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Polycystic Ovarian Syndrome
Polycystic Ovary Syndrome (PCOS) is a condition that affects 1 in 10 women aged 15 to 40 or childbearing age. It is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance causes problems in the ovaries, like the egg may not develop as it should or it may not be released during ovulation as it should be.
PCOS can cause an irregular menstrual cycle which can lead to infertility and the development of cysts in the ovaries.
Polycystic ovarian syndrome is a multifaceted syndrome with Gynaecologic, endocrine, metabolic and psychiatric sequelae.
It is generally diagnosed by Rotterdam criteria requiring at least two of the following three symptoms:
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Oligo or anovulation
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Biochemical evidence of hyperandrogenism
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Polycystic morphology
PCOS is the most common endocrine disorder in women. PCOS prevalence varies highly by ethnicity and as much as 40% of the infertile population is found in South Asians. In the US approx. $4.36 billion is spent on the evaluation and treatment of reproductive age group women with PCOS.
5% to 10% of women between 15 and 44 have PCOS. Most women find out that they have PCOS in their 20s and 30s when they have problems getting pregnant. Having PCOS doesn’t mean that you can’t get pregnant, it is treatable and there are ways to help you ovulate and raise your chances of getting pregnant. You can talk to your gynaecologist in Delhi near you and discuss your problems.
Etiology
The exact etiology of PCOS remains unknown though familial associations are frequently observed.
Pathology
The exact pathogenesis remains unknown but characteristic pathology includes elevated secretion of luteinizing hormone. LH levels lead to excess activity of ovarian theca cells favoring a more androgenic environment than an estrogenic environment. The androgenic ovarian environment leads to follicular atresia and failure of follicles to mature and ovulate, as well as, symptoms of Hyperandrogenism including hirsutism, acne, and alopecia.
PCOS women often demonstrate peripheral insulin resistance, which has been linked to serum hyperandrogenemia.
Predictive/Risk Factors
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Family History
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Obesity
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Type 1 and type 2 GDM
Prevention of PCOS
No interventions have been made to prevent the development of PCOS. Lifestyle modification prior to conception has the potential to mitigate the expression of PCOS phenotype in offspring due to healthier intrauterine fetal programming. You can consult the Gynaecology Hospital in Delhi to know more about your diet and lifestyle changes.
Typical Presentation
PCOS will typically present as a young female with a long-standing history of irregular or absent periods.
They may have difficulty conceiving. Some women may also report hirsutism, weight issues, or a history of mood disorders.
Lab Tests
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Androgen Panel - Full testosterone, DHEAS, and 17-OHP
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Hormonal Profile - Estradiol, FSH/LH profile can be tested on Day 2/3. 3)TSH and prolactin should be tested on all women with irregular cycles. 4)USG for antral follicle count and measurement of ovarian volume.
Treatment of PCOS
There are 5 main domains that may require treatment:
1. Irregular Bleeding
Even a 5% weight loss may improve menstrual irregularity. First-line treatment options include hormonal therapy such as OCPs or Mirena.
2. Hirsutism
It includes hair removal procedures and Anti androgenic medicines.
3. Weight
Discuss nutrition and exercise regime. Do a fasting lipid profile, 2 hr OGTT, and HbA1c. Treat abnormal results as indicated. Consider Bariatric Surgery for women with BMI>40 and in women with BMI>35 and comorbidities.
4. Infertility
Emphasize preconception health optimization. 1st line treatment options include Ovulation induction with letrozole or clomiphene citrate.
5. Mood disorders
Clinical Pearls
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Evaluate each treatment domain like irregular bleeding, hirsutism, etc at regular intervals to ensure all symptoms are addressed.
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Encourage young women considering conception to work on health optimization including weight and glycemic control.
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Metformin should not be routinely prescribed based on PCOS diagnosis alone but rather be used to slow progression to type 2 Diabetes mellitus.
Polycystic Ovarian Syndrome Treatment in Dwarka, Delhi is available at Manipal Hospital where the gynecologist provides personalized care and attention.
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