Polycystic ovary syndrome (PCOS): Causes, Symptoms and Treatment

Overview

Polycystic ovary syndrome popularly is a complex heterogeneous endocrine disorder occurring due to the synergistic interaction of genetic, epigenetic, and environmental factors associated with both metabolic and reproductive abnormalities. Mainly affects women of Reproductive age. Cardinal features of PCOS are :

•  Chronic anovulation
•  Hyperandrogenism
•  Polycystic ovarian morphology

Two out of three criteria present qualify as pcos

How common is PCOS?

The incidence of PCOS is high due to the change in life style modifications, eating unhealthy food, and various other factors. Approximately 15% of the females suffer from PCOS during their reproductive age. It usually starts around 20-30 years of age. Overall incidence varies from 8% - 10 %

Causes of polycystic ovary syndrome

The exact cause of PCOS is not known. A few of the causes which can result in causing polycystic ovary syndrome are listed below:

• Hereditary- most of the patients who are diagnosed with PCOS have a family history of having PCOS.
• Insulin resistance- insulin is a hormone produced by the beta cells of the pancreas. The main function of insulin is to control the blood sugar levels in the body. It allows the cells of the body to use sugar and convert them to energy. An increase in the level of insulin hormone in the body will result in producing too much amount of male hormone(androgen).
• Excess amount of androgen level in the body- females diagnosed with PCOS will result in producing high levels of androgen. An increase in androgen levels will interfere with ovulation.
• Disordered folliculogenesis.
• Obesity
• Vit D deficiency
• Low-grade inflammation

Symptoms associated with PCOS

The most common symptoms associated with PCOS are listed below:

• Irregular periods, missed periods
• Ovaries with multiple cysts and larger in size
• Acne or oily skin
• Hirsutism- excess body hair which includes beard, hair over chest, back, stomach
• Infertility
• Skin tags
• Weight gain especially around the belly area (abdomen)
• Male-pattern baldness or thinning of hair
• Dark or thick skin patches over the armpits or under the breast
• Headache

Diagnosis of PCOS

The diagnosis of PCOS can be done by these tests. They include:

• Medical history of the patient- initially the doctor will record the medical history of the patient. Will record the menstrual history of the patient.
• Family history of the patient- patients who are diagnosed with PCOS have a family history of PCOS.
• Physical Examination- During the physical examination, the doctor will check the patient thoroughly to look for any signs of abnormalities.
• Pelvic exam- During the pelvic exam, the doctor will examine the reproductive organs for masses, any abnormal growth, or other changes.
• Blood tests- They will help us to asses the hormone level, androgen levels. Other blood investigations include fasting cholesterol and triglyceride level, glucose tolerance test, etc.
• Investigational scan- they include ultrasonography of the abdomen and pelvis. This test will help us to evaluate the size of the ovaries, and look for any cysts in the ovaries. It will also help us to evaluate the thickness of the lining of the uterus (endometrium) [4].
• Other tests include- screening for depression and anxiety, screening for obstructive sleep apnea, and regular check-ups for blood pressure, glucose tolerance, cholesterol, and triglyceride levels.

Treatment for PCOS

The treatment plan for PCOS varies from person to person. It depends upon various factors which include, the age of the patient, severity of the symptoms, and overall condition of the patient. The treatment plan for PCOS includes:

• Change in diet and routine activity- by maintaining a healthy diet and doing exercises regularly will help in maintaining a healthy weight and help in keeping the body’s insulin level under control and lowering the blood glucose levels.
• Medications to cause ovulation- these medications will help the female have regular menstrual cycle. They will help the ovaries to release the eggs regularly. They include-

1. combination birth control pill- these pills contain both progestin and estrogen, which will decrease the androgen production and regulate estrogen. Combination birth control pill will help in regulating the hormone levels and decrease the risk of endometrial cancer and decrease the excessive hair growth, acne and correct the irregular bleeding.
2. Progestin therapy- indicated in those who are contraindicated to estrogen or risk factors for CVD are present. Given cyclically for 10-14 days per month will regulate menses and provide protection against endometrial hyperplasia.

• Females who are diagnosed with PCOS and wish to become pregnant, in such cases the doctor will advise the patient a couple of medicines, which include:

a) Clomiphene- it is an oral anti-estrogen medicine which is taken during the first part of the menstrual cycle.

b) Letrozole- it is an aromatase inhibitor, which can help in stimulating the ovaries.

c) Gonadotropins

d) Metformin- metformin is usually used to treat type 2 diabetes mellitus. This drug will help in improving insulin resistance and lowers insulin levels. Metformin can help to reduce weight and decreases the progression of type 2 diabetes mellitus.

• Medications that can help in reducing excessive hair growth and improve acne are:

a) Birth control pills- these pills can reduce the production of androgen and decrease excessive hair growth and decrease acne

b) Eflornithine- this cream can slow the facial hair growth

c) Aldactone (spironolactone)- the main aim of these medicines is to block the affect of androgen on the skin, which includes excessive hair growth and acne. This medicine is usually not recommended to females who wants to pursue children in future or female who is pregnant, because these medicines can cause birth defect to the children.

d) Hair removal therapy- There are various forms of hair removal therapy available, which includes- laser therapy, electrolysis 

• IVF treatment
• Surgery- Surgery is advised for patients who have not responded well to other medical interventions. The surgical procedure called; laparoscopic ovarian drilling (LOD) is a treatment option advised for patients for fertility problems associated with PCOS.

Complications associated with PCOS

The complications associated with PCOS are listed below:

• Infertility
• Gestational diabetes mellitus or pregnancy-induced high blood pressure
• Sleep apnea
• Prediabetes or type 2 diabetes mellitus
• Premature birth of the child or miscarriage
• Endometrial cancer
• Metabolic dysfunction
• Cardiovascular diseases
• Depression, anxiety and eating disorder 

Prevention of PCOS

Since the exact cause of PCOS is not known, hence PCOS cannot be prevented completely. However, there are a few steps which can reduce the symptoms. They are listed below:

• Eat a healthy diet
• Exercise regularly
• Avoid large quantity of carbohydrates
• Avoid smoking and drinking alcohol
• Have a regular follow-ups with the doctor