Incidence
An estimated 5 to 10 percent of women in childbearing age have PCOS. Polycystic ovary syndrome is considered the most common hormonal disorder among women of reproductive age in the United States.
Signs and symptoms of PCOS
The symptoms of PCOS can vary from woman to woman but experts agree that, a woman diagnosed with PCOS should have at least two of the following indications:
Irregular or no menstruation
This is definitely the most common symptom of PCOS. What exactly is irregular menstruation? It means having menstrual cycles that occur at intervals longer than 35 days or fewer than eight times a year.
Excess androgen
This is also a very common symptom. Elevated levels of male hormones may result in physical signs such as excess facial hair or hair on the chest, lower abdomen, back, upper arms or upper legs, acne and male-pattern baldness.
Miscarriage
It is proven that one of the hormonal abnormalities in PCOS, a raised level of luteinizing hormone, seems to be linked with miscarriage. Women with raised LH have a higher miscarriage rate compared to those who have normal LH values.
Enlarged ovaries with multiple cysts
This symptom is usually detected with ultrasound. However, it is important to understand that not all women have polycystic ovary syndrome if they have ovaries with multiple cysts. Sometimes even woman with PCOS may have ovaries that appear normal.
Obesity
Many women with polycystic ovary syndrome (PCOS) have problems losing weight or are obese
Other possible conditions associated with polycystic ovary syndrome are:
- Infertility
- Acantosis nigricans – darkened skin on the neck, armpits, inner thighs, vulva…
- Chronic pelvic pain
- Acne
- High cholesterol levels
- High blood pressure
- Sleep apnea - excessive snoring or breathing that stops at times while asleep
- Elevated insulin levels, Insulin Resistance, or Diabetes
Normal physiology of ovaries
Woman’s reproductive cycles is a very complex process. The main parts of the woman's reproductive cycle process are regulated by fluctuating levels of hormones produced by the two organs:
- Pituitary gland in woman’s brain: luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and
- Woman’s ovaries which secrete the female hormones estrogen and progesterone and also produce some androgens. Androgens include testosterone, androstenedione and dehydroepiandrosterone (DHEA).
What happens in PCOS?
In PCOS, some of the follicles remain immature, not reaching full development or ovulating to produce an egg capable of being fertilized. This means that the woman with this syndrome rarely ovulates and so is less fertile. She also does not have regular periods. Other features of the condition are excess weight and excess body hair. In polycystic ovary syndrome, female body produces an excess of androgens, and ratio of LH to FSH is often abnormally high.
Possible cause of PCOS
High insulin
The cause of polycystic ovary syndrome is not yet totally clear, but research suggests a link to excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugars, body's primary energy supply. Excess insulin is thought to boost androgen production by ovaries.
Genetics
Studies also indicate that genetic factors may play a role in this syndrome. While it is not known if women are born with this condition, this syndrome seems to run in families. Interestingly, when PCOS is passed down the man's side of the family, the men are not infertile, but they do have a tendency to become bald early in life, before the age of 30.
Obesity
Women are also more at risk if they are overweight. Maintaining weight or body mass index below a critical point is probably very important in controling the symptoms and physical features of the condition.
Diagnosis of polycystic ovary syndrome
There are several diagnostic tools which are used to diagnose a PCOS. Doctors should evaluate patient for reproductive, hormonal and cardiovascular disorders.
Complete physical examination including detailed patients history could be the key of the good diagnosis
Other tests may include:
Blood tests
Patient’s blood may be drawn for laboratory tests to measure the levels of some hormones such as testosterone, DHEA and androstenedione, LH, FSH, progesterone, prolactin, and thyroid-stimulating hormone (TSH).
Ultrasound
Doctors usually request a pelvic ultrasound to check patient’s ovaries and the thickness of the lining of the uterus.
Differential diagnosis
Experts have found out that several other disorders can cause signs and symptoms similar to those of polycystic ovary syndrome:
Hypothyroidism
In this condition, a woman’s body produces too little thyroid hormone, which can lead to an absence of menstruation – a condition called amenorrhea.
Hyperprolactinemia
This condition causes a woman’s pituitary gland to produce too much prolactin, a hormone that stimulates the production of breast milk and suppresses ovulation.
Certain tumors
Tumors of the ovary or adrenal gland can be responsible for excess androgen levels.
Treatment of polycystic ovary syndrome
Unfortunately, there is no cure for PCOS because the cause is still unknown. Anyway, there are some treatment options that could be beneficial for the woman suffering from the PCOS symptoms! Women with polycystic ovary syndrome may benefit from simple counseling to help with healthy-eating choices and regular exercise.
Birth control pills
Birth control pills can regulate menstrual cycles, reduce male hormone levels, and help clear acne. They are perfect for women who don’t want to get pregnant. However, women should understand that the birth control pill does not cure PCOS.
Diabetes Medications
Medications which are used to treat type 2 diabetes also help with PCOS symptoms. These medications will not cause a person to become diabetic.
Fertility Medications
The main fertility problem for women with PCOS is the lack of ovulation. Fortunately there are some medications which can be used to stimulate the ovary to ovulate. However, PCOS patients are at increased risk for multiple pregnancies when using these medications.
Medicine for increased hair growth
Spironolactone is a blood pressure medicine that has been shown to decrease the male hormone’s effect on hair. Other non-medical treatments such as electrolysis or laser hair removal are effective in getting rid of the excess hair.
Surgery
If other methods failed to provide the relief, a surgery called ovarian drilling can be used to induce ovulation. In this procedure the doctor makes a very small incision above or below the navel, and inserts a small instrument which is used to puncture the ovary. This instrument has a small needle carrying an electric current to destroy a small portion of the ovary. This surgery can lower male hormone levels and help with the ovulation.
Maintaining a healthy weight
Maintaining a healthy weight is another way a women can manage PCOS. This can be done with a healthy PCOS diet and physical activity. A diet composed mainly of low-GI foods combined with regular exercise will also help to combat the effects of insulin resistance.
Complications if left untreated
Women with polycystic ovary syndrome are at the increased risk of:
- type 2 diabetes,
- high blood pressure,
- increased triglycerides,
- decreased high-density lipoprotein (HDL) cholesterol
- cardiovascular disease
Because PCOS disrupts the reproductive cycle and exposes the uterus to a constant supply of estrogen, women with PCOS are at risk of:
- abnormal uterine bleeding
- cancer of the uterine lining
During pregnancy, women with this disorder may be at increased risk of:
- gestational diabetes
- pregnancy-induced high blood pressure
- www.mayoclinic.com/health/polycystic-ovary-syndrome/DS00423
- www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
- youngwomenshealth.org/2014/02/25/polycystic-ovary-syndrome/
- https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/ Photo by shutterstock.com