Polycystic Ovarian Syndrome

27 years old Kay has been suffering from Polycystic Ovarian Syndrome (PCOS) for the past 3 years. She called off her wedding since she thought she couldn’t get pregnant.

Maria is tired of plucking her ever-growing facial hair on a regular basis.

Anne is happily married to her husband for 6 years now but she is going through a series of extensive investigations for primary infertility. She has not been able to conceive since her wedding.

Suzan misses her school often because she has horrible pain and excessive bleeding during her periods that stains literally every chair that she sits in.

Laura says “I would also love to be able to meet someone and have a family one day”. She is finding it difficult to cope emotionally and she hates herself because of this disease.

The emotional stress that one undergoes in PCOS is terrible. Leading a normal life is next to impossible for people affected with PCOS.

PCOS affects women of all races worldwide. It is a disease of the modern day women. A recently concluded seminar in an edition of ‘The Lancet’ says that PCOS affects 1in 15 women worldwide causing a major economic health burden and this number is likely to increase in the future.

Fortunately, there are various online and offline support groups that exists for PCOS sufferers. Patient education about PCOS is practically the most important in terms of the treatment of PCOS. The more the information the patient is educated with, the more the chances are that she battles the disease more efficiently.

What causes PCOS?
The exact cause is unknown, although both environmental and genetic factors are implicated. Various researches are currently on going to determine the exact cause of the same. There are multiple factors involved in the cause of PCOS. Primary factor includes a defect in the hypothalamic-pituitary axis. The resulting hormonal imbalance causes high androgen levels, high luteinizing hormone (LH), reduced follicle-stimulating hormone (FSH), peripheral insulin resistance and hyperinsulinemia.

What are the symptoms of PCOS?
The major symptoms of PCOS include:

• Menstrual dysfunction
• Anovulation
• Hirsutism
• Infertility
• Obesity
• Hair loss
• Acne

Other symptoms include:

• Insulin resistance
• Acanthosis nigricans
• Diabetes
• Metabolic syndrome

One can present with varied symptoms and the symptoms usually worsen over the years.

How is PCOS diagnosed?
An essential update from the endocrine society says that we can use the Rotterdam criteria to diagnose PCOS. This includes the presence of 2 of the following:

• Androgen excess
• Ovulatory dysfunction
• Polycystic ovaries

Other key studies would be an essential work up of all the hormones namely androgens, follicle-stimulating hormone and luteinizing hormone levels, thyroid-stimulating hormone and free thyroxine levels. Blood glucose level, insulin and lipid profile are also necessary as a part of the basic work up. Imaging is done in the form of an ultrasound of the ovaries to look for cysts. CT scan and MRI scan may be required for obese women.

How to treat PCOS?

• Lifestyle modifications such as diet, exercise and weight loss are the first-line treatment options for PCOS.
• Medications used are oral contraceptives (Metformin, Prednisone, Leuprolide, Clomiphene, and Spironolactone). Medications are chosen based on the patient’s profile. Patients presenting with symptoms and signs of androgen excess usually require hormonal contraceptives and Metformin. For infertility, Clomiphene is the first line drug.
• Excessive hair growth is treated with topical hair removal agents like Eflornithine.
• Surgery in the form of electrocautery, laser drilling and multiple biopsies would be required in certain patients who do not respond well to medication.

Unfortunately, there is no definite cure for PCOS, and it re-occurs often. A continued healthy lifestyle in the form of regular exercise, healthy diet and ideal weight maintenance is what helps the sufferer in the long run.