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The World Health Organization estimates that (PCOS) affects 116 million women worldwide as of 2010 (3.4% of the population).
Polycystic ovarian syndrome (PCOS) is a condition that occurs in women only where their levels of sex hormones become imbalanced, including an elevated level of androgen hormone which are male sex hormones. Signs and symptoms of (PCOS) include irregular or no menstrual cycle, excess body and facial hair, acne, pelvic pain, and conceiving difficulties.
A combination of genetic and hormonal imbalance factors cause (PCOS). (PCOS) can be increased by certain factors such as family history, other reproductive disorder, diabetes and obesity. For a diagnosis of (PCOS), a doctor depends on the medical history of the patient, doing physical and pelvic exams, blood tests, and ultrasound.
The pathophysiology of (PCOS) resides in the stimulation of the ovaries to produce androgens, particularly testosterone, through two paths that include the release of extra amounts of luteinizing hormone (LH) or by raising the amount of free androgens.
(PCOS) could lead to many complications such as type 2 diabetes, high blood pressure, infertility and sleep apnea, to name few.
No definite treatment can completely cure (PCOS). However, different treatment procedures can help improve the condition of the patient like lifestyle changes including weight loss, the regulation of menstrual cycle using mainly birth control pills and metformin, excessive hair growth treatments, and medications to improve fertility or in some cases the use of laparoscopic ovarian drilling surgery.
The process of preventing (PCOS) is still unclear; however, complications limiting procedures such as nutrition and weight management can be done, especially in pregnancy associated problems.
It is worth mentioning that women with (PCOS) who do receive treatment are most likely to conceive, whereas the risk of miscarriage, high blood pressure, and gestational diabetes are increased by (PCOS).
In 2010 (PCOS) affected 116 million women worldwide.
Polycystic ovarian syndrome (PCOS) is a disorder that occurs in the endocrine system, where a female has an imbalance in the reproductive hormones, creating problems in the ovaries. A healthy menstrual cycle allows the ovaries to produce a mature egg and release one of the eggs each month. In women with (PCOS) the egg may not develop or be released in the proper way, in addition numerous small follicles; collections of fluid, may appear. Missed or irregular menstrual cycle can result from (PCOS).
The exact cause of (PCOS) is unknown, but the following factors may play a role:
Insulin resistance happens when the tissues of the body fail to respond normally to insulin; a hormone that regulates sugar in the blood and is produced by the pancreas. As a result, the insulin blood levels become higher than normal. High levels of insulin affect the ovaries by increasing androgen production, which may disrupt the development of the follicles; the sacs in the ovaries where eggs develop, and the normal ovulation process; the monthly release of an egg from the ovaries.
(PCOS) symptoms are worsened by weight gain that is associated with insulin resistance since extra body fat forces the body to produce even larger amounts of insulin.
Imbalances in certain hormones are linked to women with (PCOS) and could happen for unknown reasons. These imbalances include:
Usually mistaken to be only produced in men where the fact is that it is produced in small amounts in women.
Ovulation is triggered by this hormone but if found in high levels it could have adverse effects on the ovaries.
This hormone is responsible for producing milk during pregnancy via stimulation of the breast glands. The incidence of this case in (PCOS) women is low.
A protein that minimizes the effect of testosterone by binding to it.
To fight an infection, the white blood cells in the body produce substances causing an inflammation. A type of this low-grade inflammation causes polycystic ovaries to produce androgens in women with (PCOS), which may be followed by heart and blood vessel problems.
Although the specific genes responsible for causing (PCOS) are still not identified till this day, the chances of developing PCOS are increased if any relatives, such as mother, sister or aunt have (PCOS).
Risk Factors of polycystic ovarian syndrome
Some of the risk factors associated with (PCOS) are:
(PCOS) is the result of ovaries stimulation to produce extra amounts of androgens, specifically testosterone. This can be done by two ways, via the anterior pituitary gland that releases excessive quantities of luteinizing hormone; a hormone that is secreted in both females and males via the anterior lobe of the pituitary gland to produce hormones, or by raising the amount of free androgens via two ways; the presence of high levels of insulin in the blood (hyperinsulinaemia) for women affected by this stimulus ,or low levels of sex-hormone binding globulin (SHBG).
The development of (PCOS) is bound to other factors mentioned below:
The ratio of luteinizing hormone to follicle stimulating hormone (LH/FSH) is proportionally increased with the level of gonadotrophin releasing hormone (GnRH), both in women with PCOS.
Obesity and insulin resistance are common in women with (PCOS). Abnormalities in the hypothalamic-pituitary-ovarian axis cause (PCOS) and are highly linked to elevated insulin levels. Hyperinsulinemia increases GnRH pulse frequency; pulsatile manner from GnRH neurons located in the hypothalamus that control the release of LH and FSH, LH over FSH dominance, increased ovarian androgen production, decreased follicular maturation and decreased SHBG binding.
Once the first menstrual cycle occurs (PCOS) usually develops and in some cases, later onset occurs due to other reasons such sudden weight gain.
Some of the signs and symptoms of PCOS include:
Menstrual cycles could be irregular, infrequent or may take a longer time than usual to occur and in some cases they could be absent.
An enlargement of the ovaries with follicles; small fluid-filled sacs, that surround the eggs is accompanied by an ovary that fails to function.
Level of male hormone (androgen) becomes increased and is manifested in excess facial and body hair (hirsutism) that occurs in the face, arms, back, chest, thumbs, toes, and abdomen, and occasionally severe acne and to some extent skin tags and darkened patches of skin are also common in woman with (PCOS), and male-pattern baldness that are increased in middle age.
Almost 50% or women with (PCOS) face obesity and weight gain problems that are challenging to control.
(PCOS) is one of the major causes of infertility in women and may require a woman to take fertility treatments, while other women may be able to conceive without assistance.
Increased fatigue and low energy are observed in women with (PCOS). Fatigue is related to insomnia or poor sleep and is highly affected by sleep apnea; breathing is discontinued for short periods of time during sleep.
Mood swings, depression, and anxiety are increased in women with (PCOS).
Heavy bleeding and pelvic pain accompany menstruation, where the latter may happen even when there is no bleeding.
Hormonal changes stimulate headaches.
No specific tests are available to diagnose (PCOS). It is important to get a detailed medical history that includes menstruation periods and weight changes.
The doctor may also perform certain tests and exams including:
Blood pressure, body mass index (BMI), and waist size are determined though out a physical exam The doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland). Physical exams are able to provide signs of excess hair growth, insulin resistance, acne and or skin discoloration.
The doctor performs visual and manual inspection for the reproductive organs to check for signs of extra male hormones (for example, an enlarged clitoris), in addition to masses, growths or other abnormalities.
They are used for measuring hormone levels and are beneficial in eliminating other potential causes of menstrual abnormalities or androgen excess that mimics (PCOS).
Blood tests showing the levels of:
Additional blood testing may include:
A transvaginal ultrasound uses sound waves to be interpreted into images on a computer screen, where the appearance of the ovary and the thickness of the lining are inspected.
(PCOS) varies from one individual to another, since a patient may experience a set of symptoms or just one of them. Treatment in the case of (PCOS) is mainly involved in managing the symptoms. Treatments may include:
The medications are taken in order to:
By using one of the following medication:
This type of treatment regulates periods and offers protection against endometrial cancer, by take progesterone for 10 to 14 days every one to two months. This method does not stop pregnancy from occurring and will not enhance the levels of androgen.
It is an oral medication specific to type 2 diabetes that improves insulin resistance and lowers insulin levels. This may help in reducing symptoms in some women with (PCOS) symptoms by stimulating ovulation and regulating the menstrual cycle. Furthermore, metformin is useful in slowing the progression of type 2 diabetes if the patient is already pre-diabetes and is useful in weight loss.
Conceiving in women with (PCOS) may require some medications that regulate ovulation, including:
It is an oral anti-estrogen medication that is advised to be used as first treatment for women with (PCOS). It is taken in the first part of the menstrual cycle in order to regulate the monthly ovulation.
When clomiphene is not successful in encouraging ovulation, metformin is used due to its ability to lower insulin and blood sugar levels in women with (PCOS). Moreover, it helps induce ovulation, regular monthly periods and lowering the risk of miscarriage. Long-term beneficial outcomes such as lowering high cholesterol levels and reducing the risk of heart disease are also possible. A contraceptive method should also be used if pregnancy is not desired while using metformin.
These are hormones stimulate sex glands (gonads) to function properly; reproductive or endocrine functions. They include follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and the human chorionic gonadotropin (hCG); a placental hormone.
They are available as injections with an increased chance of having overstimulated ovaries and can cause multiple pregnancies. If multiple pregnancies are not desired, laparoscopic ovarian drilling can be used instead of gonadotropins which is a surgical treatment that can trigger ovulation in women with polycystic ovary syndrome (PCOS).
They can replace clomiphene used to stimulate ovulation.
-These medications either block the effects of androgens such as testosterone on the skin or suppress the production of such hormones by the ovaries. This results in controlling excessive hair growth (hirsutism) and hair loss (alopecia). These medications include:
The effects of androgen on the skin is prevented via this treatment, which shouldn’t be used during or prior to a planned pregnancy since it causes birth defects.
A cream used to make the process of facial hair growth slower in women.
This technique uses a tiny needle with a pulse of electric current, which leads to a damaged to destroyed follicle. Multiple treatments could be needed.
Overweight women with (PCOS) can reduce their symptoms and decrease the risk of developing long-term health problems related to(PCOS) by following a weight reducing diet along with moderate exercise activities in order to lose weight. Weight loss contributes to an increased effectiveness of treatment used, in addition to aiding with fertility.
A laparoscopic ovarian drilling (LOD) is a minor surgical procedure, performed under general anesthesia that is a solution to treat fertility problems associated with (PCOS). This technique resolves hormonal imbalances and makes the ovaries return to their normal function. This is due to its action on lowering the levels of testosterone and luteinizing hormone (LH) and raising the levels of follicle-stimulating hormone (FSH).
Women with (PCOS) are more likely to develop:
Women with (PCOS) are at a higher risk of developing prediabetes; the stage before type 2 diabetes and type 2 diabetes than other women. Women with (PCOS) are also more likely to develop diabetes before the age of 40 and this may be increased by:
When age is set, women with (PCOS) are at greater risk of having high blood pressure; a leading cause of heart disease and stroke.
Women with (PCOS) often have elevated level of triglycerides and low density lipoprotein (LDL); the bad form of cholesterol, and low level of high-density lipoprotein (HDL); the good form of cholesterol.
It is several conditions occurring together that point out a significantly increased risk of cardiovascular disease and type 2 diabetes. These conditions include:
Fat accumulation in the liver can cause severe liver inflammation.
Overweight or obesity that is related to (PCOS) can cause sleep apnea, where the patient experiences momentary and repeated pauses in breathing that interrupt sleep.
Are common in women with (PCOS).
The common conditions accompanying (PCOS) could be the cause of endometrial cancer. Problems with ovulation, obesity, insulin resistance, and diabetes may increase the risk of developing endometrial cancer. Furthermore, continuous exposure to high levels of estrogen may play a role.
Pregnant woman with (PCOS) are at a higher risk for pregnancy and delivery complications. These complications include:
The risk of miscarriage in woman with (PCOS) is increased by three-folds in early pregnancy than in other women.
It is the type of diabetes which affects the women during pregnancy, which can lead to large babies.
After the 20th week of pregnancy a sudden elevation in blood pressure and body swelling could occur.
Prevention is not well defined in (PCOS). However, complications can be avoided, through proper nutrition and weight management for many women with (PCOS).
Pregnancy associated problems are prevented through:
Once a woman with (PCOS) gets treatment, the possibility of conceiving is raised. The risk of miscarriage, high blood pressure, and gestational diabetes are increased by (PCOS).
The World Health Organization estimates that (PCOS) affects 116 million women worldwide as of 2010 (3.4% of the population).
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