Polycystic ovary syndrome (PCOS) is a disease in which a woman has an imbalance of female sex hormones. This can lead to changes in the menstrual cycle, cysts in the ovaries, difficulty in getting pregnant and other health problems.
PCOS – Description and Symptoms
In polycystic ovarian disease, the ovaries get many small cysts, which can be detected by ultrasonic examination. These cysts are not related to cancer.
Often the ovaries release fewer eggs than usual or none at all. Experts sometimes associate this disease with high levels of male hormones (androgens), which they consider the cause of many of the symptoms.
Polycystic Ovarian Disease has many symptoms, not all of which may be present:
- Often menstrual periods become irregular or lighter and may stop altogether. Occasionally, periods become heavier.
- Hair loss from the head.
- Hair growth elsewhere on the body, such as on the face, chest, or back.
- Weight gain
- Type II diabetes sometimes occurs if the disease persists for many years since the polycystic ovarian syndrome and high levels of insulin are related.
Males who are “carrying” the genetic trait may show some symptoms themselves, such as early baldness and excessive hair elsewhere on the body.
Polycystic Ovarian Disease Causes
Polycystic ovarian disease (or polycystic ovarian syndrome, PCOS) is a disorder of the hormone system. The underlying cause is uncertain, although symptoms are made worse by being overweight.
The disease has a strong genetic component and tends to run in families. Daughters of women with the disease are at high risk of having at least some symptoms. Males can act as “carriers” of the genetic trait.
The polycystic ovarian syndrome might relate to changes in hormone levels that make it difficult for the ovaries to release fully developed (mature) eggs.
The reasons for these changes are not clear. The affected hormones are:
- Estrogens and progesterone, the female hormones that help the ovaries of a woman to release eggs.
- Androgens, a male hormone found in small amounts in women.
Typically, a woman’s menstrual cycle prompts the release of one or more eggs; such process is called ovulation.
In most cases, the release of the eggs occurs approximately two weeks after the initiation of the menstrual cycle.
In polycystic ovary syndrome, mature eggs are not released. Instead, they remain in the ovaries surrounded by a small amount of fluid.
There may be many of them. However, not all women with this condition will have ovaries in this aspect.
These problems with the release of the eggs can contribute to sterility. The other symptoms of this disorder are due to hormonal imbalances.
Most of the time, the polycystic ovarian syndrome affects women in their 20s or 30s. However, it can also impact adolescent girls. Symptoms often begin when a girl’s period starts.
Women with this disorder often have a mother or sister with similar symptoms.
Tests and exams.
The doctor or nurse will perform a physical examination, which includes a pelvic exam, which may reveal:
- Inflammation of the ovaries
- Swelling of the clitoris (very uncommon)
The following conditions are standard in women with the polycystic ovary syndrome:
- Arterial hypertension
- High cholesterol
- Weight gain and obesity
The doctor or nurse will check the weight, body mass index (BMI) and measure the size of the abdomen.
Blood tests can be done to check hormone levels, which may include:
- Estrogen level
- Level of follicle stimulating hormone
- Luteinizing hormone level
- Level of male hormones (testosterone)
- 17 ketosteroids
Other blood tests may include:
- Fasting glucose (blood sugar) as well as glucose intolerance and insulin resistance
- Lipid levels
- Pregnancy test (serum CHG)
- Prolactin levels
- Thyroid Function Tests
The doctor may also order the next imaging examination or surgeries to examine the ovaries:
- Vaginal ultrasound
- Pelvic Laparoscopy
The Oral Contraceptive Pill can be used to regulate periods and reduce facial hair. Progesterone tablets are sometimes used to induce periods when they have become irregular or absent. Not having regular periods puts women at a higher risk of endometrial cancer (cancer of the womb lining), so they should be induced if necessary until the woman reaches menopause.
Weight gain and obesity are typical in people with the polycystic ovarian syndrome. Losing weight, even in small amounts, can help treat hormonal changes and health problems like diabetes, high blood pressure or high cholesterol.
The doctor may recommend birth control pills to make menstrual periods more regular. Such medications can also help reduce abnormal hair growth and acne after you take them for a few months.
A diabetes drug called Glucophage (metformin) is recommended for:
- Make the periods are regular.
- Prevention of type 2 diabetes.
- Help with weight loss.
Other medications that may be prescribed to help keep your periods regular and help you get pregnant include:
Luteinizing hormone-releasing hormone analogs (HLHL).
Clomiphene citrate, which helps the ovaries to grow and release eggs.
Anti-Androgens, such as spironolactone (Aldactone), reduce the activity of the male hormones. They tend to lessen the amount of facial hair.
These drugs should not be taken by women who are trying to get pregnant, since they may “feminize” a male fetus.
A woman can apply Eflornithine Cream (Vaniqa) to the area of unwanted hair such as the face and elsewhere. It slows the rate of hair growth and people typically use it after shaving.
Acne treatments are sometimes needed. Azelaic acid, benzoyl peroxide, and tea tree oil are useful skin treatments. They should not be taken internally.
Experts recommend weight loss for most overweight sufferers of the polycystic ovarian disease.
Regular exercise and a healthy diet, low in fat, sugar, and alcohol, are needed to lose weight.
Eating plenty of vegetables and whole grain food such as brown rice, oatmeal, and whole-wheat bread, can help weight loss.
Meat should always be lean (processed meat, such as sausages and burgers, should not be eaten). Watch out for sugar hidden in processed food, breakfast cereals, and fruit drinks.
Crash diets and internet “miracle weight loss” products are best avoided.
Fertility Drugs, such as clomiphene, are given to a woman with the polycystic ovarian disease who are having difficulty in becoming pregnant.
Laparoscopic Ovarian Drilling (LOD) is a surgical technique used to stimulate egg production.
Heat or a laser are used to destroy ovarian tissue. The method helps stimulate ovulation, although fertility drugs may still be needed. Some case may require In-Vitro Fertilization (IVF).
With treatment, women with polycystic ovary syndrome can very often become pregnant. There is an increased risk of miscarriage, high blood pressure and gestational diabetes during pregnancy.
Women with the polycystic ovarian syndrome are more likely to develop:
- Endometrial cancer
- Breast cancer (a slightly higher risk)