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PCOS (polycystic ovarian syndrome)
overview
Polycystic ovarian syndrome (PCOS) is a hormonal problem that happens during the reproductive years. Patients with PCOS, may not have periods very often. Or periods may last many days. This reason is the too much concentration of androgen in the body.
With PCOS, numerous small sacs of fluid are formed along the outer edge of the ovary. These sacs are called cysts. The small fluid-filled cysts have immature eggs which are called follicles. These follicles fail to release eggs regularly
The exact cause of PCOS is not known. Early diagnosis and treatment along with weight loss may prevent long-term complications such as type 2 diabetes and heart disease.
Symptoms of Polycystic ovarian syndrome
A diagnosis of PCOS is finalized when you have at least two of these:
- Irregular periods. Having few menstrual periods cycle or having menses that aren’t regular are common signs of PCOS. So is having periods that are for many days or longer than is average for a period. For example, fewer than nine periods a year. And those periods may occur more than 35 days with having trouble getting pregnant.
- Too much androgen. Excess of the hormone androgen may result in more facial and body hair. This is called hirsutism. Moreover, severe acne and baldness can happen, too.
- Polycystic ovaries. Your ovaries might be large in size. Many follicles with immature eggs may formed around the edge of the ovary. The ovaries might not function the way they should.
PCOS signs and symptoms are typically more severe in obese people.
Causes
The exact cause of PCOS isn’t known. But few factors can play role in PCOS.
- Insulin resistance. Too much insulin might induce the body to make too much of the male hormone androgen. This can trouble with ovulation, the process in which eggs are produced and released from the ovary.
Velvety patches on the lower part of the neck, armpits, groin or under the breasts are sign of insulin resistance. An increase in appetite and weight gain may be other signs.
- Low-grade inflammation. Research shows that PCOS patients have a type of long-term but low-grade inflammation that induce polycystic ovaries to produce androgens. Consequently, this can lead to heart and blood vessel problems.
- Heredity. Research suggests that having a family history of PCOS may play a role in developing PCOS.
- Excess androgen. In PCOS, the ovaries may produce high levels of androgen which can interferes with ovulation. Thus eggs don’t develop on a regular basis and couldn’t release from the follicles where they develop. Excess androgen also can lead to hirsutism and acne.
Complications
Complications of PCOS can include:
- Infertility
- Gestational diabetes (pregnancy-induced high blood pressure)
- Miscarriage or premature birth
- Non-alcoholic steatohepatitis which is a severe liver inflammation due to fat built up in the liver.
- Metabolic syndrome — a cluster of symptoms and conditions that include high blood pressure, high blood sugar, high triglyceride levels that significantly results in heart and blood vessel (cardiovascular) disease
- Type 2 diabetes or prediabetes
- Sleep apnea
- Depression and anxiety
- eating disorders
- endometrial cancer (Cancer of the uterine lining)
Medical practitioner may ask about your menses and any weight changes. A physical exam includes observing for signs of excess hair growth, insulin resistance and acne.
Diagnosis
following tests and exams are recommended:
- Pelvic exam. During a pelvic exam, your health provider checks reproductive organs for masses, growths or remarkable changes.
- Blood tests. Blood tests can measure hormone levels that cause menstrual problems or androgen excess that mimic PCOS. You might have other blood testing, such as fasting cholesterol and triglyceride levels. A glucose tolerance test explains body’s response to sugar.
- Ultrasound. An ultrasound can explain the appearance of your ovaries and the thickness of the lining of your uterus.
If you have a diagnosis of polycystic ovarian syndrome or PCOS, your provider might recommend more tests for complications. These tests can include:
- Regular checks of blood pressure,
- Checks for glucose tolerance, and cholesterol and triglyceride levels
- Screening for depression – anxiety
- Screening for obstructive sleep apnea
Treatment of polycystic ovarian syndrome
Specific treatment might involve lifestyle changes or medication.
Lifestyle changes
Weight loss through a low-calorie diet combined with moderate exercise activities.
For example, losing 5% of your body weight might improve PCOS. Weight loss may increase the effectiveness of medication for PCOS, and it can help with infertility. A registered dietitian can determine the best weight-loss plan to PCOS conditions.
Medications for treatment of polycystic ovarian syndrome
health care provider might recommend following medications plan:
- Combination birth control pills. Birth control Pills that contain both estrogen and progestin inhibit androgen production and regulate estrogen. Regulating your hormones can lower your PCOS complications
- Progestin therapy. Taking progestin for 10 to 14 days every 1 to 2 months can regulate your periods and protect against endometrial cancer.
To initiate ovulation so that you can become pregnant, your health care provider might recommend:
· Clomiphene.
This is anti-estrogen medication that is taken orally during the first part of menstrual cycle.
· Letrozole (Femara)
This breast cancer treatment can help to stimulate the ovaries.
- Metformin. This medicine for type 2 diabetes that you take orally improves insulin resistance and lowers insulin levels. Metformin helps to ovulate. In addition, it can slow the progression to type 2 diabetes and help with weight loss.
- Gonadotropins. These hormone medications are injected into the body.
in vitro fertilization is an option if PCOS patients want to get pregnant.
To reduce excessive hair growth or to treat acne, your health care provider might recommend:
- Birth control pills to reduce androgen production that can cause excessive hair growth and acne.
- Spironolactone (Aldactone) blocks the effects of androgen on the skin reducing excessive hair growth and acne. Spironolactone can cause birth defects. Thus, this medication isn’t recommended if you’re pregnant or planning to become pregnant.
- Eflornithine (Vaniqa) This is topical cream that can slow facial hair growth.
- Hair removal Electrolysis and laser hair removal are two ways to remove hair. But these procedures are temporary, and hair may grow back.
- Acne treatments. Medications and topical creams or gels can improve acne.
Lifestyle and home remedies
To help ease the effects of PCOS, try to:
- Stay at a healthy weight
- Limit carbohydrates because High-carbohydrate diets might make insulin levels go higher.
- Be active. Exercise helps lower blood sugar levels. If you have PCOS, increasing your daily activity and getting regular exercise
Preparing for your appointment
For PCOS, you may see a gynecologist, endocrinologist or reproductive endocrinologist.
Here’s some information to help you get ready for your appointment.
What you can do before your appointment
make a list of:
- Symptoms you’ve been suffering
- Information about your menstrual cycles, i.e. their frequency
- All medications you take
