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PCOS

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Dr. Sangeeta Desai
Gynecologist

verified

Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders in premenopausal women. This condition produces an abnormal amount of male sex hormones, namely, androgens, usually present in women in small amounts. PCOS is a disorder characterized by increased androgen levels, menstrual irregularities, or the presence of small cysts on ovaries.

Ovulation takes place when the egg is released from ovaries such that the sperm can fertilize it. For PCOS, the woman does not make sufficient amount of hormones necessary for ovulation. Cysts are developed when ovulation does not take place. Cysts produce high levels of androgens, which can hinder with a woman’s menstrual cycle and account for the multiple symptoms of PCOS.

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Types

As per the Rotterdam Criteria, PCOS can be divided into four types:

1) Classic polycystic ovary PCOS is characterized as a chronic absence of ovulation and increased androgens with polycystic ovaries. Women with this type of PCOS have considerable risk of metabolic and cardiovascular disorders.

2) Classic non-polycystic ovary PCOS is characterized as a lack of ovulation, increased level of androgens, and normal ovaries.

3) Non-classic ovulatory PCOS - Ovulation occurs and there are regular menstrual cycles, increased levels of androgens, and polycystic ovaries.

4) Non-classic mild PCOS - There is a lack of ovulation, polycystic ovaries, and an average androgen level. Here, women have less insulin-resistant and lack metabolic features of PCOS.

Symptoms

PCOS can lead to the development of various diseases. The three common problems associated with PCOS include ovulation irregularities, increased levels of androgens, and cystic ovaries. According to Rotterdam’s criteria, if a woman has two out of the following three symptoms, she has PCOS.

Signs and symptoms of PCOS may vary as per the type of condition; however, commonly occurring signs include the following:

· Irregular menstrual cycles - This can include absent periods, periods that infrequently occur, heavy periods, or unpredictable periods.

· Infertility

· Obesity

· Excessive hair growth on the face, chest, and abdomen

· Severe acne and oily skin

Causes And Risk Factors

Causes

The exact cause of PCOS is unclear. It is related to different genetic or family history and environmental factors that determine the condition’s type. The different causes are listed below:

· Environmental factor - This can cause obesity and weight gain because of poor dietary choices and inadequate physical inactivity. Weight gain is closely related to PCOS, although certain women with average weight may suffer from this condition. Exposure to infectious agents and toxins may contribute as an environmental factor.

· Family history: The family history may give information about the type of PCOS and severity, which helps determine additional complications. Women with a family history of PCOS or type 2 diabetes are more prone to develop PCOS.

· Insulin resistance - The body cells fail to respond to insulin; the body generates additional amount of insulin, leading to excess insulin in the blood. Therefore, there is an improper balance of insulin in the body, which may cause a higher androgen level. Lifestyle habits such as physical inactivity and an unhealthy diet contribute to insulin resistance, which causes weight gain and worsening of symptoms.

Risk Factors

PCOS not only affects the reproductive system but also affects all other areas of the body. It increases the risk of a woman’s health, which may have lifelong consequences.

· The primary risk factor for developing PCOS is if your mother or sister has it. You possibly develop it if you have insulin resistance or are obese.

· Insulin resistance is one important risk factor for the development of PCOS. It increases the risk of type 2 diabetes and cardiovascular disease.

· In some women, PCOS can cause excessive thickening of uterus lining, which increases the risk of endometrial cancer.

· The risk of sleep disorders, such as sleep apnea and depression, is higher with PCOS.

Prevention

PCOS is developed during puberty with menstrual abnormalities and infertility in adulthood and contributes to an increased risk of diabetes; thus, prevention of PCOS is important.

· Women with obesity should follow long-term intervention programs that focus on weight loss and restricted diet, resulting in beneficial effects on the symptoms and severity of the condition.

· It is necessary to be aware of insulin and androgen levels because they are responsible for PCOS development.

Diagnosis

The symptoms of PCOS are similar to those that are caused by other health problems. A proper diagnosis will help exclude conditions and determine the type and severity of the disorder.The different diagnostic tests include-

· Medical history and physical examination - This will provide the physician with information about sudden weight gain, menstrual cycle abnormalities, male pattern hair growth, skin changes, and elevated blood pressure. It will help to predict other development of risk factors such as diabetes or cardiovascular diseases.

· Ultrasound/pelvic exam - A pelvic exam confirms the health of your reproductive organs both inside and outside the body. The technology uses sound waves and provides images of blood vessels, tissues, and organs. This test can help determine the size of ovaries, presence of cysts, and thickness of the lining of the uterus.

· Blood tests - The blood tests detect the high levels of androgens, glucose, and lipid levels.

The assessment period of PCOS should eliminate other potential causes associated with reproductive and endocrine disorders.

Treatment

Various treatments are available to address PCOS-related problems. Treatment is tailored to each woman as per symptoms, other health problems, and whether she wants to get pregnant.

There is a range of treatment options available to address the PCOS-related problems. Treatment may vary as per symptoms, type, other health problems and chances of pregnancy, and therapy aims.

If the woman plans to become pregnant:

· Lifestyle modifications - A change in diet and more physical activity will promote weight loss and reduce symptoms. These can help the body use insulin more efficiently, lower glucose levels and increase chances of ovulation.

· Fertility medications - Oral or injected drugs are usually used to help ovaries release eggs. Although these medications have risks including increased chances for multiple births or cause the ovaries to release multiple hormones and cause symptoms such as pelvic pain and bloating.

If the woman does not plan to become pregnant:

· Birth control pills - These are used to prevent pregnancy and regulate menstrual cycles, lower androgen levels, reduce acne, and manage hair growth.

· Diabetes medication - This is a non-hormonal treatment option used in diabetic patients. Even if the woman does not have diabetes, this medication helps reduce insulin resistance in PCOS, decreases androgen levels, and helps to regularly ovulate. Diabetes medication is usually prescribed in obese women. This medicine can assist

with weight loss and reduce hair growth. Myoinositol can be attributed to both obese and non-obese women.

· Supplementary medications - Specialities may help manage other symptoms such as obesity, acne, and hair growth in these specific areas.

· Other treatment options include: Surgical treatment: These are secondary treatments when medications do not respond. Ovarian drilling is performed to restore ovulation in patients when medication management has failed.

· Assisted reproductive technology (ART): This is used to manage infertility in PCOS patients when medication and surgical treatment do not work. It includes fertility treatment that has a woman’s egg and a man’s sperm. In vitro fertilization (IVF) is the most common and effective type of ART.

Lifestyle/management

Lifestyle modifications are considered cost-effective treatment with the necessary medications for treating PCOS. The primary cause of PCOS is unclear; therefore, it is important to improve the patient’s condition when symptoms occur.

· Appropriate nutrition, physical exercise, yoga, and other stress management therapies contribute to the overall health benefit that influences the outcome of infertility treatment.

· Weight reduction in obese patients and a restricted healthy diet will help regulate hormone levels, thereby increasing the ovulation-related chances.

Prognosis And Complications

Prognosis

Appropriate care for the patient requires to both treat current symptoms and prevent any morbidity that might develop later in future; thus, the importance of screening recommendations as an essential part of managing PCOS. This section will focus on what is recommended in screening for morbidities in patients with PCOS.

Women with PCOS require to be treated for both presenting symptoms and prevent any morbidity that might develop in future. Therefore, screening and monitoring of the progression of symptoms are highly recommended. Women with PCOS should be routinely screened for diabetes and cardiovascular risk factors because these are the most commonly occurring conditions with PCOS.

Women are prone to develop depression and anxiety, eating disorders, and negative body image if there is no improvement in symptoms.

Complications

PCOS is a lifelong condition and can be treated at an appropriate time. Women with PCOS develop considerable complications. Some of these include:

· Diabetes: Type-2 diabetes mellitus is seen in almost 50% of the woman by the age of 40.

· Heart disease: The risk increases with age and improved cholesterol levels.

· High blood pressure: This can cause severe damage to heart, brain, and kidneys.

· Stroke: Restricted blood flow can cause clots that can turn into a stroke.

· Thickening of uterine wall may lead to endometrial cancer.

References


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