Polycystic Ovary Syndrome (PCOS)

Objectives

Does your menstrual cycle tend to be irregular? Do you often have no menstrual period for a few months? Have you recently gained weight rapidly or gotten skin problems like acne? Give it the benefit of the doubt and see a doctor. These seemingly minor symptoms may be warning signs your body is sending you.

Too Much is as Bad as Too Little, PCOS

“What is PCOS?”

PCOS is a disorder in which the ovaries produce an abnormal amount of follicles and most of which are not matured enough for ovulation.

PCOS patients are mostly young women, with 47.5% in their 20s and 25.5% in their 30s. PCOS is experienced by 4-10% of women of reproductive age and it is one of the most common causes of infertility.

Causes

Unfortunately, the exact cause of PCOS is unknown. Various factors, including insulin resistance and hormonal imbalance, are entangled and play a role.

Excess male hormone levels due to hormonal imbalances increase the risks of diabetes, heart and vascular disorders, and high blood pressure. Also, some male hormones are converted to estrogen which increases estrogen levels, and progesterone may not be enough to balance the elevated levels. If this imbalance continues for a long time, the lining of the uterus will get thicker which leads to a risk of endometrial cancer.

Symptoms and Signs

Symptoms of PCOS can vary greatly, and most symptoms first appear in adolescence and worsen over time.

• Irregular menstrual cycle (fewer than eight periods a year and more than 35 days between periods)

• No periods for more than three months

• Irregular vaginal bleeding

• Acanthosis nigricans (dark discoloration and thicker skin in body folds including armpits and behind the neck)

• Reduced size of the breast

• Thinner hair and hair loss

• Sleep apnea

• Hypertrichosis (excess hair growth)

• Acne

But these symptoms are not expressed the same for everyone. If you suspect you have PCOS, it is best to get an accurate diagnosis by ultrasound or a hormonal test rather than hastily deciding based on external signs.

Tests

There is no particular test for PCOS as there is not a single standard for diagnosing it. Various tests including hormonal testing or ultrasounds are performed to rule out the possibility of other diseases with similar conditions.

Diagnosis is determined by gathering various test results and clinical findings. If diagnosed with PCOS, additional tests including body fat tests and glucose level tests may be performed to measure and monitor risks of complications such as diabetes and cardiovascular disorder.

Treatments

PCOS cannot be fully treated, as the exact cause is unknown. There are some cases of conditions going away on their own during menopause but most women have symptoms their whole lives. Therefore, the goal of the PCOS treatment should be to manage the symptoms rather than to cure it, and to prevent potential complications. To be specific, the treatment is to induce ovulation, prevent the proliferation of the lining of the uterus, balance hormones, and reduce insulin resistance. The treatment usually involves medication with metformin and oral contraceptives.

- Metformin

Metformin is a diabetes medication and the effects are as follows.

• Increase in insulin resistance

• Weight control

• Stabilization of ovulation and menstrual cycle

However, it does not have much effect on hirsutism, acne, or infertility which are some main symptoms of PCOS.

- Oral Contraceptives

Women who do not desire to be pregnant can use oral contraceptives that contain progestin alone or progestin and estrogen. The effects of oral contraceptives are as follows.

• Reduce the risks of endometrial cancer

• Correct irregular menstrual cycle

• Reduce male hormone levels

• Improve hirsutism and acne

However, estrogen can increase the risk of stroke or deep vein thrombosis. Oral contraceptives that contain estrogen cannot be used by women with risks of heart or vascular disorders and blood clots.

Prevention

Changing your lifestyle can also help in preventing and improving the symptoms of PCOS.

• Improve eating habits

• Weight control

• Regular exercise

• Quit smoking

Even if you don't have any signs or symptoms of PCOS, women whose menstrual cycles are irregular or have a family history of PCOS should take care of themselves and watch out for symptoms. Improve your lifestyle and if you suspect PCOS get tested at the hospital sooner rather than later.

Summary

• PCOS is a disorder with no clear cause and changing your lifestyle is needed for prevention.

• Women with irregular menstrual cycles or a family history of PCOS should take particular care.