Polycystic ovary syndrome (PCOS): Symptoms, Causes, Diagnosis, Treatment.

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic ovarian syndrome (PCOS) is a hormonal condition that commonly affects women of reproductive age. The characteristic trait of having numerous small cysts on the ovaries can result in various symptoms such as irregular periods, increased body hair, acne, and weight gain. While the exact reason for PCOS is unknown, it is believed to be linked to a hormonal imbalance, especially an increase of androgens (a hormone in males) inside the body. Infertility, diabetes, and heart failure are long-term health concerns it might also cause.

Symptoms of PCOS

The main symptoms of PCOS are:

1. Irregular menstrual cycles: Women with PCOS may experience fewer than eight menstrual cycles per year, or they may have extended periods without a menstrual cycle. They may also experience heavy or prolonged bleeding during their periods. These menstrual irregularities are because the ovaries are not releasing eggs regularly, which disrupts the average hormonal balance needed for regular menstrual cycles.

2. Excessive hair growth: Women who have PCOS experience elevated levels of androgens produced by their ovaries, resulting in greater hair growth in areas such as the face, chin, chest, and back. This excess hair growth is due to the influence of androgens on hair follicles, causing them to become more sensitive to the effects of these hormones. The extent of hair growth varies from person to person, and some women with PCOS may not experience this symptom at all. However, for those who do, it can be a significant source of distress and impact their quality of life.

3. Acne: Women with PCOS are more prone to acne and other skin problems.

4. Oily skin: Oily skin is a common symptom of PCOS due to hormonal imbalances.

5. Weight gain: Women with PCOS are at a higher risk of weight gain, especially in the abdominal area.

6. Infertility: Infertility is a common symptom of Polycystic Ovary Syndrome (PCOS). The reason why women with PCOS may have difficulty getting pregnant is that they frequently experience irregular or absent ovulation. In PCOS, the ovaries produce higher than normal levels of androgens, male hormones, which disrupt the normal hormonal balance needed for regular ovulation. This means that the ovaries may not release eggs regularly, making it difficult for a woman to conceive. Additionally, the presence of small cysts on the ovaries, as seen in PCOS, can contribute to infertility. The normal functioning of the ovaries can be disrupted by these cysts, which may result in irregular ovulation and increased difficulty in achieving pregnancy.

7. Mood swings: 

Mood swings and depression are common symptoms experienced by women with Polycystic Ovary Syndrome (PCOS). This is due to the hormonal imbalances associated with the condition, which can have a significant impact on a woman's mental health.

It is important to remember that not every woman with PCOS will have all of these symptoms, and the intensity of symptoms might vary. If you think you have PCOS and you want to get a good diagnosis and treatment plan, it's important to consult a healthcare professional.

Causes of PCOS

Although the exact causes of Polycystic Ovary Syndrome (PCOS) are not entirely known, It is thought that a combination of hormonal, environmental, and genetic factors are responsible for causing it.

1. Hormonal imbalances: 

Elevated levels of androgens, male hormones, in the body can cause disruptions in the average hormonal balance needed for regular ovulation. This hormonal imbalance can lead to the development of PCOS.

2. Insulin resistance: Insulin resistance, or the inability of the body to effectively use insulin, is a common feature of PCOS. This can lead to an increase in insulin levels in the body, which can exacerbate the hormonal imbalances associated with the condition.

3. Low-grade inflammation: PCOS has been associated with low-grade inflammation, which is characterized by a constant state of mild inflammation in the body.

4. Genetics: PCOS has a strong genetic component, and it is more common in women with a family history of the condition.

The precise causes of PCOS must be still under investigation, and additional research is necessary to gain a complete understanding of the underlying mechanisms.

Complications

1. Infertility: 

PCOS can make it difficult for women to become pregnant due to irregular ovulation or absence of ovulation.

2. Metabolic syndrome: 

Women with polycystic ovarian syndrome (PCOS) have a higher risk of developing metabolic syndrome, which is a group of medical conditions that tend to occur together, and increase the risk of serious health issues such as type 2 diabetes and cardiovascular disease. The components of metabolic syndrome may include

• Abdominal fat.

• High blood pressure.

• High blood sugar.

• High levels of triglycerides.

• Low levels of good cholesterol.

3. Gestational diabetes: 

Women with PCOS are at increased risk of developing gestational diabetes during pregnancy.

4. Endometrial cancer: 

PCOS increases the risk of endometrial cancer due to irregular menstrual cycles and elevated levels of estrogen.

5. Sleep apnea: 

Women with PCOS are at increased risk of developing sleep apnea due to obesity, a common complication of PCOS.

6. Depression and anxiety: 

Women with PCOS may experience depression and anxiety related to the physical and emotional symptoms of the condition.

7. Acne and skin tags: 

Hormonal imbalances in women with PCOS can cause skin problems such as acne and skin tags.

Diagnosis of PCOS

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. The diagnosis of PCOS involves several steps, including:

1. Physical exam: The doctor may perform a physical exam to check for signs of excess hair growth (hirsutism), acne, and weight gain, which are common symptoms of PCOS.

2. Medical history: The doctor may ask about menstrual irregularities, infertility, and a family history of diabetes or heart disease. This information can help determine if there are other factors contributing to the symptoms.

3. Pelvic exam: During the pelvic exam, the doctor may feel for small cysts on the ovaries, which can be a sign of PCOS.

4. Blood tests: Checking the levels of hormones like testosterone, luteinizing hormone (LH), and follicle-stimulating hormone can be done via blood testing.  These hormones can show if their levels are abnormal. To find out if there is insulin resistance, which is frequent in women with PCOS, blood sugar and insulin levels may also be examined.

5. Ultrasound: An ultrasound may be used to see the ovaries and examine for cysts, which are a defining aspect of PCOS. The size and quantity of follicles on the ovaries can also be determined using ultrasound.

6. Diagnostic criteria: To meet the diagnostic criteria for PCOS, a woman must fulfill a minimum of two of the following three criteria:

• Irregular menstrual cycles or no menstrual cycles.

• High levels of androgens (male hormones) cause symptoms such as excessive hair growth or acne.

• Polycystic ovaries on ultrasound.

It is crucial to understand that the presence of cysts on the ovaries is not mandatory for the diagnosis of PCOS, and the diagnosis is determined based on a combination of clinical and laboratory findings.

In conclusion, the diagnosis of PCOS involves a thorough evaluation of the patient's medical history, physical exam, laboratory tests, and imaging studies. A healthcare provider can help determine the most appropriate diagnostic approach for each individual case.

Treatment of PCOS

Lifestyle changes:

• Sustaining a healthy weight by following a well-balanced diet and engaging in regular physical activity can aid in regulating hormones and insulin levels.

• Quitting smoking and limiting alcohol intake can also have positive effects on overall health and hormone balance.

• Adopting relaxation techniques like meditation and yoga to manage stress may also prove beneficial.

Medications

Several medications are commonly used to treat Polycystic Ovary Syndrome (PCOS) and its associated symptoms:

1. Hormonal contraceptives: These medications regulate the menstrual cycle and help control hormones. This can improve symptoms such as irregular periods, acne, and hirsutism. Examples of hormonal contraceptives include birth control pills, patches, and vaginal rings.

2. Metformin: This medicine can improve insulin resistance and normalize irregular menstruation in PCOS-affected women. Type 2 diabetes is commonly treated with this medicine.

3. Anti-androgens: These medications block the effects of male hormones and can reduce symptoms such as hirsutism and acne. Examples of anti-androgens include spironolactone and flutamide.

4. Clomiphene: This medication stimulates ovulation and is used to treat infertility in women with PCOS.

5. Gonadotropins: These are medications that stimulate the ovaries to produce eggs and are used in infertility treatments.

It is important to remember that not every PCOS-affected woman will require medication, and the ideal method of treatment may differ from person to person. To choose the best method of treatment for their particular requirements, women experiencing PCOS should consult directly with their doctor.