Introduction
Polycystic Ovarian
Syndrome(PCOS) is the most common cause of endocrinopathies in women. It is
also called as Stein-Leventhal Syndrome. It is a condition in which the ovary
produces an abnormally high amount of androgen hormone. Androgen hormone is a
male sex hormone that is normally present in a small amount in females.
In PCOS, numerous
fluid-filled small follicles are present in the ovary.
Causes and Risk Factors
The exact cause of PCOS
is unclear however following are some possible causes:
1) Androgen excess:
Androgen is a male sex hormone. It is increased in the case of PCOS. It is
produced in the ovary and adrenal gland.
2) Insulin resistance
3) Obesity
4) Hyperprolactinemia :
Prolactin is a hormone produces by the posterior pituitary gland. Increased
prolactin level stimulates androgen production.
5) High chances if
1st-degree relatives are affected.
6)Anovulation: Usually ovulation
occurs when a mature egg is released from the ovary every month. However, in
some women, enough hormones are not formed to ovulate. This leads to the
formation of many small cysts due to inadequate and irregular maturation of
follicles. These cysts thus make hormones called androgen which leads to the
manifestation of symptoms.
Symptoms
1)Menstrual
abnormalities
- Irregular periods with heavy bleeding
- Oligomenorrhea(periods occurring in
longer duration)
- Light periods
- Absence of periods
2)Excess body hair
present on the face, chest, stomach, back)
3)Acne
4)Hair loss with a male
pattern of baldness
5)Obesity
6)Infertility
7)Dark grey/brown
thickened and pigmented skin patches in the nape of the neck, inner thighs, groin
and axilla also known as acanthosis nigrans.
Complications
1)Type 2 DM
2)Insulin resistance
3)Endometrial carcinoma
4)Dyslipidemia
5)Risk of HTN and CVD
6)OSA following Obesity
7) Non-alcoholic fatty
liver disease
8)Depression and
anxiety
8)Anovulatory
infertility
Investigation
1) Diagnosis of
Exclusion
The following conditions are to be
excluded as they manifest similar symptoms of menstrual abnormalities.
a) Pregnancy (UPT/ beta-HCG)
b) Thyroid (TSH)
c) Hypogonadotropic hypogonadism (FSH/LH/E2)
d) Androgen secreting tumours
e) Outflow tract obstruction (for
amenorrhoea)
2) Rotterdam's criteria
Diagnosis is based on the presence of any
2 of the following criteria
a) Little bleeding or no periods
(oligo/amenorrhoea)
b) Increased androgen hormone
(Hyperandrogenism)
c) Polycyclic Ovary
3)Investigations
a) Sonography
This is done to see if there is any
presence of a cyst in the ovaries. It can also visualize the thickness of the
endometrium, the inner lining of the uterus.
b) Blood test
Blood tests are done to see the level
of androgen and other hormones like FSH, LH, Estrogen (estradiol and estrone)
Management
1) Measures that can be
taken ay home
a) Change in diet and exercise
Low-calorie diet and physical activities can help to lose weight and
utilize more insulin aiding in lower blood glucose levels and androgen levels.
b) Cessation of smoking
2)Medications
a) To reduce metabolic syndrome
- Insulin resistance is associated with
DM, Obesity, Dyslipidemia and HTN
- Use of Metformin increases insulin
sensitivity, decreases weight and BMI and reduces LDL cholesterol, BP and risk
of developing diabetes
- Thiazolidinediones are used in cases that
are resistant to Metformin.
b) Treatment when fertility is not desired
- Combined OCPs for Hyperandrogenism and
endometrial cancer
- Newer progestins like desogestrel for
Hyperandrogenism
- Anti-androgens like cyproterone acetate,
spironolactone, flutamine for hirsutism.
c) Treatment when fertility is desired
- Ovulation induction by clomiphene
citrate
3) Surgery
a) Bariatric surgery or weight reduction
surgery for morbidly obese women
b) Laparoscopic surgery if resistance to
medical therapy.