Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS)
Polycystic ovarian syndrome (PCOS) is a common endocrinal disorder and one of the common causes of infertility among women. It is characterised by an ovulation dysfunction or impedance to the normal growth and release of eggs from the ovaries. It is commonly seen in women of child-bearing age and is rare after menopause. The hormonal imbalance results in enlarged ovaries containing several small cysts (fluid-filled sacs).
Causes of PCOS
The exact cause of polycystic ovarian syndrome is unknown. However, several factors including genetics have been implicated to play a role in the development of PCOS. Women with a family history of polycystic ovarian syndrome are at a higher risk of developing this condition. Researchers have also found an association between excessive insulin production and the development of PCOS. Insulin hormone regulates blood sugar levels and any disorder affecting the insulin mechanism may result in excessive insulin secretion, which triggers androgen secretion from the ovaries. Low-grade inflammation, in response to ingestion of certain foods, may lead to the release of substances that can cause insulin resistance and cholesterol accumulation in the blood vessels or atherosclerosis. Clinical studies have demonstrated the presence of low-grade inflammation in women with PCOS. Excessive exposure to the male hormone during the fetal period may disrupt the function of normal genes and increase the risk of insulin resistance and low-grade inflammation.
Symptoms of PCOS
The symptoms of polycystic ovarian syndrome vary from person to person and depend upon the nature and severity of the condition. Some of the symptoms of PCOS include infertility, absent or irregular menstrual cycle, and obesity or accumulation of fat usually around the waist. Abnormal facial and body hair, adult acne, and male pattern baldness or hair thinning may also develop due to excessive androgen secretion. In some patients, black or dark brown patches are seen around the skin of the neck, arm, breasts or thighs. Patients often experience anxiety or depression and breathlessness during sleep.
Diagnosis of PCOS
The diagnosis of polycystic ovarian syndrome is based on the medical history along with a physical and pelvic examination to evaluate the condition of the patient and help identify the underlying cause. Blood tests are conducted to determine the level of various hormones. Additional tests such as a glucose tolerance test and evaluation of blood cholesterol may also be conducted in these patients. Pelvic ultrasound is performed to evaluate the appearance of the ovaries and the uterine lining.
Treatment of PCOS
The treatment of polycystic ovarian syndrome is based on the symptoms and individual concerns such as infertility, irregular menstrual cycle, acne or obesity. Both medications and surgical treatment can be used for the management of PCOS. Infertility may be treated by fertility therapy with ovulation-inducing drugs. Clomiphene citrate, an oral anti-oestrogen, may be prescribed to patients. In some patients, the doctor may add metformin to clomiphene to help induce ovulation. In patients not responding to clomiphene and metformin, gonadotropins, namely, follicle-stimulating hormone (FSH) and luteinising hormone (LH) can be administered by injection.
Oral contraceptives may be prescribed for the management of irregular menstrual cycles. Oral contraceptives effectively reduce the level of male hormone and are also effective in reducing excessive body hair growth and also minimize the risks of uterine cancer. Lifestyle modifications and anti-diabetic medications may be prescribed for the management or prevention of obesity and diabetes mellitus.
Surgery may be recommended in patients who do not respond to medications. Laparoscopic ovarian drilling, an outpatient surgical procedure, may be used to treat the condition and induce ovulation.
Patients with polycystic ovarian syndrome frequently develop other serious medical conditions such as diabetes mellitus, cardiovascular diseases, pregnancy-induced high blood pressure, miscarriage or premature delivery. These patients are also at risk of uterine cancer, anxiety or depression.