Polycystic ovary syndrome also known as PCOS is a condition presented with various symptoms, caused due to an elevated level of male hormones (androgens) in females.
SIGNS & SYMPTOMS OF PCOS
- Fewer than nine menstrual periods a year
- No periods for three or more consecutive months
- Infertility due to lack of ovulation
- High amount of androgens
- Hirustism, growth of hair on the chest or the chin
- Heavy & prolonged menstrual periods
- Increased hair thinning or diffuse hair loss
- Insulin resistance
- Endometrial cancer
- Type II Diabetes
- High blood pressure
- Cardiovascular disease
CAUSES & RISK FACTORS OF PCOS
- Genetic & hereditary factors
- Environmental factors like exposure to bisphenol A & some other drugs
- Increasing rate of obesity
- Hormonal & endocrine system dysfunction like;
- Ovaries are stimulated to produce excess of androgens due to following factors:
a) Release of excess luteinizing hormone (LH) by the anterior pituitary.
b) High levels on insulin in the blood.
- Increased GnRH pulse frequency
- Excess of adipose tissue present in obese women
- There is a relation between PCOS & increased oxidative stress.
- Careful noting of obvious symptoms that are present like hirustism, acne, change in menstrual pattern & obesity.
- Ultrasound of the ovaries done, looking for the presence of ovarian follicles (12 or more should be seen).
- Laparoscopic examination may reveal a thickened, smooth, pearl-white outer surface of the ovary.
- Elevated blood levels of androgens are found (androstenedione & testosterone).
- Higher level of anti-Müllerian hormone (AMH)
- Glucose tolerance test may indicate impaired glucose tolerance (insulin resistance).
TREATMENT OF PCOS
- Oral contraceptives: Increase sex hormone binding globulin which binds with free testosterone, therefore reducing symptoms of hirsutism & normalizing menstrual cycle.
- Topical cream, eflornithine to reduce facial hair
- Medications like flutamide & spironolactone are used for their anti-androgen effect & reducing hirsutism.
- 5-alpha reductase inhibitors (such as finasteride and dutasteride) block the conversion of testosterone to DHT.
- Medications to induce ovulation in case of infertility (clomiphene, leuprorelin & letrozole).
- Assisted reproductive technology procedures such as controlled ovarian hyperstimulation with follicle-stimulating hormone (FSH) injections followed by in vitro fertilisation (IVF).
- Metformin is the anti-diabetic drug used to treat insulin resistance, associated with PCOS.
- Metformin along with clomiphene increases the fertility index of the patient.
- Statins in management of metabolic disorders & obesity.
- Diet rich in fruits, vegetables & whole grains.
- Low carbohydrate diet
- Intake of Vitamin D supplements & treatment of the deficiency.
- Increase in physical activity & exercise.
- Weight loss & maintaining a healthy weight
- Stress management.