Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder and one of the common causes of infertility among women.

It is characterized by an ovulation dysfunction or impedance to the normal growth and release of eggs from the ovaries. It is commonly seen in women of childbearing age and is rare after menopause.

The hormonal imbalance results in enlarged ovaries containing several small cysts (fluid-filled sacs).

Causes of Polycystic Ovarian Syndrome (PCOS)

The exact cause of polycystic ovarian syndrome is unknown. However, several factors including genetics have been implicated to play a role in the development of PCOS.

Women with a family history of polycystic ovarian syndrome are at a higher risk of developing this condition.

Researchers have also found an association between excessive hormone production and development of PCOS. Hormone regulates blood sugar levels and any disorder affecting the hormone mechanism may result in excessive hormone secretion, which triggers androgen secretion from the ovaries.

Low grade inflammation, in response to ingestion of certain foods, may lead to the release of substances that can cause hormone resistance and cholesterol accumulation in the blood vessels or atherosclerosis.

Clinical studies have demonstrated the presence of low grade inflammation in women with PCOS. Excessive exposure to the male hormone during the fetal period may disrupt the function of normal genes and increase the risk of hormone resistance and low grade inflammation.

Symptoms of Polycystic Ovarian Syndrome (PCOS)

The symptoms of polycystic ovarian syndrome vary from person to person and depend upon the nature and severity of the condition.

Some of the symptoms of PCOS include

infertility,
absent or irregular menstrual cycle,
obesity or accumulation of fat usually around the waist,
abnormal facial and body hair,
adult acne, and
male pattern baldness or hair thinning may develop due to excessive androgen secretion.

In some patients black or dark brown patches are seen around the skin of the neck, arm, breasts or thighs. Patients often experience anxiety or depression and breathlessness during sleep.

Diagnosis of Polycystic Ovarian Syndrome (PCOS)

The diagnosis of polycystic ovarian syndrome is based on the medical history along with a physical and pelvic examination to evaluate the condition of the patient and help identify the underlying cause.

Test conducted could include:

blood tests are conducted to determine the level of various hormones.
glucose tolerance test and
evaluation of blood cholesterol may also be conducted.
pelvic ultrasound is performed to evaluate the appearance of the ovaries and the uterine lining.

Treatments for Polycystic Ovarian Syndrome (PCOS)

The treatment of polycystic ovarian syndrome is based on the symptoms and individual concerns.

if the aim is to conceive, then the treatment is directed towards inducing and or regulating the ovulation by:

-Weight reduction by 5% of body weight in overweight patients can regain ovulation and menstrual rythm.

-conventional drugs like Clomiphene citrate, or Letrozole that help induce or regulate ovulation, sometimes are also given with Metformin ( sugar uptake enhancer)

-surgical treatment can be used for the management of PCOS. Laparoscopic ovarian drilling offers a similar outcome to the above drugs.

In patients not responding to the above pharmaceuticals and management, the doctor may consider follicle-stimulating hormone (FSH) administered by injection.

if the aim is not to conceive but to achieve a relief from PCOS symptoms

then the Oral contraceptives may be prescribed for the management of irregular menstrual cycles, effectively reducing the levels of male hormone and reducing excessive body hair growth and also minimising the risks of uterine cancer.

Lifestyle modifications and anti-diabetic medications may be prescribed for the management or prevention of obesity and diabetes mellitus.

Surgery may be recommended in patients who do not respond to medications. Laparoscopic ovarian drilling, an outpatient surgical procedure, may be used to treat the condition and induce ovulation.