Polycystic Ovarian Syndrome (PCOS)

What is PCOS?

Polycystic ovarian syndrome (PCOS) is a common endocrinal disorder as well one of the common causes of infertility among women, which is characterised by an ovulation dysfunction or impedance to the normal growth and release of eggs from the ovaries. It is commonly seen in women of the child-bearing age and is rare after menopause. The hormonal imbalance results in enlarged ovaries containing several small cysts (fluid-filled sacs).

Causes of PCOS

The exact cause of the polycystic ovarian syndrome is unknown. However, several factors, including genetics, have been implicated to play a role in the development of PCOS. A family history of polycystic ovarian syndrome increases your risk of developing this condition.

Researchers have also found an association between excessive insulin production and the development of PCOS. The insulin hormone regulates the blood sugar levels and any disorder affecting the insulin mechanism may result in excessive insulin secretion, which triggers androgen secretion from the ovaries.

Low grade inflammation, in response to ingestion of certain foods, may lead to the release of substances that may cause insulin resistance and cholesterol accumulation in the blood vessels or atherosclerosis. Clinical studies have demonstrated the presence of low grade inflammation in women with PCOS.

Excessive exposure to the male hormone in foetal period may disrupt the function of normal gene and increase the risk of insulin resistance and low grade inflammation.

Symptoms of PCOS

The symptoms of the polycystic ovarian syndrome vary from person to person and the nature and severity of the condition. Some of the symptoms of PCOS include

  • Infertility
  • Absent or irregular menstrual cycle
  • Obesity or accumulation of fat, usually around the waist
  • Abnormal facial and body hair
  • Adult acne
  • Male pattern of baldness or hair thinning
  • Black or dark brown patches around the skin of the neck, arm, breasts or thighs
  • anxiety or depression
  • Breathlessness during sleep

Diagnosis of PCOS

The diagnosis of polycystic ovarian syndrome is based on your medical history along with a physical and pelvic examination. Blood tests may be ordered to determine the level of various hormones. Addition tests such as glucose tolerance test and evaluation of blood cholesterol may also be ordered. Pelvic ultrasound is performed to evaluate the appearance of the ovaries and the uterine lining.

Treatment of PCOS

The treatment of polycystic ovarian syndrome is based on the symptoms and individual concerns such as infertility, irregular menstrual cycle, acne or obesity. Both medications and surgical treatment can be used for the management of PCOS.

  • Infertility may be treated by fertility therapy with ovulation-inducing drugs. Clomiphene citrate, an oral anti-estrogen, may be prescribed. In some, your doctor may add metformin to clomiphene help induce ovulation. If you don’t respond to clomiphene and metformin, gonadotropins, namely, follicle-stimulating hormone (FSH) and luteinising hormone (LH) can be administered by injection.
  • Oral contraceptives may be prescribed for the management of irregular menstrual cycles. Oral contraceptives effectively reduce the level of male hormone and are also effective in reducing the excessive body hair growth and minimising the risks of uterine cancer.
  • Lifestyle modifications and anti-diabetic medications may be prescribed for the management or prevention of obesity and diabetes mellitus.
  • Surgery may be recommended if you do not respond to medications. Laparoscopic ovarian drilling, an outpatient surgical procedure, may be performed to treat the condition and induce ovulation.

Associated Risks of PCOS

Polycystic ovarian syndrome may frequently increase the risk of other serious medical conditions such as

  • Diabetes mellitus
  • Cardiovascular diseases
  • Pregnancy-induced high blood pressure
  • Miscarriage or premature delivery
  • Uterine cancer
  • Anxiety or depression
royal-college-obstetricians-and-gynaecologists royal-australian-and-new-zealand-college-obgyn queens-university-belfast ivf-australia royal-australian-college-medical-adm unsw-sydney