Polycystic Ovary Syndrome (PCOS)

What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a disease of the ovaries in which there is a hormonal imbalance which affects the ability to conceive but also impacts on other systems throughout the body. It is marked by higher than normal androgen (male hormone) levels in females. The condition is seen primarily in the ovulation period prior to menstruation during the reproductive years of life. The ovaries may be seen containing multiple cysts hence the name polycystic ovarian syndrome. However, at times there may be no cysts despite the condition being present. Early diagnosis and treatment of PCOS reduces the risk of long-term complications such as diabetes, heart disease or high blood pressure.

What are the symptoms of PCOS?

The main symptoms of the PCOS are:

  • Change in frequency of menstruation or absent menstruation. Menstruation can be prolonged to more amounting to less than 8 per year or even may be absent for months.
  • Menstrual bleeding may be prolonged or sometimes scanty.
  • Symptoms of excess androgen levels such as facial and body hair growth (hirsutism) or male pattern baldness or acne.
  • Ovaries contain small cysts seen on ultrasound.
  • Obesity or unexplained weight gain.
  • Difficulty in falling pregnant.

The signs and symptoms usually begin at the time when the menses start in young girls – at menarche. Sometimes it may start later in life within the reproductive period of a woman’s life, secondary to factors such as obesity. Signs and symptoms can vary from person to person. Menstrual problems, hirsutism and polycystic ovaries are the most common symptoms and at least two of these need to be present to reach the diagnosis.

Some of the complications are:

  • Type 2 diabetes.
  • High blood pressure and high cholesterol which may lead to heart disease and stroke.
  • Fatty deposition in liver.
  • Abnormal uterine bleeding.
  • Uterine cancer.
  • Gestational diabetes and high blood pressure during pregnancy.

What causes polycystic ovary syndrome?

No known cause has been identified for PCOS. Excess insulin and high levels of androgens are believed to be the cause of the disease. Some people exhibit resistance to insulin. In such cases more insulin is required for adequate absorption of glucose by the body cells. The pancreas secrete excessive insulin to meet this requirement. This has an adverse effect on the ovaries which secrete excessive androgens thereby producing symptoms such as hirsutism. Women with a family history of polycystic ovary syndrome are at a greater risk although a definitive genetic link has not as yet been conclusively identified.

How is polycystic ovary syndrome treated?

Pelvic examination, ultrasound and blood tests help in the diagnosis. The treatment is directed mainly towards treatment of symptoms initially. These symptoms can severely affect the patient’s quality of life and self esteem.  Irregular menstrual cycles are regulated with the use of low dose birth control pills which contain estrogen and progesterone. Along with drugs to control insulin resistance, the cysts may shrink and the condition can resolve. Surgery may at times be necessary to remove the cysts along with healthy ovarian tissue.

Medication that may be used specifically for polycystic ovary syndrome includes :

  • Metformin which reduces insulin levels thus improving ovulation and slows the progression of diabetes.
  • Clomiphene citrate is used to stimulate ovulation.
  • Gonadotropins such as follicle stimulating hormone, luteinizing hormone if the above drugs are not helpful.
  • Spironolactone to control hirsutism.

Surgical intervention in the form of ovarian resection or drilling is performed in patients in whom medication treatment does not help the patient conceive.

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