POLYCYSTIC OVARIAN SYNDROME (PCOS)
This syndrome is a chronic condition that causes irregular menstrual periods and elevated levels of male hormone levels (Androgens) in women. It occurs in about 5%-10% of all women.
This condition is not completely reversible but there are a number of treatment modalities that can decrease the symptoms and signs. Almost all women with this condition (PCOS) will lead a normal life.
CAUSES:
The causes are not completely understood but it is thought that abnormally high levels of LH and male hormone levels will cause dysfunction of the ovaries. Whether the underlying problem is actually the cysts in the ovary or the high LH levels that cause the cysts in the ovaries, is yet to be established.
FEATURES:
Menstrual irregularity
This is common as a result of not ovulating. The endometrium becomes thick and then sheds after some weeks. It is not infrequent for women to have only 1 or 2 periods a year.
Androgenization
There may be features of increased male hormone levels such as abnormal hair growth or loss, weight gain and acne.
Insulin resistance
High levels of Insulin and sugar in the blood is commonly associated with PCOS. It is for this reason that Metformin is required to reduce these levels.
This aspect of PCOS can occur in both overweight and normal weight women.
Infertility
This is a common presenting feature of the PCOS. Sleep apnea. This is a condition where breathing may stop during sleep. It is said that this condition may occur in 20%-30% of women with the PCOS.
Diagnosis of PCOS
- physical examination
- blood tests including fasting blood sugars and Insulin
- vaginal probe ultrasound to look for cysts on the ovaries
Treatment
The management of this condition depends on the presenting feature and whether one wants to get pregnant or not.
In general terms one would want to regulate the blood sugars and Insulin levels and decrease male hormone levels. One would also want to regulate the menstrual periods and this can be done artificially with the oral contraceptive pill or by triggering ovulation.
Oral contraceptives
These are the most commonly used treatment for establishing menstrual regularity. They will also decrease the production of male hormone levels in various ways.
Progesterone
Progesterone may also be used to regulate menstrual cycles but this does not provide contraception.
- Weight loss
- This is one the simplest yet, most difficult, of treating Insulin resistance. It may also improve menstrual irregularities.
- Spironolactone
- This is a fluid tablet that may be used to decrease male hormone effects.
- Anti-diabetic drugs (Metformin)
This treatment improves the effectiveness of the body’s use of Insulin. It also helps in the reduction of male hormone levels in the body. It occasionally triggers ovulation. Infertility
If the patient wants to become pregnant then one has to establish whether she is ovulating or not. If she is not then some of the above methods may be used but she will usually need to go onto a program of induction of ovulation with Clomiphene. This is a fertility drug and obviously needs to be monitored on a monthly basis.
Surgery
There is no specific surgery that will cure PCOS.
When pregnancy is desired then “laparoscope ovarian drilling” can be considered. This is often reserved for patients who do not respond to medical induction of ovulation. Success rates for this procedure have been reasonably good and is given as about 80%.
In severe cases of PCOS where pregnancy is not desired currently or in the future and where other symptoms are severe, then removal of the ovaries and/or a hysterectomy may be a consideration.