Polycystic ovary syndrome

Introduction 

Polycystic ovary syndrome (PCOS) is a condition in which a woman has an imbalance of female sex hormones hence affecting the normal work of the ovaries.
The three main features of PCOS are:

• cysts that develop in your ovaries (polycystic ovaries)
• your ovaries not regularly releasing eggs (ovulating)
• high levels of "male hormones" called androgens in your body

 

Polycystic ovaries

Polycystic ovaries contain a large number of harmless cysts up to approximately 8mm  in size. The cysts are under-developed sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means that ovulation doesn't take place.

 

 Signs and symptoms

  

Irregular Periods.  Not getting a period after you have had one or more normal ones during puberty also called secondary amenorrhea.Irregular periods that may come and go, and be very light to very heavy

Excess androgen.This may result in development of male characteristics, due to elevated levels of male hormones (androgens) ,may result in physical signs, such as excess facial and body hair (hirsutism), adult acne or severe adolescent acne, and male-pattern baldness (androgenic alopecia).

Polycystic ovaries.Polycystic ovaries become enlarged and contain numerous small fluid-filled sacs which surround the eggs

Causes of polycystic ovary syndrome 

Doctors don't know what causes polycystic ovary syndrome, but it's thought to be related to abnormal hormone levels.Here are some of the factors:

Excess insulin
Insulin is a hormone produced by the pancreas to control the amount of sugar in the blood. It helps to move glucose from blood into cells, where it's broken down to produce energy.
If you have Insulin resistance,it means the body's tissues are resistant to the effects of insulin. The body therefore has to produce extra insulin to compensate.
High levels of insulin cause the ovaries to produce too much testosterone, which interferes with the development of the follicles (the sacs in the ovaries where eggs develop) and prevents normal ovulation.
Insulin resistance also results in excessive weight gain, which worsens symptoms of PCOS, because having excess fat causes the body to produce even more insulin.

Hormone imbalance

Many women with PCOS are found to have an imbalance in certain hormones, including:

• raised levels of testosterone, a hormone often thought of as a male hormone, although all women usually produce small amounts of it
• raised levels of luteinising hormone (LH) ,this stimulates ovulation, but may have an abnormal effect on the ovaries if levels are too high
• low levels of sex hormone-binding globulin (SHBG) ,a protein in the blood, which binds to testosterone and reduces the effect of testosterone
• raised levels of prolactin (only in some women with PCOS) ,  hormone that stimulates the breast glands to produce milk in pregnancy

Researchers also are still looking into exact reason why these hormonal changes occur . It's been suggested that the problem may start in the ovary itself, in other glands that produce these hormones, or in the part of the brain that controls their production. The changes may also be caused by the resistance to insulin.

Heredity

PCOS sometimes runs in families. If any relatives, such as your mother, sister or aunt, have PCOS, then the risk of you developing it is often increased.
 Researchers also are looking into the possibility that certain genes are linked to PCOS.

Tests and diagnosis

There's no specific test to definitively diagnose polycystic ovary syndrome. The diagnosis is one of exclusion, which means your doctor considers all of your signs and symptoms and then rules out other possible disorders.
During this process, you and your doctor will discuss your medical history, including your menstrual periods, weight changes and other symptoms. Your doctor may also perform certain tests and exams:

• Physical exam. During your physical exam, your doctor will note several key pieces of information, including your thyroid gland,skin,hair, height, weight, blood pressure and Body Mass Index.
• Pelvic exam. During a pelvic exam, your doctor visually and manually inspects your reproductive organs for signs of masses, growths or other abnormalities.
• Blood tests. Your blood may be drawn to measure the levels of several hormones to exclude possible causes of menstrual abnormalities or androgen excess that mimic PCOS. Additional blood testing may include fasting cholesterol and triglyceride levels and a glucose tolerance test, in which glucose levels are measured while fasting and after drinking a glucose-containing beverage.

      
  Some of the hormonal test are:

•  Human chorionic gonadotropin (hCG), detects pregnancy pregnant.
• Testosterone,is an androgen. At high levels blocks ovulation and may cause acne, male-type hair growth on the face and body, and hair loss from the scalp.
• Prolactinhormone, play a part in a lack of menstrual cycles or infertility.
• Cholesterol and triglycerides
• Thyroid-stimulating hormone (TSH) checks for an overactive or underactive thyroid.
• Adrenal gland hormones, such as DHEA-S or 17-hydroxyprogesterone. An adrenal abnormalities  cause symptoms much like PCOS.
• Glucose tolerance and insulin levels, shows presence of insulin resistance.

• Ultrasound. An ultrasound exam can show the appearance of your ovaries( which might show enlarged ovaries with small cysts) and the thickness of the lining of your uterus.

 Treatments and drugs

 There's no cure for PCOS, but the symptoms can be treated. Speak to your GP if you think you may have the condition.

 

Lifestyle changes

In overweight women, weight loss is recommended through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — calculating your body mass index (BMI)
shows the progress in weight loss thus improving your condition.

 

Medications

Your doctor may prescribe a medication to:

• Regulate your menstrual cycle. To regulate your menstrual cycle, your doctor may recommend combination birth control pills — pills that contain both estrogen and progestin. These birth control pills decrease androgen production and give your body a break from the effects of continuous estrogen, lowering your risk of endometrial cancer and correcting abnormal bleeding. As an alternative to birth control pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin. During the time that you take this medication to relieve your symptoms, you won't be able to conceive.
  If  combination birth control pills do not work well with you, an alternative approach is to take progesterone for 10 to 14 days every one to two months. This therapy regulates your periods and offers protection against endometrial cancer, though it does not improve androgen levels and it would not prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device are better choices if you also wish to avoid pregnancy.
  Your doctor also may prescribe metformin (Glucophage, Fortamet, others), an oral medication for type 2 diabetes that improves insulin resistance and lowers insulin levels. This drug may help with ovulation and lead to regular menstrual cycles. Metformin also slows the progression to type 2 diabetes if you already have prediabetes and aids in weight loss if you also follow a diet and an exercise program.
  
• Fertility Treatment.If you are trying to concieve a baby, Clomiphene (Clomid, Serophene)  an oral anti-estrogen medication is administered. Its taken in the first part of your menstrual cycle. If clomiphene alone isn't effective, metformin may be added to help induce ovulation.
  If you don't become pregnant using clomiphene and metformin, gonadotropins — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications are administered by injection. Another medication that your doctor may have you try is letrozole (Femara). Doctors don't know exactly how letrozole works to stimulate the ovaries, but it may help with ovulation when other medications fail.
  When taking any type of medication to help you ovulate, it's important that you work with a reproductive specialist and have regular ultrasounds to monitor your progress and avoid problems.
  
• Reduce excessive hair growth. Doctors may recommend  combined oral contraceptive tablets (such as co-cyprindiol, Dianette, Marvelon and Yasmin) to decrease androgen production, or  spironolactone (Aldactone) that blocks the effects of androgens on the skin. Spironolactone can cause birth defects, effective contraception is required when using the drug, and it's not recommended in pregnancy or if planning to become pregnant.Other drugs includes: cyproterone acetate,flutamide ,finasteride and  Eflornithine (Vaniqa)  cream is another medication possibility;it slows facial hair growth in women.

Preparing for your appointment

For PCOS, you might first see your family doctor or primary care provider. However, you may be referred to a gynecologist,endocrinologist (one who specializes in hormone disorders) or reproductive endocrinologist (one who specializes in treating infertility).Facebook