Polycystic ovarian syndrome (PCOS) is a common endocrinal disorder as well one of the common causes of infertility among women. Women with PCOS have an imbalance in the levels of the sex hormones estrogen and progesterone. This leads to the growth of multiple follicles in ovary perceived as cysts on ultrasound – which can impede the normal growth and release of eggs from the ovaries. PCOS can cause problems with a woman’s menstrual cycle, fertility, metabolic function, and appearance. It is commonly seen in women of child bearing age and is rare after menopause.
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, type 2 diabetes, obesity, hypothyroidism are at a higher risk of developing this condition.
Overproduction of the hormone androgen may be another contributing factor. Androgen is a male sex hormone that women’s bodies also produce. Women with PCOS often produce higher-than-normal levels of androgen. This can affect the development and release of eggs during ovulation.
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 depend upon the nature and severity of the condition. Some of the symptoms of PCOS include infertility, absent or irregular menstrual cycle and obesity or accumulation of fat, 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. Patients often experience anxiety or depression and breathlessness during sleep.
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. Pelvic ultrasound is performed to evaluate the appearance and volume 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. Oral contraceptives may be prescribed for the management of irregular menstrual cycles. Oral contraceptives effectively reduce the level of male hormone and are also effective in reducing excessive body hair growth and also minimize 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 outpatient 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, anxiety or depression.