Polycystic Ovarian Syndrome

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

Causes

The exact cause of polycystic ovarian syndrome is unknown. However, several factors, including genetics, have been implicated to play a role in the development of PCOS. Women with a family history of polycystic ovarian syndrome are at a higher risk of developing this condition. Researchers have also found an association between excessive insulin production and the development of PCOS. The insulin hormone regulates blood sugar levels and any disorder affecting the insulin mechanism may result in excessive insulin secretion, which triggers androgen secretion from the ovaries.

Symptoms

The symptoms of polycystic ovarian syndrome vary from person to person and depends upon the nature and severity of the condition. Some of the symptoms of PCOS include infertility, absent or irregular menstrual cycle and weight gain, usually around the waist. Abnormal facial and body hair, adult acne and male pattern baldness or hair thinning may also develop due to excessive androgen secretion. In some patients, black or dark brown patches are seen around the skin of the neck, arm, breasts or thighs.

Diagnosis

The diagnosis of polycystic ovarian syndrome is based on the medical history, along with a physical and pelvic examination to evaluate the condition of the patient and help identify the underlying cause. Blood tests are conducted to determine the level of various hormones. Additional tests, such as a glucose tolerance test and evaluation of blood cholesterol may also be conducted in these patients. A pelvic ultrasound is performed to evaluate the appearance of the ovaries and the uterine lining.

Treatment

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-oestrogen, may be prescribed to patients. In some patients the doctor may add metformin to clomiphene, to help induce ovulation. In patients not responding to clomiphene and metformin, gonadotropins, namely, follicle-stimulating hormone (FSH) and luteinizing 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 the male hormone and are also effective in reducing excessive body hair growth and also minimise 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 in patients who do not respond to medications. Laparoscopic ovarian drilling, an inpatient surgical procedure, may be used to treat the condition and induce ovulation.

Associated Risks

Patients with polycystic ovarian syndrome frequently develop other serious medical conditions, such as diabetes mellitus, cardiovascular diseases, pregnancy induced high blood pressure, miscarriage or premature delivery. These patients are also at risk of uterine cancer.

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