Definition:
Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.
The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.
The 4 types of PCOS include:
• Insulin resistant PCOS. This is the most common type of PCOS, affecting around 70% of people.
• Post-pill PCOS. Post-pill PCOS occurs in some people after they stop taking the oral contraceptive pill.
• Adrenal PCOS.
• Inflammatory PCOS.
Signs and symptoms:
The major features of PCOS include menstrual dysfunction, anovulation, and signs of hyperandrogenism. Other signs and symptoms of PCOS may include the following:
• Hirsutism
• Infertility
Diagnosis:
On examination, findings in women with PCOS may include the following:
• Virilizing signs
Testing:
• Serum prolactin level
• Total and free testosterone levels
• Free androgen index
• Serum hCG level
• Cosyntropin stimulation test
• Serum 17-hydroxyprogesterone (17-OHPG) level
• Urinary free cortisol (UFC) and creatinine levels • Low-dose dexamethasone suppression test
Other tests used in the evaluation of PCOS include the following:
• Androstenedione level
Imaging tests:
The following imaging studies may be used in the evaluation of PCOS:
• Ovarian ultrasonography, preferably using transvaginal approach
• Pelvic CT scan or MRI to visualize the adrenals and ovaries
Procedures:
An ovarian biopsy may be performed for histologic confirmation of PCOS; however, ultrasonographic diagnosis of PCOS has generally superseded histopathologic diagnosis. An endometrial biopsy may be obtained to evaluate for endometrial disease, such as malignancy.
Management:
Lifestyle modifications are considered first-line treatment for women with PCOS. Such changes include the following
• Diet
Pharmacotherapy:
Pharmacologic treatments are reserved for so-called metabolic derangements, such as anovulation, hirsutism, and menstrual irregularities. First-line medical therapy usually consists of an oral contraceptive to induce regular menses. If symptoms such as hirsutism are not sufficiently alleviated, an androgen-blocking agent may be added. First-line treatment for ovulation induction when fertility is desired are letrozole or clomiphene citrate.
• Medications used in the management of PCOS include the following:
• Oral contraceptive agents (eg, ethinyl estradiol, medroxyprogesterone)
• Antiandrogens (eg, spironolactone, leuprolide, finasteride)
• Hypoglycemic agents (eg, metformin, insulin)
• Selective estrogen receptor modulators (eg, clomiphene citrate)
• Topical hair-removal agents (eg, eflornithine)
• Topical acne agents (eg, benzoyl peroxide, tretinoin topical cream (0.02–0.1%)/gel (0.01–0.1%)/solution (0.05%), adapalene topical cream (0.1%)/gel (0.1%, 0.3%)/solution (0.1%), erythromycin topical 2%, clindamycin topical 1%, sodium sulfacetamide topical 10%)
Surgery:
Surgical management of PCOS is aimed mainly at restoring ovulation. Various laparoscopic methods include the following:
• Electrocautery
• Laser drilling
• Multiple biopsy
5 Myths about PCOD:
Myth #1: You Did Something to Cause It:
While the exact cause of PCOS is unknown, one thing is certain: You are not to blame. However, several factors — including genetics — are widely believed to play a role. Androgens, or male hormones, control the development of male traits. “While all women produce small amounts of androgens, those with PCOS have more androgens than normal, which can prevent ovulation and make it difficult to have regular menstrual cycles,” explained Justin Sloane, MD, physician at Penn Ob/Gyn Chester County.
Androgens, or male hormones, control the development of male traits. “While all women
produce small amounts of androgens, those with PCOS have more androgens than normal, which can prevent ovulation and make it difficult to have regular menstrual cycles,” explained Justin Sloane, MD, physician at Penn Ob/Gyn Chester County.
The follicles grow and build up fluid, but the eggs do not get released. Ovulation does not occur, and the follicles might turn into cysts. If this happens, your body might fail to make the hormone progesterone, which is needed to keep your cycle regular.
Women whose mothers and sisters have PCOS are more likely to be affected by this condition, too
Myth #2: If You Lose Weight, You Can Get Rid of PCOS:
Unfortunately, there is no cure for PCOS, but overweight and obese women can help balance their hormone levels by losing weight. Otherwise, treatment is aimed at managing symptoms
A wide range of treatment options can help prevent any potential problems Lifestyle changes, such as healthy eating and regular exercise, improve the way your body uses insulin and, therefore, regulates your hormone levels better. Fertility medications also can help stimulate ovulation if you want to get pregnant. In some cases, that may be enough to spur the process for women with a lack of ovulation — the main reason women with PCOS struggle with fertility A surgical procedure known as ovarian drilling can also increase your chances of successful ovulation. While the operation can temporarily lower your androgen levels, it does pose the risk of creating scar tissue .
Myth #3: PCOS is a Rare Condition:
According to the PCOS Foundation, less than half of all women with PCOS are actually diagnosed correctly, meaning that millions of women are potentially unaware of their condition.
Myth #4: You Can’t Get Pregnant if You Have PCOS:
This isn’t true for everyone. Give your body a chance by talking with your doctor about fertility treatment .
A number of medications can stimulate ovulation, which is the main issue that women with PCOS face Other fertility treatments for women with PCOS include assisted reproductive technologies such as in vitro fertilization
Myth #5: PCOS Only Affects Overweight Women:
