Women and Health; Polycystic Ovarian Syndrome

Its interesting how many people walk around carefree not knowing what's happening inside of us. Is ignorance bliss? Let's find out! There are so many complex and understood mechanisms in the body and some result in abnormalities and irregularities. Okay, let's talk about quite a common one, Polycystic ovary syndrome(PCOS).

Introduction.
Polycystic ovary is a syndrome of ovarian dysfunction characterized by;
• Anovulation
• Hyperandrogenism
• Polycystic ovary morphology
Okay, let's break these down for simple comprehension. Anovulation is when a woman undergoes a complete cycle without the release of an ovum(egg).
Hyperandrogenism is a state of increased levels of steroid hormones, typically found in males, such as testosterone. This feature is responsible for the Male pattern hair distribution seen in such patients.
Polycystic ovary morphology is a feature seen on ultrasound or any applicable imagine technique.

Aetiology
The cause of this syndrome is unknown. But some factors have been implicated and includes;
• Abnormalities in estrogen and testosterone metabolism
• Hyperinsulinaemia as a result of increased insulin resistance, which causes the ovaries to produce more androgens.
• Abnormal function of the hypothalamic-pituitary-ovarian(HPO)axis.
The HPO axis is responsible for regulating the gonadal hormones, that is, estrogen, estradiol, prolactin and androgens.

Epidemiology
5-10% of women aged 15-44 years, the child bearing period.

Clinical features
• Asymptomatic
• Oligomenorrhoea or amenorrhoea
• Anovulation
• Hirsutism
• Obesity
• Subfertility
• Recurrent early miscarriages
• Acanthosis nigrican
For more details, click here

Diagnosis
• Elevated serum levels of the following hormones;

Testosterone
Leutinizing hormone & follicle stimulating hormone
Free androgen index
• The following may be slightly elevated or normal;
Estrogen
Fasting Insulin
OGTT
• The following have low serum levels;
Sex hormone binding globulin
• Transvaginal ultrasound scan
Shows features of a polycystic ovary morphology which includes;
• >12 subcapsular follicular cysts,
• <10mm in diameter and
• an increased ovarian volume of>10mm³
Diagnosis us made using the Rotterdam criteria.
• Chronic anovulation(anovulation of >6 months)
• Hyperandrogenism evidenced by hirsutism or voice changes
• Polycystic ovary morphology on ultrasound sonography
Treatment
There is no definitive treatment for PCOS and treatment principle is directed towards rectifying the symptoms.
• Treatment of Amenorrhoea
Oral contraceptive pills
Oral cyclical progesterone
• Treatment of subfertility
Ovulation induction agents;

Clomiphene citrate
Tamoxiphene
Metformin
Gonadotropins
Laparoscopic ovarian drilling
• Treatment of hirsutism

Medical
• Cytoperone acetate
• Metformin
• Flutemide
• Ketoconazole
Physical
• Depilatory cream
• Hair plucking
• Laser treatment
• Electrolysis
• Treatment of obesity

Diet
Exercise
Complications
• Diabetes mellitus
• Dyslipidemia
• Hypertension
• Cardiovascular diseases
• Endometrial cancer
• Breast cancer
No evidence to suggest that prophylactic treatment is beneficial.
Follow up is recommended.

Conclusion
PCOS is a common disorder in women of reproductive age and they mostly present with complaints of subfertility. Treatment aids the symptoms but there is no definitive treatment.

References: https://emedicine.medscape.com/article/256806-overview#a1