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About Polycystic Ovarian Syndrome (PCOS)

What is polycystic ovary syndrome?

PCOS is a complex disorder of the reproductive hormones and metabolism in women. It is very common, occurring in 7-10% or reproductive age women, and it is the most common cause of irregular menstrual cycles and infertility in women in their reproductive years. Tiny cysts (follicles) develop in your ovaries. (Polycystic means many cysts.).The balance of hormones that you make in the ovaries is altered. In particular, your ovaries make more than normal of the male hormone testosterone.

What can be the symptoms of PCOS?

PCOS can have three general types of effects:

  • Cosmetic – acne, hair growth on the face, chest, and abdomen
  • Reproductive – irregular or absent menstrual cycles, infertility
  • Metabolic – changes in blood pressure, blood cholesterol, and glucose (sugar) metabolism that may predispose to problems like heart disease, stroke, and diabetes

Not all symptoms occur in all women with PCOS. For example, some women with PCOS have some excess hair growth, but have normal periods and fertility.

How does doctor diagnose PCOS?

PCOS is a syndrome, or group of symptoms. Following criteria are used by most endocrinologists:

  • Menstrual disturbance – irregular or absent menses
  • Hyperandrogenism – elevated effects of androgens (masculinizing hormones) manifest by acne, extra hair growth, balding, and/or elevated blood androgen levels (e.g. testosterone)
  • An ultrasound of the ovaries to look for cysts may be done to look for cystic ovaries.
  • Exclusion of other causes – such thyroid problems, high prolactin levels, early menopause

To diagnose PCOS, your doctor will typically listen to your history and will perform a physical exam. Blood testing is typically performed to evaluate androgen levels and to exclude other causes.

Can diagnosis be done only on USG?

No. The doctor will correlate your USG findings with clinical history and blood tests. 25% of women with PCOS may have normal appearing ovaries (but will still respond to treatment) and 25% of women without PCOS have cystic ovaries.

What causes PCOS?

The precise cause of PCOS is unknown, and likely there are multiple factors involved. A key feature of PCOS is insulin resistance. The body tries to overcome this resistance by making more insulin. It causes the ovaries to make too much testosterone. A high level of insulin and testosterone interfere with the normal development of follicles in the ovaries. It is this increased testosterone level in the blood that causes excess hair growth on the body and thinning of the scalp hair. If you are overweight or obese, excess fat can make insulin resistance worse. PCOS is not strictly inherited from parents to children, but it may run in some families.

Possible long-term problems of polycystic ovary syndrome

If you have PCOS, over time you have an increased risk of developing type 2 diabetes, diabetes in pregnancy, a high cholesterol level, and possibly high blood pressure. These problems in turn may also increase your risk of having a stroke and heart disease in later life. Other possible problems in pregnancy include more chance of having babies too early or having pre-eclampsia (high blood pressure in pregnancy). There may be twice the risk of developing diabetes in pregnancy if you have PCOS so you would be checked for this regularly.A sleeping problem called sleep apnoea is also more common than average in women with PCOS.

What is the treatment for pcos?

PCOS may be treated with lifestyle changes, medications, or both. The choice of therapy depends on many factors, including desire for pregnancy and individual circumstances.

Lifestyle modifications
You should aim to lose weight if you are overweight.Losing weight helps to reduce the high insulin level that occurs in PCOS. Losing weight can be difficult. A combination of eating less and exercising more is best. Ideally you should obtain 30 minutes of exercise on most days of the week.

Medications
Medications may be used to help treat the effects of PCOS, and are tailored to each individuals needs, desire for pregnancy, etc. To treat insulin resistance- Metformin

To treat androgen excess- OC pills, Spironolactone, Finasteride Medicines taken by mouth to treat hair growth take 3-9 months to work fully. You need then to carry on taking them, otherwise hair growth will come back (recur). Removing hair by the methods ( shaving, waxing, hair-removing creams, electrolysis, and laser) may be advised whilst waiting for a medicine to work.

To treat infertility; Metformin, Clomiphene, "Gonadotropin" injections

What if I become pregnant while on medication?

If you become pregnant while taking medication to treat PCOS, please notify your doctor to discuss your medications. You should immediately stop birth control pills, spironolactone, and/or finasteride if you are on any of these, as they may adversely affect the developing baby. There is some evidence that metformin may protect against early pregnancy loss in women with PCOS. Please discuss with your doctor whether you should continue this for the first trimester of pregnancy.

Some Useful links:

http://www.mayoclinic.org/diseases-conditions/pcos/basics/definition/con-20028841
http://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics
http://www.hormone.org/diseases-and-conditions/womens-health/polycystic-ovary-syndrome

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