Polycystic Ovary syndrome

Polycystic ovary/ovarian syndrome (PCOS)

Polycystic ovary/ovarian syndrome (PCOS)

Polycystic ovary (ovarian) syndrome (Pcos) is a common hormonal disorder affecting an increasing number of women between puberty and menopause. It is called a ‘syndrome’ because it refers to a number of symptoms experienced at the same time. It is also known as ‘polycystic ovary disease’, ‘stein-leventhal syndrome’ or ‘hyperandrogen anovulation syndrome’.

It is characterized by chronic anovulation and hyperandrogenism, and is the most common endocrinopathy in women. Consequently, it is the most common cause of anovulatory infertility, oligo-amenorrhea, amenorrhea, and hirsutism. It has recently also become clear that PCOS is linked to a number of metabolic disturbances including type 2 (noninsulin dependent) diabetes mellitus (T2DM) and possibly cardiovascular disease (CVD)

The condition is usually diagnosed based on the following factors:

1. Increased androgens (male hormones, such as testosterone) as shown by excess hair growth, acne or raised blood testosterone levels

2. Lack of regular ovulation (irregular menstrual periods or failure to release an egg from the ovary)

3. A characteristic appearance of the ovaries on ultrasound (polycystic ovaries – Pco).

Usually the diagnosis of Pcos requires the presence of at least two polycystic ovaries. Having polycystic ovaries alone is not enough to make the diagnosis of Pcos. Where required, your doctor will exclude other, rare conditions that may present as Pcos.

What are polycystic ovaries?

Polycystic ovaries are slightly larger than normal ovaries and have twice the number of follicles (fluid-filled spaces within the ovary that release the eggs when you ovulate). These cysts lead to a hormonal imbalance because of an increased amount of testosterone. This can result in acne, an increase in facial and body hair and irregular periods.

Polycystic Ovary syndrome

Why does it occur?

Doctors are not exactly sure what causes Pcos, although it is believed to be linked to both lifestyle factors and genetics – in other words it runs in the family. Sometimes another family member may have similar symptoms, however Pcos may be inherited from the male side where symptoms may not be obvious. Parents and siblings may have some of the metabolic features of Pcos, i.e. insulin resistance

The majority of women who have Pcos also have what is known as insulin resistance, which occurs when the body struggles to carry out the normal actions of insulin such as regulating the blood glucose levels. High levels of insulin can also increase the production of the male hormones including testosterone from the ovary, which contributes to such symptoms as excessive hair and acne. Insulin resistance can be caused by either genetic factors or lifestyle factors (such as being overweight) or it can be due to a combination of both.

What are the symptoms of PCOS?

• Dermatological Features: High levels of androgens typically lead to various dermatological symptoms. These include hirsutism (coarse and dark hair on the body areas where men typically grow hair e.g., the face, abdomen, chest, and back), acne, and balding/alopecia. In adolescents, some of the dermatological symptoms may be caused by puberty rather than PCOS.

• Menstrual Disorders: Menstrual disorders may vary, from complete absence of menstruation (amenorrhea) to menstruation delayed to 35 days or more (oligomenorrhea) to heavy bleeding (menorrhagia). Women with irregular menstrual periods have a 91% chance of having PCOS. Those with PCOS are 15 times more likely to report infertility.

• Polycystic Ovaries: Excessive follicles, which is defined as 25 or more follicles that are 2 mm to 10 mm in a single view of a transvaginal ultrasound, may be present in PCOS. Additionally, increased ovarian volume, an ovary that is more than 10 mL, may be present.

• Abnormal blood fats (lipids, such as cholesterol and triglycerides).

• Pre-diabetes or diabetes

• being overweight, experiencing a rapid increase in weight or having difficulty losing weight

• Difficulty becoming pregnant (reduced fertility).

Depression and psychological problems can also result from having PCOS.

The symptoms vary from woman to woman. Some women have very few mild symptoms, while others are affected more severely by a wider range of symptoms.

Your menstrual cycle and Pcos

In order to better understand the symptoms of Pcos, you might like to familiarize yourself with the process of ovulation, the menstrual cycle and the role of the various hormones.

The menstrual cycle refers to the maturing and release of an egg (ovulation) from an ovary and the preparation of the uterus (womb) to receive and nurture an embryo. A typical cycle takes approximately 24 to 35 days.

Your menstrual cycle is governed by hormone levels in the body, which rise and fall in a monthly pattern that continues throughout your reproductive life. When the cycle is running smoothly, the pituitary gland in the base of the brain produces a hormone called follicle stimulating hormone (FsH) to prepare an egg for release. FsH stimulates a fluid-like sac surrounding the egg to grow into a follicle about 2 cm wide.

About two weeks before your period when the egg is ready, the pituitary gland produces another hormone called luteinising hormone (lH). This prompts the follicle to release one egg into the fallopian tube in the process known as ovulation. Ovulation is the fertile period of a women’s menstrual cycle.

While this is happening, the ovaries are secreting other hormones such as oestrogen and progesterone to thicken the lining (endometrium) of the uterus and prepare it for pregnancy. The ovaries also produce small amounts of androgens (male hormones), such as testosterone, which is converted into oestrogen.

If the egg meets the sperm in the fallopian tube, conception may occur. The fertilised egg is swept through the tube toward the uterus where the embryo – as it is now called – will implant into the lining about six days after ovulation. It begins to produce a hormone called human chorionic gonadotrophin (hcG), which tells the body it is pregnant. If fertilization doesn’t occur, the levels of oestrogen and progesterone drop again and the lining of the endometrium comes away. This is called your period.

How is PCOS diagnosed?

Having polycystic ovaries does not mean you have PCOS.

Women with PCOS often have symptoms that come and go, particularly if their weight goes up and down. This can make it a difficult condition to diagnose, which means it may take a while to get a diagnosis.

A diagnosis is made when you have any two of the following:

• Irregular, infrequent periods or no periods at all

• An increase in facial or body hair and/or blood tests that show higher testosterone levels than normal

• An ultrasound scan that shows polycystic ovaries.

Adolescence: Diagnosing PCOS in adolescents is difficult because PCOS and puberty have similar features. These include irregular menstrual cycles and acne. For an accurate diagnosis, adolescents should have all three elements of the Rotterdam criteria for PCOS. Hyperandrogenemia is the main marker for PCOS in adolescents. Oligomenorrhea or amenorrhea should be present for at least 2 years after the first period. Forty percent of adolescents with menstrual irregularity have polycystic ovaries.

Reproductive age: Fertility issues and hirsutism are the primary issues for women at reproductive ages. Infertility is caused by high levels of androgen and luteinizing hormones, which can lead to irregular menstrual cycles and anovulation, which is an absence of ovulation during a menstrual cycle. Women with PCOS have three to four times the rate of pregnancy-induced hypertension and preeclampsia. There is also a significantly increased risk of endometrial cancer in women with PCOS

Late reproductive to menopausal age: In addition to endometrial cancer, women over 54 years of age with PCOS were found to have a significant risk of ovarian cancer, though the risk for breast cancer is not significantly increased by having PCOS. Older women with PCOS have a fourfold to six fold increase of diabetes compared with women without PCOS. Older women with PCOS also have more severe hirsutism, in addition to an increased number of metabolic and cardiovascular risk factors.

Complications

Obesity and cardiovascular risks: The metabolic abnormalities caused by PCOS, specifically increased abdominal fat and insulin resistance, contribute extensively to increased risk of type 2 diabetes and cardiovascular disease. For women with PCOS, 50–80% have insulin resistance, 61% are overweight or obese, and 50% become prediabetic or diabetic before age 40

Anxiety: Anxiety has been found to be significantly higher in women with PCOS compared with controls. PCOS may introduce an additional layer of complexity to the psychological profile and should be considered when evaluating the mental health of women.

Depression: The prevalence and risk of depression and depressive disorders in women with PCOS are 40–64%, significantly higher than in women without PCOS. Women with PCOS are four times more likely to be at risk for depression compared with women without PCOS.

Complications in pregnancy, i.e gestational diabetes: Women with Pcos who become pregnant are more likely to develop diabetes during pregnancy.

Metabolic syndrome: this cluster of illnesses can occur with Pcos. It includes impaired glucose intolerance, which is closely related to type 2 diabetes. It also includes obesity and high blood cholesterol.

Endometrial cancer: this cancer is three times more common in women with Pcos.8When women experience few or no periods, the endometrium or lining of the uterus can thicken and develop cancerous cells. Risks can be reduced by taking the oral contraceptive pill and by maintaining a healthy body weight.

Treatment

Currently, there is no cure for PCOS, but symptoms can be managed with lifestyle changes and medications. Increasing daily activity—along with eating a high-fiber, low-sugar diet with lots of vegetables, whole grains, and fruits—will help to reduce excess weight and maintain a healthy waist circumference. Also, avoiding or reducing intake of processed foods, trans fats, and saturated fats helps to maintain stable blood sugar levels. Consider consulting a nutritionist or dietitian. Furthermore, quitting smoking (or never starting) will also improve overall health.

In addition to these lifestyle changes, there are medications that can help with the management of PCOS, which should be tailored to each individual’s risk profile, desires, and treatment goals:

• Low-androgen oral contraceptives that contain drospirenone or progestin-only pills, known as minipills

• An inositol supplement (myo-inositol, D-chiro-inositol, or a combination of the two), which can help manage PCOS symptoms, such as hirsutism, acne, difficulty conceiving, etc

• Metformin

• Lipid-lowering agents for women with lipid abnormalities

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