Polycystic ovary syndrome
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Polycystic ovary syndrome or PCOS is a common hormonal problem in women of reproductive age. The imbalance levels of androgen hormone which causes irregularities in the menstrual cycle, such as a missed period or prolonged period days. It is a common cause of infertility in women.
PCOS is a “syndrome”, or collection of symptoms, that has an impact on the ovaries and ovulation. “Polycystic” means “many cysts” and is one of its main characteristics. It refers to the many fluid-filled sacs that form in the ovaries due to lack of ovulation. The sacs are called follicles, containing one immature egg each. Not all women with PCOS have small cysts in the ovaries.
PCOS has unknown cause. The treatment focuses on management of symptoms and lowering risk for other health conditions such as type 2 diabetes, high blood pressure, heart problems, and endometrial cancer.
Symptoms
PCOS can affect women and girls of reproductive age. According to a study, up to 70% of women with PCOS are not diagnosed.
The symptoms can vary for every individual. Women may start noticing the symptoms of PCOS around the time of their first period or during pregnancy difficulties. Common symptoms are:
- Menstrual irregularities: Higher levels of androgen prevent ovulation and cause irregular periods. Women with PCOS have longer periods than what is considered normal. Some will have fewer than eight periods a year, with intervals greater than 35 days. Some will not have any period at all. Women with irregular periods may experience difficulties getting pregnant.
- Too much androgen: Excessive level of male hormones (androgen) can cause acne, excess body hair growth and thinning of scalp hair in women. Hirsutism is an excess hair growth pattern that appears in the face and body – including the back, belly, and chest of women.
- Polycystic ovaries: Women with PCOS can have multiple small cysts on the ovaries. The follicles which contain one immature egg can form on the border of the ovary. Immature eggs cannot trigger ovulation.
Some women with PCOS may not have any symptoms. However, women who are overweight are most likely to experience severe symptoms.
Women who experience these symptoms are recommended to consult the gynecologist for proper diagnosis.
Causes
PCOS has unknown cause. Several factors that may contribute are:
- Family History: Women whose mother or sister has PCOS are more likely to develop this condition. One or many genes can contribute to PCOS.
- Insulin resistance: Women with PCOS often have insulin resistance as the body cannot effectively use the insulin, which is a hormone produced by the pancreas that helps the body use sugar for energy. The body needs more insulin when cells cannot effectively use it, therefore the pancreas produces extra insulin, which further causes the ovaries to create more male hormones known as androgen. Excessive levels of androgen negatively impact the ovaries.
Obesity is one of the major contributors to insulin resistance. Women with insulin resistance have higher risk for type 2 diabetes. They may also notice darkening of skin in the lower part of the neck, armpits, groin or under the breasts.
- Inflammation: Research suggests a strong association between PCOS and low-grade inflammation. The levels of C-reactive protein (CRP) and white blood cells seen in blood tests determines the level of inflammation in the body.
Chronic, low-grade inflammation causes polycystic ovaries to create androgens which can result to heart and blood vascular issues. Inflammation can also be increased by being overweight.
- Androgen: Excess androgen production can cause PCOS and cause acne and hirsutism. Abnormal androgen levels hamper ovulation which causes irregular menstrual period.
Diagnosis
PCOS has no specific diagnostic test and women are diagnosed after an examination, in which the doctors ask about the symptoms and medical history, including the family’s medical history. The doctor will likely take patient’s weight and blood pressure as part of the examination as well as a physical exam particularly for hirsutism, thinning hair, insulin resistance and acne is also performed.
The doctor may also order the following:
- Pelvic examination: Find problems with ovaries or other reproductive system organs by the doctor inserting gloved fingers into the vagina and feeling for any growths or changes in the uterus or ovaries.
- Ultrasound: This uses a device called a transducer to produce the sound waves to determine abnormalities in the uterus and ovaries. The condition of the ovaries and the thickness of uterus lining is examined through the ultrasound.
- Laboratory tests: This test aims to evaluate hormone and glucose levels. Levels of triglycerides, insulin and cholesterol is also measured to assess the risk for diseases like diabetes and heart disease. This testing can rule out other reasons of irregular menstruation or androgen excess that resemble PCOS.
Women may be required to closely monitor their health for any complications related to the diagnosis of PCOS. Several tests may be necessary:
- Monitor blood pressure, glucose tolerance, and cholesterol and triglyceride levels
- Assessment for depression and anxiety symptoms
- Assessment for obstructive sleep apnea
Treatment
The treatment plan for PCOS depends on the signs and symptoms experienced by the patient. Since PCOS has no definite cause, the treatment will focus on the management of the symptoms such as thinning of hair, excess hair growth, acne, infertility, and obesity as well the medical history. Generally, the treatment comprises of medications, lifestyle changes or both.
- Lifestyle changes: Research shows that symptoms of PCOS including problems with menstrual cycle may be addressed with just a 5 to 10 percent weight loss. A woman’s ideal weight-loss strategy is best discussed with the doctor and a qualified dietician. The doctor could advise losing weight by following a healthy diet and exercising. Losing weight can aid with infertility, boost the effectiveness of PCOS drugs, improves ovulation, and lowers risk for diabetes and heart disease.
- Medications: To improve the menstrual cycle and other symptoms of women with PCOS, doctors may prescribe:
- Combination birth control pills: Normalizing the hormones can reduce the chance of endometrial cancer and get rid of acne, excess hair growth, and irregular bleeding. Combination pills contain estrogen and progestin which reduce androgen production and control estrogen.
- Progestin therapy: This is recommended for women who are not allowed to take estrogen due to medical conditions. Progestin may come in a pill, patch, or vaginal ring. The choice will depend on whether the patient is considering pregnancy or not. Progestin-only mini-pill or progestin-containing intrauterine device is a preferable option for those who want to prevent pregnancy. The use of progestins for a specified period can regulate ovulation, relieve PCOS symptoms, regain hormonal balance and reduce risk for endometrial cancer.
Women with PCOS who wish to get pregnant may be prescribed by their doctor with medications, such as:
- Clomiphene: This medication is proven to cause ovulation or treat infertility in women with PCOS. It is an anti-estrogen medication taken orally, which increases the chances of twins and multiple births.
- Gonadotropins: This medication aims to induce ovulation. This medicine is administered by injection.
- Letrozole: Fights a few forms of breast cancer by stimulating the ovaries. It functions by reducing the amount of estrogen the body produces, which slows or halts the growth and spread of breast cancer cells.
- Metformin: This drug works by helping the body effectively process insulin and is recommended to treat type 2 diabetes by enhancing insulin resistance and reduces insulin levels. Metformin can help lose weight, stimulate ovulation, and delay the onset of type 2 diabetes for those who have prediabetes.
If the initial medication fails to resolve the symptoms of PCOS and improve chances of pregnancy, the doctor may recommend in vitro fertilization.
To minimize thinning of hair and hormonal acne, the doctor may prescribe:
- Birth control pills: PCOS symptoms such as hirsutism and acne are managed through birth control pills as it limits the production of androgen.
- Acne treatments: Several creams and pills may be recommended to treat the acne caused by hormonal imbalance depending on the skin condition of the patient.
- Spironolactone (Aldactone): This antiandrogen medication is recommended to those who are not pregnant and have no plans for pregnancy as the use of this drug can lead to birth abnormalities. Spironolactone is an androgen blocker that reduces the effects of androgen hormones and help treat some symptoms of PCOS such as acne and hirsutism.
- Eflornithine (Vaniqa): This is a cream-based prescription drug that slows the growth of hair in unwanted areas such as face.
- Hair removal: Noninvasive procedures such as electrolysis is a known permanent solution to inhibit new hair growth for all skin and hair types by preventing hair growth by damaging the hair follicles using shortwave radio frequencies.
Laser is another hair removal solution which is ideal for women with pigmented hair. The laser is attracted to hair’s melanin pigment. It works by targeting the hair follicles with concentrated light.
Results are not achieved instantly and require multiple appointments. Temporary solution for hair removal such as shaving, plucking, and waxing are also recommended for unwanted hair growth.
