POLYCYSTIC OVARIAN SYNDROME
Polycystic ovary syndrome (PCOS) is a condition that
affects a woman's hormone levels. Women
with PCOS produce higher-than-normal amounts of
male hormones. This hormone imbalance causes
them to skip menstrual periods and makes it harder
for them to get pregnant.
The polycystic ovarian syndrome ( PCOS ) is one of the most
common causes of an ovulatory infertility .the classification of
the disease is depend on both endocrine and clinical features
with a well known ultrasound ovarian morphology , obesity
,menstrual cycle abnormalities , hyperandrogenaemia ,
chronic anovulation ,abnormal secretion of gonadotrophin
and insulin resistance . ( PCOS ) is abnormal hormonal
disorder with a potential to lead to various disease . it is a
common cause of infertility among women (PCOS ) is affects
at least 7% of adult women, and family history of (PCOS) is
relatively common , obesity can be exacerbated by poor
dietary choices and physical inactivity is implicated in (PCOS) ,
infectious agents and toxins may also play a role .
It is also known as or Stein-Leventhal syndrome.
Symptoms include changes to the menstrual cycle
and excess hair growth. Untreated, it can lead
to infertility and other complications. The exact cause
is unknown.
Early diagnosis and treatment are recommended.
Weight loss may also decrease the risk of associated
health risks, such as insulin resistance, type 2
diabetes, high cholesterol, heart disease, and high
blood pressure.
What are the symptoms of PCOS?
The symptoms of PCOS may include:
Missed periods, irregular periods, or very light
periods
Ovaries that are large or have many cysts
Excess body hair, including the chest, stomach,
and back (hirsutism)
Weight gain, especially around the belly
(abdomen)
Acne or oily skin
Male-pattern baldness or thinning hair
Infertility
Small pieces of excess skin on the neck or
armpits (skin tags)
Dark or thick skin patches on the back of the
neck, in the armpits, and under the breasts
(PCO) are morphological ovarian phenotype in women with
the polycystic ovary syndrome and this morphology was
defined as an ovary with 12 or more follicles measuring 2-9
mm in diameter and or increased ovarian volume ( ˃ 10 cmᶾ ) .
Hyperandrogenism , a clinical hall mark of ( PCOS ) can cause
inhibition of follicular development , micro cysts in the ovaries
, anovulation and menstrual changes .
What are the complications of PCOS?
Women with PCOS are more likely to develop certain
serious health problems. These include type 2
diabetes, high blood pressure, problems with the
heart and blood vessels, and uterine cancer. Women
with PCOS often have problems with their ability to
get pregnant (fertility).
Diagnosis criteria
A diagnosis of PCOS can usually be made if other rare
causes of the same symptoms have been ruled out
and you meet at least 2 of the following 3 criteria:
you have irregular periods or infrequent periods
–
this indicates that your ovaries do not regularly
release eggs (ovulate)
blood tests showing you have high levels of "male
hormones", such as testosterone (or sometimes
just the signs of excess male hormones, even if
the blood test is normal)
scans showing you have polycystic ovaries
As only 2 of these need to be present to diagnose
PCOS, you will not necessarily need to have an
ultrasound scan before the condition can be
confirmed.
Physical Exam
Your doctor may check your blood
pressure, BMI (body mass index), and waist
size. She may also look at your skin to check
for extra hair growth, acne, and discolored
skin, which can all happen if you have PCOS.
The ultrasound helps visualize these changes in more
than 90% of women with PCOS, but they are also
found in up to 25% of women without PCOS
symptoms. Laparoscopy may be used to evaluate
ovaries and sometimes used as part of surgical
treatment.
Laboratory Tests
A few blood tests for hormones may be used to aid in
the diagnosis of PCOS:
– this is often the initial test to
determine whether you are producing excess
androgens. The level is usually elevated with
PCOS.
Sex hormone binding globulin (SHBG)
– may be
reduced in PCOS
– an increased
level is often seen with PCOS
Some secondary tests may be done, such as:
Follicle stimulating hormone (FSH)
– will be
normal or low with PCOS
– will be elevated
– may be normal or elevated
– may be elevated
– may be elevated
A few tests may help rule out other conditions with
similar signs and symptoms:
Thyroid-stimulating hormone (TSH)
– to rule out
– to rule out Cushing syndrome
– to rule out elevated prolactin
(hyperprolactinemia)
– to rule out the most
common form of congenital adrenal hyperplasia
Human chorionic gonadotropin (hCG)
– to rule
out pregnancy
– to rule out excess growth hormone (which
may cause acromegaly)
If you are diagnosed with PCOS, some blood tests
may be done to check and monitor your general
health and detect any complications that might
develop:
– to help determine risk of
developing cardiovascular disease; risk is
associated with a low HDL, high LDL, high total
cholesterol and/or elevated triglycerides
– can be used to screen for,
diagnose and monitor diabetes
What's the Treatment for PCOS?
One of the best ways to deal with PCOS is to
eat well and exercise regularly.
Many women with PCOS
are overweight or obese. Losing just 5% to
10% of your body weight may ease some
symptoms and help make your periods more
regular. It may also help manage problems
with blood sugar levels and ovulation.
Medications
A number of medications are available to treat
different symptoms associated with PCOS.
These are described below.
Irregular or absent periods
The contraceptive pill may be recommended to induce
regular periods, or periods may be induced using
an intermittent course of progestogen tablets (which
are usually given every 3 to 4 months, but can be
given monthly).
This will also reduce the long-term risk of
developing cancer of the womb lining (endometrial
cancer) associated with not having regular periods.
A medication called clomifene is usually the first
treatment recommended for women with PCOS who
are trying to get pregnant.
Clomifene encourages the monthly release of an egg
from the ovaries (ovulation).
Metformin is often used to treat type 2 diabetes, but it
can also lower insulin and blood sugar levels in
women with PCOS.
As well as stimulating ovulation, encouraging regular
monthly periods and lowering the risk of miscarriage,
metformin can also have other long-term health
benefits, such as lowering high cholesterol levels and
reducing the risk of heart disease.
If you're unable to get pregnant despite taking oral
medications, a different type of medication
called gonadotrophins may be recommended.
These are given by injection. There's a higher risk that
they may overstimulate your ovaries and lead to
multiple pregnancies.
Letrozole is sometimes used to stimulate ovulation
instead of clomifene
Unwanted hair growth and hair loss
Medications to control excessive hair growth
(hirsutism) and hair loss (alopecia) include:
particular types of combined oral contraceptive
tablets (such as co-cyprindiol, Dianette, Marvelon
and Yasmin)
cyproterone acetate
spironolactone
flutamide
finasteride
These medications work by blocking the effects of
"male hormones", such as testosterone, and some
also suppress production of these hormones by the
ovaries.
If you have unwanted hair growth, you may also want
to remove the excess hair by using methods such as
plucking, shaving, threading, creams or laser removal
Even after making lifestyle changes, some women still
experience infrequent ovulation. In these cases,
women may choose in vitro fertilization (IVF) to help
with conception. The initial therapy involves taking
a drug to stimulate ovulation.
In women with PCOS, the ovaries may develop a thick outer
surface that can affect ovulation. Ovarian drilling breaks
through a thick outer layer and boosts fertility. Many
women ovulate more regularly after ovarian drilling since
testosterone production is directly affected. Contrary to the
scary name, Ovarian Drilling is actually a relatively simple
and minimally invasive procedure
laparoscopic ovarian drilling is a
surgical treatment that can trigger ovulation in women
who have polycystic ovary syndrome (PCOS).
Electrocautery or a laser is used to destroy parts of
the ovaries.