Polycystic Ovarian Syndrome
Polycystic ovarian syndrome (PCOS) is a disorder of the endocrine system, characterised by an imbalance in the secretion of female hormones that affects the ovaries and secondary sexual characteristics in women.
The female reproductive system is primarily made up of the ovaries, fallopian tubes, uterus (womb), cervix and vagina. At puberty, a monthly cycle follows; beginning with ovulation and ending with menstrual flow or period. Ovulation is the process by which a mature egg is released from an ovary into the fallopian tube so that it can be fertilised by a sperm and become implanted in the womb as a potential baby. In the absence of a sperm, the wall of the womb sheds its lining causing menstruation. This entire cycle is controlled by an interplay of hormones.
In cases of PCOS, adequate amounts of hormones for ovulation are not produced, leading to the formation of small fluid-filled cysts in the ovaries that produce high levels of androgens. These male hormones further disrupt ovulation and the menstrual cycle, and can produce secondary male characteristics.
The exact cause of PCOS is not known, but it may be due to an increased production of insulin, a low-grade inflammatory response by white cells or an inherited condition.
Polycystic ovarian syndrome has a negative impact on your self-image, and physical and psychological well-being. It can also affect your ability to conceive, with high chances of infertility.
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The symptoms of polycystic ovarian syndrome may show soon after puberty or later in your reproductive life, and may include irregular menstrual periods, acne, weight gain with inability to lose excess weight and scalp hair thinning. Male pattern distribution of body hair on your chest, back and face is characteristic of PCOS.
PCOS can be further classified as:
Mild: Normal mensuration and ovulation, but problems with conceiving and increased chances of spontaneous miscarriage
Moderate: Irregular or absence of menstruation, and failure to ovulate
Severe: Amenorrhea, infertility, excessive growth of facial hair and obesity
PCOS is diagnosed if you have any two of the following symptoms: irregular periods, elevated androgen levels and/or multiple ovarian cysts (polycystic ovaries). Your doctor will review your medical history, family history, and duration and frequency of your menstrual cycles. Diagnostic tests may also include a general physical exam and a pelvic exam to examine your reproductive organs for increased size, or presence of growths or abnormalities. Blood tests may be required to measure levels of the hormones insulin and androgen, and cholesterol. An ultrasound may be ordered to examine the ovaries and the lining of the uterus for any abnormality.
If left untreated polycystic ovarian syndrome may cause complications such as diabetes, abnormal cholesterol levels, heart diseases, nonalcoholic steatohepatitis (accumulation of fat in the liver), infertility, gestational hypertension and diabetes, endometrial cancer, and abnormal uterine bleeding.
PCOS is a chronic condition that cannot be cured, but can be managed. Treatment is usually symptomatic and may include:
Weight loss through diet and exercise
Medications, such as birth control pills and progesterone therapy, to regulate the menstrual cycle
Oral medication to lower insulin levels in the blood and improve insulin resistance
Anti-oestrogen medication along with luteinizing hormones and follicle-stimulating hormones to stimulate ovulation for conception
Medication to treat male pattern baldness
Medicated creams to slow facial hair growth in women
Surgical ovarian drilling to reduce the production of androgens
In vitro fertilisation to improve fertility
Early diagnosis improves your chances of managing polycystic ovarian disease, avoiding complications and achieving pregnancy. One should observe a healthy life style with proper nutrition, regular exercise program and avoid smoking.
Extensive research is being done in the treatment of polycystic ovarian syndrome. This includes:
Badawy A, Elnashar A. Treatment options for polycystic ovary syndrome. Int J Womens Health. 2011 Feb 8;3:25-35.
Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013 Dec 18;6:1-13.