Polycystic Ovarian Syndrome

Topic Highlights

●    Polycystic Ovarian Syndrome or PCOS is a hormonal disorder affecting women of reproductive age.

●    It is characterized by multiple cysts, an increased number of under-developed follicles, and enlarged ovaries.

●    This visual presentation provides information on the causes of PCOS, risk factors for PCOS, its symptoms, and treatment.

●    The presentation also has a section on guidelines to manage the condition.

Transcript

Polycystic Ovarian Syndrome (PCOS) is the most common hormonal disorder among women of reproductive age. In 1935, Dr. Stein and Dr. Leventhal were the first to discover the association between polycystic ovaries and certain classical symptoms ranging from infertility to hirsuitism and obesity.

PCOS is an endocrine dysfunction that affects nearly 5-10% of all women. The exact etiology of PCOS is unknown, however it has been found to affect 60% of obese women, 20% of lean women and 20% of women with normal body mass index (BMI). The ovaries do not produce sufficient quantities of hormones required for the follicle to mature; as a result the follicles remain in the ovary and eventually turn into cysts. Some follicles may be immature and contain an egg, while others are empty.

A follicle has a thin outer wall and is filled with clear fluid. Each follicle may vary between 2-8 millimeters in size. These immature follicles turn to cysts and form a ring around the edge of the ovary. As the cysts accumulate, the ovarian volume increases and the ovary enlarges.

Progesterone is not produced because ovulation does not occur. As a result, menstruation is not regulated, resulting in irregular menstrual cycles. In addition, the polycystic ovaries produce androgens or male hormones, which further inhibit ovulation. Overproduction of androgen often results from excess of LH or excess of insulin.

The immature follicles present in the ovaries cannot convert excess androgens to estrogen, due to the lower levels of FSH. This hormonal imbalance causes several symptoms. A pattern of symptoms is called a syndrome. The polycystic ovary causes a classical set of symptoms and is hence known as the polycystic ovarian syndrome.

Insulin resistance may stimulate the ovaries to produce androgens causing PCOS. Insulin, a hormone secreted by the pancreas helps the body maintain its blood glucose level. Insulin resistance is the inability of insulin to open the cell receptors for glucose. The cells are unable to utilize glucose. This may lead to diabetes. Obesity is another factor that can lead to insulin resistance.

Women are genetically prone to PCOS. Environmental factors, intra uterine programming, diabetes, gestational diabetes mellitus, hypertension and cardiovascular diseases are the other risk factors associated with PCOS.

PCOS increases the risk for endometrial cancer and breast cancer at a young age.

PCOS is associated with classical symptoms such as irregular or missed periods, abnormal hair growth on the face, acne, male pattern baldness, obesity and infertility. An important feature of PCOS is ovarian stromal hyperplasia.

PCOS cannot be diagnosed by a single test. A complete medical history along with other tests determines the cause of symptoms. A pelvic examination may be done to study the ovaries, but ultrasonography is the method used to confirm PCOS. Blood tests are done to check insulin resistance and reproductive hormone levels.

The first line of treatment for PCOS includes weight reduction via lifestyle changes and regular exercise. Exercising regularly helps tone muscles, burn calories and remove toxins from the body. Reducing body weight helps control the symptoms of PCOS.

Further, treatment for PCOS depends on whether the woman wants to conceive. Birth control pills and other hormonal drugs can be prescribed to those women who are not pregnant or planning to have children in the near future. There are two types of birth control pills that help prevent pregnancy combination drugs and progestin-only drugs.

For those patients trying to conceive, losing weight helps improve ovulation. Fertility drugs such as clomifene and gonadotropins are prescribed to stimulate ovulation.

Insulin-sensitizing drugs such as metformin are used to enable normal ovulation by controlling blood glucose levels, which restore normal hormonal balance.

Ovarian drilling is the surgical procedure done to treat PCOS. This procedure involves puncturing the ovary with a laser or an electrosurgical needle during laparoscopy. The ovary is punctured around 4-8 times. This lowers the androgen levels in the blood, thus stimulating ovulation. The benefits of this procedure include menstrual regulation.

Reducing weight and maintaining a proper diet helps to manage PCOS. The diet should include high-fiber carbohydrate foods like bread, cereals, brown rice, beans and whole wheat pasta. Avoid soda, excess fruit juice, cake, cookies and doughnuts. A doctor or a dietician should be consulted for the best dietary plan. Although PCOS is not a curable condition, the symptoms are manageable.