conceive because it causes irregular ovulation.

Prognosis

Diagnosis of PCOS suggests an increased risk of the following disorders:

•    Insulin resistance/type II diabetes

•    Gestational diabetes

•    High blood pressure particularly in obese and pregnant women

•    Endometrial hyperplasia

•    Endometrial/cervical cancer

•    Hyperandrogenism

•    Hyperinsulinemia

•    Depression and anxiety

•    Dyslipidemia (disorder of lipid metabolism)

•    Atherosclerosis and arteriosclerosis

•    Cardiovascular diseases including angina and myocardial infarction

•    Stroke

•    Weight gain

•    Miscarriage

•    Sleep apnea particularly in obese individuals

•    Nonalcoholic fatty liver disease

•    Autoimmune diseases including thyroiditis

•    Miscarriage

•    Acanthosis nigricans (patches of dark skin in underarms, groin and back region)

The risk of ovarian cancer and breast cancer does not increase significantly.

Conclusion

PCOS poses a serious threat to women’s health and can lead to a number of serious diseases. Visit a primary care center for regular screening to diagnose the disease at its earliest possible stage.

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