A Family Doctor's Tale - POLYCYSTIC OVARIAN SYNDROME

DOC I HAVE POLYCYSTIC OVARIAN SYNDROME

Polycystic ovarian syndrome (PCOS) is a hormonal disease that causes women to have a combination of symptoms:

1.Oligomenorrhea -less menses than before

2.Obesity

3.Hirsutism -skin is more hairy

4.Infertility

Most women with PCOS have some small cysts in the ovaries hence the name Polycystic ovarian syndrome.

However cysts in the ovaries can be caused by a number of other illness than PCOS.

It is the characteristic  symptoms rather than the presence of the cysts that is important in the the diagnosis of PCOS.

PCOS occurs in 5% to 10% of women and is present in all races.

It is the main cause of infertility in women.

Symptoms of polycystic ovarian syndrome are:

1.menstrual disturbances  -

a.fewer than normal menstrual periods (oligomenorrhea),

b.the absence of menstruation for more than three months (secondary amenorrhea)

c.heavy bleeding (menorrhagia).

2.excess hair growth on the body (hirsutism),

3.obesity -excess weight gain,

4.infertility - due to  irregular or no release of eggs from the ovaries

5.multiple, small cysts in the ovaries.

Other symptoms are:

1.skin discolorations,

2.high cholesterol levels,

3.elevated blood pressure

4.raised insulin levels

5.raised androgen levels

6.oily skin,

7.dandruff,

The causes of polycystic ovarian syndrome (PCOS) are unknown but could be due to :
1.Genetic - Women with PCOS often have a mother or sister with the condition,

2. environmental factors:

a.exposure to male hormones

b chronic inflammation of the body from childhood illnesses

The diagnosis of PCOS is based on:

1.clinical signs and symptoms as  above

2.Serum male hormones (DHEA and testosterone) are usually raised

3.Blood luteining hormone which is secreted by the pituitary gland in the brain is usually raised

4.Ultrasound can also detect cysts in the ovaries

5.CT scan and MRI  detect cysts but are used mainly to exclude ovarian or adrenal gland tumors

The complications associated with PCOS are:
1. high blood pressure

2.diabetes

3.heart disease

4.cancer of the uterus (endometrial cancer).

5.infertility

6. abnormal levels of LDL ("bad") cholesterol and blood triglycerides

Treatment of PCOS is as follows:

1. Oral contraceptic pill with low androgenic (male hormone) side effects can help to  regulate menses and reduce the risk of cancer of the uterus

2.Oral Progesterone treatment used intermitently can induce regular menses

3.spironolactone (Aldactone)  can reduce water retention and acne

4. clomiphene (Clomid) can be given to infertile women with PCOS to induce ovulation (cause egg production)

5.Metformin used to treat type 2 diabetes reduce the action of insulin and reduce the symptoms and complications of PCOS such as irregular periods, ovulation induction, weight loss, prevention of type 2 diabetes

6.gonadotropin hormones injection can help women who wish to have babies and do not want to be on Clomid treatment which cause multiple pregnancies

7.weight loss in obese females with PCOS can cause menstrual cycles to be normal and increases the possibility of pregnancy.

Weight loss can help reduce or prevent the complications associated with PCOS, including diabetes and heart disease.

8. ovarian drilling (some ovarian tissue is removed bypassing an electric current through a needle inserted into the ovary)can  induce ovulation in women who are not responding  to other treatments

Prognosis is good for patient to regulate menses but not so good for infertility.