Polycystic Ovarian Syndrome

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Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. Women with this condition have an imbalance of the female hormones that prevent their ovaries from releasing an egg every month and the many unreleased eggs in the ovaries resulting in the characteristic polycystic appearance of the ovaries. This made women with PCOS have difficulty in conception and low, irregular, or absent periods. Other common symptoms and signs are excessive male pattern hair growth, acne, weight gain, and obesity. Patients with these signs can consult a doctor to seek treatment and reduce bothersome symptoms.

What is PCOS?

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, affecting about 10% of women in this age group. It is not known why some women develop the syndrome although it is likely to be a genetic disorder. The word ‘polycystic’ means many cysts and women with this condition have several cysts in their ovaries. Women with this condition have an imbalance of the female hormones that prevents their ovaries from releasing an egg every month and the many unreleased eggs in the ovaries result in the characteristic polycystic appearance of the ovaries. Since both fertility and a normal menstrual cycle rely on a regular release of an egg each month from the ovary, these women have difficulty in conception and low, irregular, or absent periods. Many women with PCOS also tend to produce too much male hormone (which normally all women produce in small quantities) which results in male pattern hair growth, for example on the chin, chest inner thighs etc., and the formation of acne. These women tend to gain weight quite rapidly and obesity makes the hormonal imbalance worse.

 What are the symptoms and signs of PCOS?

Signs and symptoms of PCOS may include:

  • Infrequent or absent periods
  • Infertility and Miscarriage
  • Acne
  • Excess body hair
  • Scalp hair loss
  • Weight gain and obesity
  • High blood pressure
  • Elevated insulin levels and diabetes
  • Slightly enlarged ovaries containing at least ten cysts 2-8mm in diameter

What are the risk factors of PCOS?

  • PCOS tends to run in families, but little is known about its cause or how it passes from one generation to the next.
  • Researchers believe that stress and environmental factors (including diet, exercise, and pollution) play a role in the development of PCOS. Other possible causes include excessive prenatal exposure to androgen/testosterone and excessive insulin production.

How is PCOS diagnosed?

The doctor may suspect that polycystic ovarian syndrome is the cause from the symptoms listed above. Hormonal blood tests and a pelvic ultrasound scan are used to confirm the diagnosis.

How to treat PCOS?

Although PCOS is not completely reversible, there are several treatments that can reduce or minimize bothersome symptoms.

  • Lifestyle measures: There is some evidence to show that reduction of excess weight can improve most of the problems related to PCOS by helping to restore the normal hormone balance, since fat plays a part in the production of certain hormones.

The treatment varies depending on which aspect the woman finds most troublesome:

  • Irregular periods: The usual treatment is the oral contraceptive pill which will almost always restore regular periods. This treatment is obviously not suitable for women trying to conceive.
  • Infertility: Ovulation can be induced artificially using medications. The most used drug is clomiphene. If the tablets fail, hormone injections can be used to stimulate the ovaries. In selected cases where the women are unresponsive to medical treatment, surgery in the form of laparoscopic ovarian drilling can be used to diathermies part of the ovary, thereby correcting the hormonal imbalance, and allowing ovulation to occur.

  • Excessive hair growth: Local techniques such as depilatory creams, shaving, waxing, bleaching, plucking and electrolysis may prove useful but need to be repeated. Suppression of male hormone production with tablets such as the oral contraceptive pill or an anti-male hormone drug may reduce excessive hair growth if used for at least 9 months. Laser hair removal is the best available long-term method and may be performed if the other modalities do not help.

  • Obesity: A change in lifestyle, paying particular attention to diet and exercise can help weight loss.

Other medications used to treat PCOS include:

  • Metformin and other insulin-sensitizing drugs – Metformin improves the effectiveness of insulin produced by the body. It is used to treat the insulin abnormalities associated with PCOS in selected patients. This medication can decrease the ovary’s production of androgens and restore the body’s normal hormone balance resulting in improvement of some signs and symptoms of PCOS.

References:

1.polycystic ovarian syndrome, https://www.nuh.com.sg/Health-Information/Diseases-Conditions/Pages/Polycystic-Ovary-Syndrome.aspx

  1. polycystic ovarian syndrome (PCOS), https://nwhn.org/polycystic-ovary-syndrome-pcos

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