Polycystic ovary syndrome (PCOS)

 

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts. The name polycystic ovary syndrome describes the numerous small cysts (fluid-filled sacs) that form in the ovaries.

The prevalence of polycystic ovaries seen on ultrasound isaround 25% of all women but is not always associated with the full syndrome.

 

Etiology and Cause of PCOS

The aetiology of PCOS is not completely clear, although the frequent familial trend points to a genetic cause. The exact cause of PCOS is unknown. There is evidence that genetics and several other factors  play a role in causing PCOS: Higher levels of male hormones called androgens: High androgen levels prevent the ovaries from releasing eggs (ovulation), which causes irregular menstrual cycles.

Clinical features of PCOs

• Oligomenorrhoea/amenorrhoea in up to 75% of patients, predominantly related to chronic anovulation.

• Hirsutism.

• Subfertility in up to 75% of women.

• Obesity in at least 40% of patients.

• Acanthosis nigricans (areas of increased velvety skin pigmentation occur in the axillae and other

flexures).

• May be asymptomatic.

Diagnosis criteria for PCOS

Patients must have two out of the three features below:

• Amenorrhoea/oligomenorrhoea.

• Clinical or biochemical hyperandrogenism.

• Polycystic ovaries on ultrasound. The ultrasound criteria for the diagnosis of a polycystic ovary are eight or more subcapsular follicular cysts <10 mm in diameter and increased ovarian stroma. While these findings support a diagnosis of PCOS, they are not by themselves sufficient to identify the syndrome.

 

Management of PCOS

Management of PCOS involves the following:

Medication for PCOS;

• Combined oral contraceptive pill (COCP) to regulate menstruation. This also increases sex hormonebinding globulin, which will help reduce androgenic symptoms.

• Cyclical oral progesterone: used to regulate a withdrawal bleed.

• Clomiphene: this can be used to induce ovulation where subfertility is a factor.

• Lifestyle advice:

Dietary modification and exercise is appropriate in these patients as they are at an increased risk of developing diabetes and cardiovascular disease later in life. Aerobic exercise has been shown to improve insulin resistance.

• Weight reduction.

Surgical treatment of PCOS:

• Ovarian drilling, a laparoscopic procedure to destroy some of the ovarian stroma that may prompt ovulatory cycles.

 

 

Treatment of hirsutism/androgenic symptoms of PCOS:

• Eflornithine cream (Vaniqua™) applied topically;

• Cyproterone acetate (an antiandrogen contained in the Dianette™ contraceptive pill, sometimes used alone);

• Metformin: this is beneficial in a subset of patients with PCOS, those with hyperinsulinaemia and cardiovascular risk factors. It improves parameters of insulin resistance, hyperandrogenaemia, anovulation and acne in PCOS, and may aid weight loss. It is less effective than clomiphene for ovulation induction and does not improve pregnancy outcome;

• GnRH analogues with low-dose HRT: this regime should be reserved for women intolerant of other therapies;

• Surgical treatments (e.g. laser or electrolysis).

Home remedies for fertility and PCOs

1. It's also been found to help with fertility in some cases of PCOS.

2. Chromium. Chromium supplements may improve your body mass index, which can help with PCOS.

3. Cinnamon. Cinnamon comes from the bark of cinnamon trees.

4. Turmeric.

5. Zinc.

6. Evening primrose oil.

7. Combined vitamin D and calcium.

8. Cod liver oil.