Polycystic Ovary Syndrome

Article Context:

1. Polycystic Ovary Syndrome
2. Causes
3. Symptoms
4. Diagnosis
5. Treatments
6. Preventions
7. Frequently Asked Questions

What is PCOS?

Pathophysiology of PCOS

Large numbers of small, cyst-like ovarian follicles are resistant to normal growth signals and therefore are unable to release eggs. Luteinizing hormone (LH), androgen, and insulin levels may be elevated and can correlate with acne, excess hair growth, abnormal blood sugar metabolism, or diabetes.

What Causes PCOS?

• It has been demonstrated that the ovaries of women with PCOS may produce excessive amounts of male hormones, or androgens, causing disruptions in the menstrual cycle and impaired fertility.
• Insulin resistance or an impaired utilization of insulin is likely related to PCOS.
• The presence of small cysts in the ovaries are not specific to PCOS, as women without PCOS may have ovarian cysts. As a result, cysts are unlikely to be the cause of PCOS symptoms.

What are the Symptoms of PCOS?

• Acne
• Weight gain
• Pelvic pain
• Infertility
• Depression
• Hair loss
• Excess hair on the face and body
• Decrease in breast size

PCOS signs and symptoms frequently appear shortly after a woman begins her first menstrual cycle. Sometimes, it appears later in life during the reproductive years as a result of weight gain or other medical conditions. Though the type and severity of symptoms may vary from woman to woman, irregular menstrual periods are the most common feature of PCOS. But the other symptoms include:

• Acne: Excess androgens can also lead to acne and male pattern balding.
• Obesity-PCOS is also associated with insulin resistance, weight gain, and obesity. According to reports, approximately one-half of women with PCOS are obese. Insulin resistance, accompanied by elevated blood insulin levels, occurs in the majority of women with PCOS, regardless of obesity. PCOS is associated with risk of developing type 2 diabetes in women.
• Pelvic pain
• Infertility-Menstrual cycles may be normal at first and then become irregular. The menstrual irregularities in PCOS women are accompanied by a lack of ovulation, and the women may experience infertility.
• Depression
• Hair loss
• Excessive hair on the face and body: In PCOS, an increase in androgen (male hormone) production by the ovaries may result in excess hair growth in areas resembling a male pattern, a condition known as hirsutism. Thick hair growth occurs on the upper lip, chin, around the nipples, and on the lower abdomen.
• Decrease in breast size
• Absence or reduction in ovulation
• Uterine bleeding: Women suffering from PCOS have lower levels of the hormone progesterone (normally produced in the second half of the menstrual cycle). This can stimulate the growth of the endometrium (uterine lining tissues), resulting in dysfunctional uterine bleeding and breakthrough bleeding. Increased endometrial stimulation in the absence of progesterone production is a risk factor for the development of endometrial hyperplasia and uterine cancer.

Complications:

• Infertility
• Gestational diabetes or pregnancy-induced high blood pressure
• Miscarriage or premature birth
• Nonalcoholic steatohepatitis: Severe liver inflammation due to fat accumulation in the liver
• Metabolic syndrome: High blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels which significantly increase the risk of cardiovascular problems and type 2 diabetes or prediabetes.
• Sleep apnea
• Depression, anxiety, and eating disorders
• Abnormal uterine bleeding
• Cancer of the uterine lining (endometrial cancer)

How is PCOS Diagnosed?

• Blood tests to measure sex hormone levels
• Thyroid function tests
• Fasting glucose tests
• Lipid level tests

There's no test to definitively diagnose PCOS. A physical exam is done for signs of excessive hair growth, insulin resistance, and acne.
Pelvic exam: Examines reproductive organs manually for masses, growths, or other abnormalities.

Blood tests: Hormone levels in the blood can be measured. This testing can rule out potential causes of menstrual irregularities or androgen excess that mimics PCOS.

Additional blood tests will be performed to assess glucose tolerance as well as fasting cholesterol and triglyceride levels.

Ultrasound: To examine the appearance of ovaries and the thickness of the lining of the uterus.

How is PCOS Treated?

• Prescribing birth control pills to regulate menstruation
• Anti-hair growth medications
• Inducing ovulation to treat infertility
• Medication to block the excess production of androgens
• Treatment for acne
• Treating other skin problems associated with PCOS
• Medication to lower the insulin levels

There is no cure for PCOS, but it can be treated. The treatment for PCOS starts with the proper diagnosis and is based on the woman’s symptoms, age, and future pregnancy plans. PCOS treatment focuses on managing individual symptoms, such as infertility, acne, hirsutism, or obesity. Specific treatment might involve lifestyle modifications or medication.

Lifestyle changes

Recommend losing weight through a low-calorie diet combined with moderate exercise.

Medications:

(a) To regulate the menstrual cycle:

• Combination birth control pills: Estrogen and progestin-containing pills reduce androgen production and regulate estrogen.
  Regulating hormone levels can lower the risk of endometrial cancer and correct abnormal bleeding, excess hair growth, and acne.
  Instead of pills, use an estrogen and progestin-containing skin patch or vaginal ring.
• Progestin therapy: Progestin, taken for 10 to 14 days every one to two months, can help regulate periods and protect against endometrial cancer. Progestin therapy has no effect on androgen levels and will not prevent pregnancy. If you also want to avoid pregnancy, a progestin-only minipill or a progestin-containing intrauterine device is a better option.

(b)To help for ovulation:

• Clomiphene: This anti-estrogen medication is taken orally during the first half of the menstrual cycle.
• Letrozole: This breast cancer treatment can work to stimulate the ovaries.
• Metformin: This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels.
• Gonadotropins: These hormone medications are administered via injection.

(c) To reduce excessive hair growth:

• Birth control pills: These pills reduce androgen production, which can cause excessive hair growth.
• Spironolactone: This medication inhibits androgen's effects on the skin. Because spironolactone can cause birth defects, it is necessary to use effective contraception while taking this medication. It is not advised during pregnancy or when planning to become pregnant.
• Eflornithine: This cream can slow facial hair growth in women.
• Electrolysis: Each hair follicle is pierced with a fine needle. The needle emits an electric current pulse that damages and eventually destroys the follicle. So might need multiple treatments.

(d)Lifestyle and home remedies:

• Maintain a healthy weight: Weight loss can lower insulin and androgen levels, potentially restoring ovulation.
• Limit carbohydrates Diet: Low-fat, high-carbohydrate diets might increase insulin levels. Choose complex carbohydrates, which raise blood sugar levels more slowly. Exercise helps lower blood sugar levels.

How can PCOS be Prevented?

• A healthy diet, low in refined carbohydrates and fats with high protein helps to regulate the blood sugar levels.
• Being physically active regulates the levels of insulin and keeps excess weight off.
• It is difficult to lose weight for women with PCOS, but doing so can help to reduce the levels of male hormones in the body.