Polycystic ovary syndrome (PCOS) is common condition which consists of irregular or absent periods, excessive , body hair, obesity and slightly enlarged ovaries.
Understanding Ovaries and Ovulation
The ovaries are a pair of glands that lie on either side of the uterus (womb). Each ovary is about the size of a large marble. The ovaries make ova (eggs) and various hormones.
Ovulation normally occurs once a month when you release an ovum (egg) into a fallopian tube which lead into the uterus (womb). Before an ovum is released at ovulation, it develops within a little swelling of the ovary called a follicle (like a tiny cyst). Each month several follicles start to develop, but normally just one fully develops and goes on to ovulate.
The main hormones that are made in the ovaries are oestrogen and progestogen – the main ‘female’ hormones. These hormones help with the development of breasts, and are the main controllers of the menstrual cycle. The ovaries also normally make small amounts of ‘male’ hormones (androgens) such as testosterone.
Figure : The placenta provides the fetus with oxygen and nutrients and takes away waste, such as carbon dioxide, via the umbilical cord.
PCOS is a syndrome where at least two of the following occur, and often all three:
At least 8-12 follicles (tiny cysts) develop in your ovaries. (Polycystic means ‘many cysts’.)
You do not ovulate each month. Some women do not ovulate at all. (In PCOS, although the ovaries usually have many follicles, they do not develop fully and so ovulation often does not occur.) If you do not ovulate then you do not have a period.
The balance of hormones that you make in the ovaries is altered. In particular, your ovaries make more testosterone (male hormone) than normal.
Why do I develop PCOS?
The exact cause is not totally clear. Several factors probably play a part. These include the following:
A raised level of insulin in the bloodstream is thought to be the main underlying reason why PCOS develops. Insulin is a hormone that you make in your pancreas (a gland behind your stomach). The main role of insulin is to control your blood sugar level. Insulin acts mainly on fat and muscle cells causing them to take in sugar (glucose) when your blood sugar level rises.
Women with PCOS have what is called ‘insulin resistance’. This means that cells in the body are resistant to the effect of a normal level of insulin. Therefore, the level of insulin in the blood needs to be higher than normal to control the blood sugar level.
Luteinising hormone (LH)
This hormone is also probably involved in causing PCOS. This hormone is secreted from the pituitary gland. LH stimulates the ovaries to ovulate. It is assumed that a high level of insulin and a high level of LH work together to cause more testosterone than normal to be made in the ovaries.
Hereditary factors Your genetic makeup is probably important. One or more genes may make you more prone to develop PCOS. PCOS is not strictly inherited from parents to children, but it may run in some families.
Being overweight or obese is not the underlying cause of PCOS. However, if you are overweight or obese, excess fat can make insulin resistance worse. This may then cause the level of insulin to rise even further. It also causes changes in female hormonal level so that you do not ovulate. However, PCOS may also be a contributing cause of overweight and obesity.
What Would I Experience if Have PCOS?
Period problems – You may have irregular or light periods, or no periods at all.
Fertility problems – You may not ovulate each month, and some women with PCOS do not ovulate at all. PCOS is one of the commonest causes of infertility. PCOS women who do manage to become pregnant tend to have increased frequency of miscarriage.
Excess hair growth (hirsutes) -It occurs in more than half of women with PCOS. It is mainly on the face, lower abdomen, and chest. This is the only symptom in some cases.
Acne may persist beyond the normal teenage years.
Thinning of scalp hair (similar to ‘male pattern baldness’) – It occurs in some cases .
Weight gain – women with PCOS become overweight or obese.
Depression or poor self esteem may develop as a result of the other symptoms.
Symptoms typically begin in the late teens or early 20s. Not all symptoms occur in all women with PCOS. Symptoms can vary from mild to severe.
Possible Long-Term Problems of PCOS
If you have PCOS, over time you have an increased risk of developing type 2 diabetes, diabetes in pregnancy, a high cholesterol level, and possibly high blood pressure. For example, about 1 in 10 women with PCOS develop diabetes at some point. These problems in turn may also increase your risk of having a stroke and heart disease in later life. These increased health risks are due to the long-term insulin resistance (and also being overweight which is common in women with PCOS). PCOS are at higher risk of developing endometrial cancer.
Tests may be advised to clarify the diagnosis, and to rule out other hormone conditions.
Blood tests may be taken to measure certain hormones- FSH and LH (High LH) an ultrasound scan of the ovaries may be advised. An ultrasound scan is a painless test that uses sound waves to create images of structures in the body. The scan can detect the typical appearance of PCOS with the many follicles (small cysts) in slightly enlarged ovaries with increased stromal thickness. Serum insulin (high) and oral glucose tolerance test (altered).
What is the Treatment for PCOS?
There is no cure for PCOS : Treatment is basically tailored to the symptoms of the patient.
You should aim to lose weight if you are overweight : Losing weight helps to reduce the high insulin level that occurs in PCOS. This then improves the chance of you ovulating, which improves any period problems, fertility, and may also help to reduce hair growth and acne. The increased risk of long-term problems such as diabetes, high blood pressure, etc, is also reduced. Losing weight can be difficult. A combination of eating less and exercising more is best. Advice from a dietician, and help and support from a practice nurse, may increase your chance of losing weight. Even a moderate amount of weight loss can help.
Treating hair growth : Drugs taken by mouth to treat hair growth take 3-9 months to work fully. You need then to carry on taking them otherwise hair growth will recur. Things like waxing, shaving, electrolysis and laser might also help.
Treating acne : The treatments used for acne in women with PCOS are no different to the usual treatments for acne.
Treating period problems : some women with PCOS are advised to take the contraceptive pill as it causes regular ‘withdrawal bleeds’ similar to periods. If this is not suitable, another option is to take progestogen hormone for several days every month which will cause a monthly bleed like a period.
Fertility issues : The chance of becoming pregnant depends on how often you ovulate. Some women with PCOS ovulate now and then, others not at all. If you do not ovulate but want to become pregnant, then fertility treatments may be recommended by a specialist and have a good chance of success. But remember, you are much less likely to become pregnant if you are obese. If you are obese or overweight then losing weight is advised in addition to other fertility treatments. Fertility chances can be increased by doing laparoscopic ovarian drilling, which is a day care procedure.
Preventing long term problems : A healthy lifestyle is important to help prevent the conditions listed above in ‘long-term problems’. Eat a healthy diet, exercise regularly and lose weight if you are overweight or obese.
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