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What is Polycystic Ovarian Syndrome (PCOS)?

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Polycystic ovarian syndrome is a heterogeneous genetic disorder that mostly affects young girls of fertile age (Norman et al., 2004). Polycystic ovaries contain multiple fluid-filled cysts.

In PCOS, excess androgen hormones are produced. Androgens are predominantly present in males and less frequently in females. Multiple cysts in the ovary, almost 10-12 in number are present unilaterally or bilaterally. These cysts are the characteristic feature of PCOS.

Egg formation is an important cycle occurring in the ovaries. Luteinizing hormone (LH) and Follicle-stimulating hormone (FSH) are concerned with the genesis of follicles and ovum.

Hypersecretion of androgens (male hormones) affects the formation of FSH and LH, resulting in irregular periods and multiple immature eggs formations. These immature eggs get converted into cysts (Tzalazidis & Oinonen, 2021).

Onset:

PCOS most commonly occurs after menarche and before menopause, during 14-48 years of age.

Statistics:

According to advanced research and statistics, 19% of young females cannot conceive or stay pregnant due to polycystic ovarian syndrome.

These statistics indicate the importance of early detection and treatment of PCOS in adult and fertile women.

Factors associated with PCOS?

  • Genetic factors
  • Environmental factors
  • Life style

What is the difference between PCOS and PCOD?

Polycystic ovarian disease (PCOD) is somewhat less severe than PCOS. PCOS is concerned with anovulation, but PCOD does not cause anovulation. PCOS affects fertility and makes women hard to conceive, but women with PCOD can ovulate and retain fertility (Tzalazidis & Oinonen, 2021).

What are the types of PCOS?

PCOS is associated with different factors like inflammation, insulin, stress and different pills. There are mainly 4 types of PCOS:

  1. PCOS-associated with inflammation.
  2. PCOS-associated with insulin resistance (most common)
  3. Hormone-associated PCOS (mainly in stress).
  4. PCOS-Associated with pills

What does PCOS do to your body?

PCOS has multiple physical and metabolic effects on your body. Hypersecretion of androgen can cause:

  • Disturbed metabolism

PCOS can affect your metabolism and is associated with:

  1. Abnormal lipid metabolism that causes an increase in blood cholesterol level (LDL)
  2. Hypertension
  3. Increase in blood sugar level due to insulin-resistant response

These pathological factors can lead to:

  • Atherosclerosis
  • Vascular thromboembolism
  • Type 2 diabetes
  • Ischemia and stroke

What are the signs and symptoms of PCOS?

PCOS can be asymptomatic and symptomatic. PCOS usually presents with:

  • Hypersecretion of androgens
  • Decrease libido (sexual desire)
  • Hair growth(hirsutism) with the predominant male patterns and baldness.
  • Acne
  • Depression
  • Stress
  • Obesity
  • Cosmetic disfigurement (Acanthosis symptoms
  • Irregular menstrual periods
  • Heavy menstrual bleeding
  • Lower abdominal pain (pelvic area)
  • Enlargement of ovaries

When to see your doctor?

It is mandatory to call your doctor for an appointment if you have the following symptoms:

  • skipped menstrual periods in the absence of pregnancy
  • Abnormal hair growth on your body
  • Symptoms associated with diabetes
  • Unable to conceive

How to diagnose PCOS?

PCOS is diagnosed:

  • Physically
  • Biochemically
  • Ultrasonography

-Physically, PCOS is diagnosed by examination of the pelvic area to rule out an abnormality or mass.

-Biochemically, it is interpreted by the presence of excess androgen in blood.

-Ultrasonography shows an enlargement of both ovaries with multiple (10-12) immature small follicles in them (Gomel & Yarali, 2004).

How to treat PCOS?

Treatment of PCOS includes lifestyle changes medical as well as surgical treatment.

Lifestyle modifications:

  • lifestyle modifications include diet control, healthy food, avoidance of stress, and exercise
  • It includes a diet with low cholesterol and insulin administration to overcome diabetes and heart-related disorders, mainly in people with diabetes.

Medication based treatment:

  • To overcome androgens level:

Pills and androgen blockers are the drug of choice to lower androgens levels in your body and normalise the ovulation process. e.g., progesterone and oestrogen-containing pills, e.g., progestin. Androgen blockers are used to overcome the secretion of androgen and androgen-associated hirsutism (Mclennan & Keir, 1975).

  • Induction of ovulation:

Clomiphene is the drug of choice to treat anovulation.

Metformin is the drug of choice used in type 2 diabetes (Atiomo et al., 2000).

Surgical treatment:

Surgical treatment of PCOS is indicated in patients resistant to medical treatment. Ovarian drilling is done through a laparoscopic approach. It destroys ovarian stroma that produces excessive androgens (Goodarzi et al., 2011).

What are the complications of PCOS if left untreated?

PCOS should be treated as early as it is diagnosed. Otherwise, it can lead to serious long and short-term health effects on your body, including:

  • Infertility
  • Endometrial carcinoma
  • Hypertension or high blood pressure induced by pregnancy
  • Eclampsia and preeclampsia
  • Fatty liver disease
  • Psychological impairment (Gomel & Yarali, 2004)

Conclusion

Polycystic ovarian syndrome (PCOS) is a disorder of young girls during childbearing age. It is caused by high androgens levels associated with multiple cysts in ovaries resulting in anovulation (Escobar-Morreale, 2018).

It affects various organs in your body like the heart, liver, brain, ovaries, skin, etc. It should be treated as early as possible to avoid complications and risk factors associated with this syndrome.

 

Written by: Emmanuel J. Osemota

References

  1. McLennan, A. G., & Keir, H. M. (1975). Euglena gracilis deoxyribonucleic acid polymerases: subcellular locations and variations during the cell cycle. Biochemical Society transactions, 3(5), 652. https://doi.org/10.1042/bst0030652
  2. Escobar-Morreale H. F. (2018). Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature reviews. Endocrinology, 14(5), 270–284. https://doi.org/10.1038/nrendo.2018.24
  3. Tzalazidis, R., & Oinonen, K. A. (2021). Continuum of Symptoms in Polycystic Ovary Syndrome (PCOS): Links with Sexual Behavior and Unrestricted Sociosexuality. Journal of sex research, 58(4), 532–544. https://doi.org/10.1080/00224499.2020.1726273
  4. Atiomo, W. U., Pearson, S., Shaw, S., Prentice, A., & Dubbins, P. (2000). Ultrasound criteria in the diagnosis of polycystic ovary syndrome (PCOS). Ultrasound in medicine & biology, 26(6), 977–980. https://doi.org/10.1016/s0301-5629(00)00219-2
  5. Ajossa, S., Guerriero, S., Paoletti, A. M., Orrù, M., & Melis, G. B. (2004). The treatment of polycystic ovary syndrome. Minerva ginecologica, 56(1), 15–26.
  6. Gomel, V., & Yarali, H. (2004). Surgical treatment of polycystic ovary syndrome associated with infertility. Reproductive biomedicine online, 9(1), 35–42. https://doi.org/10.1016/s1472-6483(10)62107-4
  7. Norman, R. J., Dewailly, D., Legro, R. S., & Hickey, T. E. (2007). Polycystic ovary syndrome. Lancet (London, England), 370(9588), 685–697. https://doi.org/10.1016/S0140-6736(07)61345-2
  8. Goodarzi, M. O., Dumesic, D. A., Chazenbalk, G., & Azziz, R. (2011). Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nature reviews. Endocrinology, 7(4), 219–231. https://doi.org/10.1038/nrendo.2010.217

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