Polycystic Ovarian Syndrome – An Overview

Polycystic ovary syndrome (PCOS) is hormonal in origin and affects up to 10% of women in the childbearing age range. The ovaries and adrenal glands of women with PCOS produce an excessive amount of the male hormone, testosterone. This is one of the factors that results in disruption of the menstrual cycle and quite often the muscularization of the sufferer.

Typically, numerous cysts (fluid-filled sacs) form in the enlarged ovaries. A small percentage of women with PCOS have no ovarian cysts.

PCOS can start at any age after puberty. However, most women are not diagnosed until they are in their 20s and 30s, primarily when they are investigated for infertility. Up to 70% of women with PCOS remain undiagnosed.

PCOS is generally treated with lifestyle modification, weight loss, and medications.

The earlier the intervention, the better the chances of reducing the potential complications often associated with this condition.

Some quick facts regarding PCOS

• By age 40, up to 40% of women who have PCOS are pre-diabetic or diabetic.
• Two of the following three criteria must be present in order to make a diagnosis of PCOS – (a. irregular or absent periods, (b. elevated blood androgen levels and (c. multiple ovarian cysts.
• Not all women with PCOS have multiple ovarian cysts.
• Not all women with PCOS have irregular or absent periods.
• PCOS is the most common cause of infertility in women.
• Up to 70% of women with PCOS have abnormal cholesterol and triglyceride levels.
• 33% of women with PCOS are within their recommended weight range.
• Acne is very common in women with PCOS.
• Regular exercise helps control many of the symptoms associated with PCOS.
• Fatty liver is quite common in women with PCOS.
• If overweight, the loss of 5-10% of body weight often reverses many of the symptoms of PCOS.

Causes of PCOS

While the exact cause of PCOS remains unknown, however, the following may play a role to varying degrees in the development of PCOS:

• Genetics – often runs in families
• Being overweight
• Insulin resistance
• Higher blood levels of the male hormone, testosterone
• Low-grade systemic inflammation
• Hormone imbalances – elevated testosterone, reduced oestrogen, elevated luteinizing hormone (LH), reduced sex hormone-binding globulin, elevated prolactin levels
• Sedentary lifestyle
• Stress
• Endocrine disrupting chemicals.

Symptoms and signs may include:

• Irregular or absent periods
• Reduced fertility
• Excess weight, especially centripetal
• Body hair growth in areas such as the chin, upper lip, chest, thumbs, toes, abdomen, buttocks, and upper back
• Oily skin and or acne
• Thinning of the hair on the head
• Darkening of the skin on the back of the neck, in the armpits, and below the breasts
• Skin tags
• Increased muscle mass
• Clitomegaly
• Mood swings, depression, and anxiety
• Obstructive sleep apnea,

Possible complications:

• Infertility
• Obesity
• Type 2 diabetes
• Gestational diabetes
• Preeclampsia
• Metabolic syndrome
• Hypertension
• Heart disease
• Uterine cancer
• Miscarriages
• Depression, anxiety, eating disorders
• Dermatological/ skin – hair growth, acne, and skin tags
• Fatty liver
• Obstructive sleep apnea.

Diagnosis:

Your doctor will take a detailed medical history and perform a thorough physical examination, inclusive of a pelvic examination.
You will be referred for:

• Pelvic ultrasound: To assess the size of the ovaries and see if they have cysts.

The thickness of the lining (endometrium) of the womb (uterus) will also be checked.

• Blood tests: To determine the levels of androgens and other hormones. Blood sugar and lipid levels may also be evaluated.

Treatment:

PCOS cannot be cured, however, your healthcare provider will develop a treatment plan specific to your unique circumstances. No two cases of PCOS are identical, its management is highly dependent on your:

• Wishes
• Age
• Desire to become pregnant
• General health.

General recommendations

• Exercise & Diet: A healthy diet and exercise not only reduces symptoms but also lowers blood sugar levels and aids with ovulation.
• Weight loss if overweight
• Stress reduction

If you plan to become pregnant in the near future:

Ovulation medications: These increase the release of eggs from the ovaries. However, it must be noted that suchlike medicines increase the chances of multiple births – i.e. having twins, triplets or more.
If you do not plan to become pregnant (soon):
Oral contraceptive pills Metformin (Diabetes medication).
Other medications may be prescribed for associated conditions – e.g. acne, elevated cholesterol, and other medical conditions.

Author: Dr. C. Malcolm Grant – Family Physician – Family Care Clinic, Arnos Vale – Former Tutor, Faculty of Medical Sciences, UWI, Cave Hill, Barbados. For appointments: clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.