PCOS

PCOS

Opeyemi Asorobi

Opeyemi Asorobi

14-Sep-2020 - 3 min read

If you have irregularities in your menses, probably with some stubborn recurrent face acne(pimples), abnormal hair growth pattern (such as beards or chest hair) and then you are on the relatively big side. You likely have PCOS and should visit your Doctor.

 

Polycystic Ovarian Syndrome (PCOS) also known as Stein-Levinthal Syndrome is a common endocrine(hormonal) disorder among women of reproductive age. Basically women with PCOS have their ovaries enlarged and containing small collections of fluid (follicles) in it. This is seen with the aid of Ultrasonography

 

Prevalence of the disease is about 10% of the global population. Recent study done in Nigeria shows that approximately 1 in 6 infertile Nigerian women have PCOS.

 

PCOS can typically present with infrequent, irregular or absent menstrual periods, excess hair growth / abnormal hair growth pattern (usually male pattern), acne (pimples) and obesity.

 

For Adolescents, absent or infrequent menstruation is enough to raise suspicion.

 

CAUSE

The exact cause is unknown, however it is said to be multifactorial (in this case, genetic and environmental factors have been implicated). It is common to see sisters or mother and daughter to have PCOS although there is yet to be a specific gene implicated.  Other speculations include insulin resistance in which the body cannot use insulin efficiently thus leading to high blood levels of insulin (hyperinsulinemia). This hyperinsulinemia is believed to increase androgen(a predominantly male hormone) levels as well as obesity and type 2 Diabetes.

 

HOW DOES PCOS AFFECT OVULATION

Ovulation is a process in which a mature egg(ovum) ready to be fertilized by a sperm cell is released from one of the ovaries. If the egg does not get fertilized, the endometrium (inner lining of the uterus) is shed and passes out as menses (menstruation).  An ovulation problem occurs when the woman’s reproductive system does not produce the adequate amounts of hormones necessary to develop, mature and release a healthy egg. When the ovaries do not produce the hormones needed for ovulation and proper function of the menstrual cycle, the ovaries become enlarged and develop many small cysts which produce androgens (male hormone) in excess. This increased levels of androgens further interfere with ovulation and normal menstrual cycle.

 

SYMPTOMS

Symptoms often begin when a woman first begins having her period (menarche) however in some other people, it begins later on during the reproductive years.

To make diagnosis, your Doctor looks for at least 2 out of these 3 criteria 

  • Irregular periods: This is the most common symptom. This ranges from fewer menstrual cycles per year (<8) to prolonged periods of heavy or scanty menses to menstrual intervals >35days.
  • Excess androgen: Androgens are male hormones produced normally in very small quantity in women, however in this case, they are produced in excess leading to physical signs such as excess facial and body hair (hirsutism), adult acne (pimples), male pattern baldness, male pattern pubic hair
  • Polycystic ovaries: Enlarged ovaries with numerous small fluid filled sacs surrounding the eggs.   

 

TIME TO SEE A DOCTOR

It is advisable to see your Doctor if you have any of these symptoms or experiencing infertility (PCOS is a common cause of female infertility as highlighted in our previous post).

 

COMPLICATIONS

Having PCOS predisposes one to having certain other conditions as complications. These conditions are

  • Type 2 Diabetes
  • Cholesterol and lipid abnormalities
  • Metabolic Syndrome (a group of signs & symptoms that indicates a significant increase risk of cardiovascular disease (CVD))
  • Raised BP
  • Depression & anxiety
  • Sleep apnea
  • Gestational Diabetes (i.e diabetes in pregnancy) / Pregnancy induced hypertension (PIH)

If you have symptoms already discussed, prepare to see your Doctor who will further refer you to a Gynaecologist and/or a reproductive endocrinologist.

 

Before seeing your Doctor,

> first highlight any of these symptoms discussed above that you may be having

> take down a list of medications/dietary supplements you may be on

> Inform the Doctor if you are currently trying to conceive as this would largely determine what mode of management to take.

 

TEST & DIAGNOSIS

Diagnosis is often made by considering all the presenting signs/symptoms and ruling out other possible disorders.

(1) A general physical examination and pelvic examination is carried out.   

(2) Blood test is also done to measure levels of several hormones in order to exclude endocrine conditions that can cause menstrual abnormalities such as CAH, androgen secreting tumor, Cushing’s syndrome.

(3) Pelvic Ultrasound scan to view the appearance of the ovaries and the uterine lining.

 

TREATMENT

This is generally focused on management of patient’s individual main concern such as Hirsutism, Infertility, acne or obesity. However, treatment is mainly by Drugs and Lifestyle changes.

Drugs: There are various types of drugs used for treatment all depending on what the focus of management is.

Lifestyle changes: This includes Diet (low calorie) and Exercise with the aim to lose weight. Weight loss of as low as 5% improves patient’s condition. Change diet to low calorie diet to reduce obesity (since obesity is implicated in worsening insulin resistance). Weight loss would reduce both insulin & androgen levels and possibly restore ovulation. Close monitoring of BMI, reduced food portion sizes, and a weight control program with a dietician are all essential.

 

 

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