healthy : polycystic ovarian syndrome

POLYCYSTIC OVARIAN SYNDROME (PCOS)

PCOS is a problem with hormones that affects women during their childbearing years (ages 15 to 44). The cause of polycystic ovary syndrome isn’t well understood, but may involve a combination of genetic and environmental factors. The major features of polycystic ovarian syndrome (PCOS) include menstrual abnormalities and signs of excess male hormones. Although the exact cause of this condition is unclear, PCOS can result from abnormal function of the brain area responsible for periods and the ovary (hypothalamic-pituitaryovarian (HPO) axis). A key characteristic of PCOS is female hormonal imbalance, which is more likely a result of, rather than a cause of, ovarian dysfunction. In addition, one of the most consistent biochemical features of PCOS is a raised blood male hormone (testosterone). Insulin resistance is also associated with polycystic ovarian syndrome. Genes, insulin resistance, and inflammation have all been linked to excess male hormone (androgen) production.

By Dr Abigael Jemedze

What is polycystic ovarian syndrome (PCOS)?

What are the symptoms of PCOS?

Symptoms include menstrual irregularity, excess hair growth, acne and obesity. Menstrual irregularities include abnormal menstruation, absence of menstruation, heavy menstruation, irregular menstruation, short and light menstruation, or spotting. High levels of male hormones prevent the ovaries from producing hormones in a balanced way and thus affecting maturation of eggs normally. This results in a peripheral ring of cysts measuring between 2mm-9mm and the cysts range from 9 to 20 cysts. The layer covering the ovary thickens thus preventing ovulation from taking place.

Weight issues: obesity, overweight, or weight gain. Polycystic ovarian syndrome is linked to insulin resistance which subsequently results in weight gain. The weight is concentrated in the midsection (truncal obesity-belly fat)

Skin: acne or oily skin. High level of male hormones free testosterone, contribute to acne from oily skin. Common also are subfertility /infertility, depression, loss of scalp hair, unwanted hair for example beard, leg hair, or virilization. Both hormonal changes

and symptoms like unwanted hair growth can negatively affect your emotions. Many with PCOS end up experiencing anxiety or even depression when coupled with subfertility and obesity.

How do Doctors diagnose PCOS?

Doctors diagnose PCOS if women have at least two of three main symptoms Excessive Hair- high androgen levels, irregular periods, and cysts in the ovaries. A pelvic exam, blood tests, and ultrasound can confirm the diagnosis.

What are the chances of getting pregnant with PCOS?

The infertility rate with polycystic ovaries is very high. These women usually will have difficulty getting pregnant - and usually require treatment to improve chances for pregnancy. Some women with polycystic ovary syndrome will ovulate (release a mature egg) occasionally - others do not ever ovulate. Chances of conception are higher under the age of 35 years.

Can PCOS be treated?

Treatment modalities depend on the presenting complaint such as infertility, hirsutism, acne or obesity. PCOS treatment focuses on managing your individual concerns, Specific treatment might involve lifestyle changes or medication.

Lifestyle changes

Weight loss through a low-calorie diet combined with moderate exercise activities. A reduction in your weight by 5 to 10 percent of your body weight improves one’s condition. Losing weight may also increase the effectiveness of medications for PCOS, and can help with infertility.To regulate your menstrual cycle, the following may be recommended:

Combined birth control pills (brown

and white). Pills that contain oestrogen and progestin decrease androgen production and regulate oestrogen. Regulating hormones can lower the risk of endometrial cancer and also correct abnormal bleeding, excess hair growth and acne.

Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn’t improve androgen levels and won’t prevent pregnancy. The progesterone-only pill (POP) or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.

If subfertility is the main problem then fertility pills will be prescribed for example letrozole or clomid. Metformin, the oral medication for type 2, diabetes improves insulin resistance and lowers insulin levels. It helps with weight loss and conception. If you have prediabetes, metformin can also slow the progression to type 2 diabetes. Gonadotropins. These hormone medications are given by injection. To reduce excessive hair growth, birth control pills, decrease androgen production that can cause excessive hair growth. Spironolactone, blocks the effects of androgen on the skin. But spironolactone can cause birth defect, so effective contraception is required while taking this medication. It isn’t recommended if you’re pregnant or planning to become pregnant.