Polycystic Ovarian Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a commonly found syndrome among women of reproductive age, affecting 5%-10% of this population. The cause is a hormonal imbalance in which the polycystic ovaries produce more of the male hormone, testosterone, than the normal ovary. It is thought to be one of the leading causes of female subfertility. Some people don't even realize until they want to conceive. Polycystic ovary syndrome (PCOS) PCOS is a complex, endocrine, disorder of uncertain etiology, with a strong evidence of genetic disorder with varying presentations. Its also called as Stein-Leventhal syndrome. The other principal features being irregular menstruation, amenorrhea, prolonged bleeding, infertility, and polycystic ovaries. Excessive androgenic( male ) hormones, results in acne and excessive facsial hair (hirsuitism) and insulin resistance. Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone

Association with risks:

Many women mistakenly believe that PCOS only affects the menstrual cycle and a woman's fertility. However, polycystic ovary syndrome is a complex disorder which can impact many body systems. Possible complications of PCOS include endometrial cancer, heart disease, diabetes and metabolic syndrome. PCOD is diagnosed by symptoms as mentioned earlier , signs and blood examinations. The appearance of the polycystic ovary on ultrasound examination is very characteristic being usually larger and bald ovaries with 10-12 follicles of 10-12mm size arranged peripherally like a necklace pattern . Not all women with PCOS have polycystic ovaries (PCO), nor do all women with ovarian cysts have PCOS; although a pelvic ultrasound is a major diagnostic tool, it is not the only one. Laboratory examinations in the blood may include that the luteinising hormone (LH), FSH level, fasting insulin levels and testosterone levels . The laboratory findings are inconsistent but the diagnosis can often be made on clinical grounds alone as any two of the following are enough to confirm the diagnosis: irregular or absent periods, hirsutism and/or persistent acne, the characteristic appearance of polycystic ovaries on ultrasound examination.

Management :

Those who take medicine and neglect their diet waste the skill of the physician. --Chinese proverb PCOS is treatable, but not curable, by medications, changes in diet, and exercise. Once the diagnosis has been established the treatment depends on the symptoms.

Lifestyle Modification with diet and exercise:

The most common presentations among the adolascents is overweight or obesity, menstrual irregularities and hirsuitism. Successful weight loss is the most effective method of restoring normal ovulation and menstruation and also helps in conceiving. Low carbohydrate diet and regular exercise is all that is required. As mentioned earlier there is no cure for PCOS, but controlling it lowers your PCOS related associated risks such as infertility, miscarriages, diabetes, heart disease, and uterine cancer.

Regulating the Menstrual Cycle:

It is important in adolascents to use Currently "the pill" usually as the practitioner's first choice. The pill contains a combination of estrogen and progesterone which regularize the cycle and prevent long term effects of anovulation such as endometrial cancer. Adolescents with PCOS are particularly concerned about their appearance and excess facial or body hair or persistent acne may be a particular disaster from a psychological point of view. A common choice of contraceptive pill effective in reducing hirsuitism is one that contains cyproterone acetate. The available brands are Dianette/Diane/crimson-35. Eflornithine (Vaniqa) is a drug which is applied to the skin in cream form, and acts directly on the hair follicles to inhibit hair growth. Permanent hair removal options include:

  • Electrolysis
  • Laser hair removal
  • Infertility Treatment The first choice of treatment who wants to conceive is clomiphene citrate to induce ovulation. CC can be Followed used up to 6-12 cycles before terming it as resistant. Along with CC insulin sensatisers are used such as metformin to combat associated insulin resistance. Surgery Ovarian drilling, is the only surgey done on the ovaries with the hope of reducing androgen and LH secretion, thereby inducing ovulatory cycles in infertility patients. For patients who do not respond to clomiphene, diet and lifestyle modification, and ovarian drilling there are other options available including assisted reproductive technology procedures such as controlled ovarian hyperstimulation with follicle-stimulating hormone (FSH) injections followed by IUI/ in vitro fertilisation (IVF). Complementary or alternative approaches At least two inositol isomers ?C D-chiro-inositol and myo-inositol have shown considerable promise in improving PCOS. They are generally very well tolerated and have been evaluated by several small-scale trials. Inositol has no documented side-effects and is a naturally occurring human metabolite known to be involved in insulin metabolism.