Polycystic Ovary Syndrome – PCOS

Polycystic Ovary Syndrome is a medical condition in women caused due to hormonal unbalance leading to difficulties in menstruation and conception.

The ovaries produce human eggs or ovules on a monthly basis. A mature ova is passed via a follicle into the uterus by the ovaries. However, in the case of PCOS there is an abnormal development of at least twelve or more follicles in the ovaries. These follicles are also known as cysts, hence disease has been named Poly(many) Cystic(follicles) Ovary Syndrome. In women with PCOS, the cysts in the ovary are fluid-inundated sacs and wholly benign, however grave complications could arise if it is left untreated.

In PCOS, there are several under-developed follicles in the ovaries. The eggs present in these follicles do not attain maturity hence their release from the ovaries is inhibited, instead forming cysts in the ovary thus contributing to sterility.

The under-developed follicles and the incapability in releasing an egg are possibly caused due to depleted follicle stimulating hormone (FSH) and more than normal male hormone levels (androgens) that the ovary produces.

The alarming rise in the number of PCOS cases, as frequent as, one in fifteen women have been observed to majorly affect adolescent women than the middle or elderly aged bracket women. PCOS might additionally cause undesirable alterations in one’s appearance. Often the symptoms start during the teen years. Treatment could aid in curbing the symptoms and avert long-lasting problems.

Polycystic Ovary Syndrome Causes:

All causes that lead to the development of POCS are interrelated, leading to a vicious circle of events.

• Changes in hormone levels that could be caused by more than one reason.
• Hereditary in certain cases and could be passed down from either the maternal or paternal side.
• Inactive and unhealthy lifestyle.
• Faulty dietary intake.
• Irregular meal times.
• Smoking, stress and alcohol intake.

Polycystic Ovary Syndrome Symptoms:

• Erratic menstrual cycles and at times lesser flow. Many women with PCOS often experience less than nine menstrual cycles during a year while others having no periods or conversely some having quite heavy menstrual flow.
• Stoppage of periods, though not often, after going through a single or more, normal menstrual cycle during teenage years – a condition known as secondary amenorrhea.
• Abdominal pain.
• Unexplained, sudden weight gain that is difficult to lose and if prolonged might additionally lead to depression.
• Inexplicable and excessive hair growth on the face and other parts of the body known as hirsutism. Mostly women with PCOS develop thicker texture and comparatively darker facial hair growths. There is more hair growth on the chest, abdominal and back area.
• Virilisation like excessive body and facial hair, voice getting deeper, clitoral enlargement, scalp hair starts thinning out resembling male-pattern balding.
• A decrease in breast size.
• Problems with conception or infertility.
• Skin darkening or pigmentation on the neck and arms.
• Excessive skin eruptions or acne.
• Diabetes.
• Improper insulin response that leads to the accumulation of insulin in the blood.

Diagnosis & Tests:

• The doctor after delving into the patient’s health history, symptoms and menstrual cycles would then carry out a physical examination to lookout for signs like excessive hair growths, high blood pressure and check for the BMI or Body Mass Index count after noting the height and weight.
• During the course of the pelvic exam, the doctor might note for an enlargement in the ovaries and the clitoris (a very atypical finding).
• A blood test is carried out that helps in determining levels of insulin, female hormones – oestrogen and progesterone and male hormones like testosterone. The blood tests done would be inclusive of the serum HCG or Pregnancy test, Prolactin levels and Thyroid function tests.
• If there is a surge in testosterone levels then the doctor would further recommend a sonography to corroborate the findings in the blood test. A sonography would help in detection of cyst formations on the ovary and aid in determining the extent of the problem.
• Tests would also include a MRI scan and ultrasound of the abdomen, ovary biopsy, levels of estrogen, LH and FSH, urine 17-ketosteroids, fasting blood glucose and insulin levels, laparoscopy. Hormone tests could aid in ruling out thyroid and other associated gland problems that might cause analogous symptoms.

Polycystic Ovary Syndrome Treatment:

• A women with PCOS needs to shed excess weight by altering the diet to ideally  be low in carbohydrates and high in proteins, eating healthy and light meals and engaging in some form of physical exercise. Even a mere loss of ten pounds would aid in getting the hormonal balance and menstrual cycle back on track.
• Cessation of smoking is advisable as it has been observed to lead to higher levels of androgen that could be a contributor to both PCOS and heart ailments.
• Reducing the intake of foods that have high levels of saturated fats. Those with blood insulin issues would benefit if they had similar levels of carbohydrates during every meal time. Seeking advice from a qualified dietician would aid in crafting an idyllic dietary plan to suit one’s lifestyle and health conditions.
• The doctor could recommend contraceptive pills that are quite safe, hassle-free and could decrease the appearance of excessive facial hair and skin eruptions or acne. An androgen-decreasing medication, spironolactone might be employed alongside birth control pills to aid in further reduction of symptoms, however not used when one is trying to conceive. In those women trying to conceive, the doctor would suggest other fertility pills that aid in synchronisation of the hormone levels and stalling cystic growths.
• Glucophage (Metformin), a diabetes medicine could aid in controlling insulin and blood glucose levels and reducing androgen levels. This lowers the chance of getting diabetes and heart ailments and aids in restoring normal menstrual cycles and fertility.
• Treatment with medicines like clomiphene citrate stimulates the pituitary gland to produce more levels of FSH that helps the egg is maturation and release. Other medications like flutamide and spironolactone are also used to treat PCOS.
• As these treatments could take some periods of time to aid with the symptoms like facial hair or acne, one could in the meanwhile take certain prescription or other over-the-counter medications to help lower skin ailments. For excessive, undesirable hair growths there are an array of options like one could wax, tweeze or shave them. Electrolysis and laser treatments though pricey can help in permanent hair removal. A topical skin cream could also be advised to slow down hair growth for as much of time as one could apply it on a regular basis.

Possible Complications:

• The conditions of hirsutism and obesity continue unabated.
• Possible heightened chances of breast cancer.
• Abrupt halt in menses way prior to menopause.
• Sterility.
• Early diabetes.
• Heart ailments or hypertension.
• Hypothyroidism.
• Increased likelihood of cancer of the womb or endometrial cancer.

Prevention:

There are no evident means of preventing PCOS, though preliminary diagnosis and treatment of PCOS aids in averting long lasting escalations like sterility, metabolism syndrome, heart ailments, diabetes and obesity.

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