Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome is a common hormonal disorder among women of reproductive age. It can affect you from adolescence to older age. The symptoms are irregular or prolonged periods, excessive hair growth all over, acne, increased weight, male-pattern baldness and infertility.

At different stages of life, it can express itself in different ways, for example, in adolescence: absence or infrequent menstruation may be a single sign associated with increase in weight and excessive hair growth. In women past adolescence, it can express itself as an irregular ovulation cycle, leading to pregnancy issues, unexplained weight gain and/ or difficulty in losing weight and difficulty in falling pregnant.

Large ovaries containing numerous small cysts:

This can be detected by ultrasound. The exact cause of PCOS is unknown, however this factor may contribute to the problem.

Excessive insulin:

This condition causes insulin resistance so the pancreas has to produce more insulin, which can increase the production of androgen, therefore leading to acne, excessive hair growth and weight gain.

Excessive Androgen:

This condition can cause male pattern hair growth and acne and also it causes the ovaries to be prevented from releasing an egg each month (missed ovulation) that can lead to infertility.

PCOS affects all areas of the body, not just the reproductive system. It increases a woman’s risk of serious conditions that may have lifelong consequences.

Insulin resistance increases the risk of type 2 diabetes mellitus and cardiovascular disease.

Women with PCOS tend to have a condition called endometrial hyperplasia, in which the lining of the uterus (the endometrium) becomes too thick. This condition increases the risk of endometrial cancer.

In summary, complications are;

This is a lifetime condition that one needs to be prepared for. Such as, higher risk of obesity, diabetes type 2, high blood pressure, high cholesterol and lipids, sleep apnoea, heart attack and stroke and endometrial cancer. Further complications may include abnormal uterine bleeding, gestational diabetes and sub-fertility.

A thorough medical history, physical examination, pelvic examination, blood tests for androgen/insulin levels, a BSL lipid profile and a pelvic ultrasound looking for pearl necklace appearance of the ovaries.

Life style changes:

Only 5% reduction in body mass may help a woman to ovulate. Consider dietary changes, such as low fat and low carbohydrate diet. This will decrease insulin levels and help with weight reduction. Lastly, increase exercise, which can lower your blood sugar levels.

Medication:

Oral contraceptive pills or marina IUD are a first-line to regulate the periods and to prevent increase in the thickness of endometrial lining.

Clomid/Metformin can induce ovulation if the problem is infertility.

Spironolactone or contraceptive pills which decrease androgen production, therefore reduces excessive hair growth and acne

Surgery:

Laparoscopic ovarian drilling, which can reduce androgen formation.