Polycystic Ovary Syndrome (PCOS) is the commonest endocrine condition to affect women with an estimated prevalence of 10-15%, depending on the population studied. It usually starts during adolescence, but symptoms may fluctuate over time. Up to 70% of affected women remain undiagnosed worldwide.
PCOS is the commonest cause of anovulation and leading cause of infertility.
- PCOS is associated with a variety of long term health problems that affect physical and emotional well-being.
- There is an interference in women’s reproductive health, metabolic health, and psychological health.
- PCOS runs in families, but there are ethnic variations in its manifestation.
MBBS, MD, FRCOG (UK), MRCOG (UK)
Specialist Obstetrics & Gynecology
Symptoms and Long-term Health Implications
Symptoms include
- Heavy, long, intermittent, unpredictable or absent periods
- Infertility
- Acne or oily skin
- Excessive facial hair and hair over the body
- Male pattern baldness or hair thinning
- Weight gain, central obesity, etc.
Long-term health implications include
- Type 2 Diabetes
- Hypertension
- High cholesterol
- Cardiovascular disease
- Endometrial carcinoma
PCOS can also cause anxiety, depression and a negative body image.
Treatment and Conclusion
Use of Birth Control Pills
- They help to regulate the menstrual cycle and improve acne & excessive hair growth.
- Insulin-sensitizing medicines (e.g., Metformin & Inositol) reduce the insulin resistance.
- Medications for infertility due to PCOS include lifestyle changes, medicine & surgery to stimulate ovulation.
- In vitro fertilization (IVF)
- If they do not respond or conceive despite ovulating, then there are other factors for their infertility.
Conclusion
PCOS is one of the most common endocrine disorders. It may present with a single finding of polycystic ovarian morphology as detected by pelvic ultrasound. At the other end of the spectrum, symptoms such as obesity, menstrual cycle disturbances, symptoms of androgen excess & infertility may occur & have a significant impact on quality of life.
- Women with PCOS are characterized by insulin resistance, central obesity & dyslipidemia which places them at a higher risk of developing diabetes & metabolic problems.
- Encouraging weight loss in overweight & obese women remains the most effective first-line intervention in these women.
Diagnosis
Some symptoms of infertility, obesity & unwanted hair growth can lead to social stigma. This can affect family relationships, work & involvement in the community.
Diagnosis
Polycystic Ovary Syndrome is diagnosed by the presence of at least two of the following
- Signs and symptoms of high androgen levels (unwanted facial or body hair, loss of hair from the scalp, acne, high testosterone levels in the blood) – after other causes for this have been excluded.
- Irregular or absent menstrual periods – after other causes have been excluded.
- Polycystic ovaries on ultrasound scan.
Investigations and Management
Blood tests can be used to identify changes in the hormone levels, but can be normal. These include
- Testosterone levels
- LH hormone – elevated in 40% of women, especially thin women
- Insulin
- Anti-Müllerian Hormone
Management
- There is no cure for PCOS but symptoms can be managed according to the concern of the woman at that point.
- The treatment can include medication, lifestyle changes or a combination of both.
- Lifestyle changes and maintaining an optimal body weight reduces insulin resistance.
- If pregnancy is not desired, then treatment options include
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