Polycystic Ovary Syndrome (PCOS) is a hormonal disorder in which there is a growth of multiple small cysts on the ovaries(cystic ovaries/bilateral cystic ovaries), that can lead to irregular periods, excessive androgen production, and infertility. It commonly affects women in reproductive age.
For better understanding let's fist discuss the structure of female reproductive system
what is the structure and function of ovaries?
The ovaries are a pair of reproductive organs in the female body that produce eggs and sex hormones e.g estrogen, progesterone, and testosterone(low levels physiologically). These hormones play important roles in regulating the menstrual cycle. The ovaries are also responsible for the development and release of an egg each month in the process of ovulation.
what are the cause of PCOS?
The exact cause of PCOS is not fully understood, however it is believed that the condition can be related to abnormal insulin levels in the body. Insulin resistance, a condition in which the body is unable to use insulin effectively to regulate blood sugar levels, is commonly observed in PCOS. When the body is unable to use insulin properly, it produces more insulin to compensate, which can lead to the production of excess androgen hormones by the ovaries via hypothalamus pituitary ovarian axis .
Studies have found that insulin resistance and high levels of insulin in the body may be a key factor in causing PCOS.
Genetics also play a role in the development of PCOS, as the condition tends to run in families.
Other factors that may contribute to the development of PCOS include obesity, sedentary lifestyle, and exposure to certain environmental toxins.
While the exact cause of PCOS is not fully known, research suggests that a combination of genetic, environmental, and lifestyle factors may interact to increase the risk of PCOS.
What is the pathophysiology of PCOS?
The pathophysiology of PCOS involves several key aspects:
Hormonal Imbalance: Women with PCOS typically have higher levels of androgens . This excessive androgen production often originates from the ovaries, adrenal glands, or both. The elevated androgen levels disrupt the normal balance between hormones, leading to anovulation (lack of regular ovulation) and the development of various symptoms.
Insulin Resistance: Many women with PCOS also have insulin resistance and so excessive insulin production. Elevated insulin levels can stimulate the ovaries to produce more androgens, contributing to hormonal imbalance and ovarian dysfunction.
Follicular Abnormalities: In PCOS, the normal development and maturation of ovarian follicles is disrupted. Multiple small follicles may develop in the ovaries but often fail to reach full maturation and ovulation. These immature follicles can accumulate in the ovaries, giving them a characteristic appearance of "polycystic" ovaries on ultrasound.
Abnormal Gonadotropin Levels: Gonadotropins are hormones released by the pituitary gland that regulate the menstrual cycle and ovarian function. In PCOS, there is an imbalance in the levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) contributing to disrupted follicular development.
Chronic Low-Grade Inflammation: Inflammation may play a role in the pathophysiology of PCOS. Increased levels of inflammatory markers like CRP have been observed in PCOS. Inflammation can further contribute to insulin resistance and disrupt normal ovarian function.
It's important to note that the manifestations and severity of PCOS can vary among individuals. The interplay between genetics, hormonal imbalances, insulin resistance, and other factors contributes to the complex pathophysiology of PCOS.
What are the symptoms of PCOS?
PCOS can present with following signs and symptoms.
Irregular periods: Women with PCOS may experience menstrual irregularities like irregular excessive or prolonged periods
hair growth: Women with PCOS may experience excess hair growth on their face, chest, back, or buttocks. This is due to the increased production of androgens, or male hormones, by the ovaries.
Acne: PCOS can cause acne, particularly on the face, chest, and upper back. The excess androgen production can also cause oily skin and hair.
Male-pattern baldness: Women with PCOS may experience hair thinning or baldness on the scalp.
Weight gain: Women with PCOS may struggle with weight gain, particularly in the central obesity.
Difficulty getting pregnant: PCOS is a common cause of infertility, it can disrupt ovulation and make it difficult to conceive.
Darkening of the skin: PCOS can cause areas of skin to darken paticularly in certain areas like neck etc.
Mood changes: Women with PCOS can experience mood swings, depression, or anxiety.
Sleep apnea: PCOS is associated with an increased risk of sleep apnea, where breathing is temporarily interrupted while asleep.
Headaches: Women with PCOS experiences frequent headaches or migraines.
Insulin resistance: PCOS is associated with insulin resistance, leading to high blood sugar levels and an increased risk of developing type 2 diabetes
High blood pressure: Women with PCOS may have higher than normal blood pressure, which can increase the risk of cardiovascular disease.
It is important to note that not all women with PCOS will experience all of these pcos symptoms.
How PCOS is diagnosed?
When diagnosing Polycystic Ovary Syndrome (PCOS), several investigations are conducted to rule out other conditions and determine if the patient meets the diagnostic criteria for PCOS. Here are some of the investigations that may be performed for PCOS diagnosis
Blood tests: Blood tests may be performed to check hormone levels, including testosterone, luteinizing hormone (LH) and follicle stimulating hormone. Blood glucose and cholesterol levels may also be checked.
Pelvic ultrasound: An ultrasound of the pelvis to check for cystic PCOS ultrasound findings.
Glucose tolerance test: A glucose tolerance test may be performed to check for insulin resistance.
Thyroid function test: Thyroid function test (TFT) may be performed to rule out thyroid disorders that can mimic PCOS symptoms.
Magnetic resonance imaging (MRI): An MRI is useful to obtain detailed images of the ovaries and check for cysts or other abnormalities.
Androgen-secreting tumor testing: If an androgen-secreting tumor is suspected as the cause of high androgen levels, testing may be performed to check for the presence of the tumor.
Genetic testing: PCOS may be caused by a genetic condition, and genetic testing may be used to identify any underlying genetic abnormalities
Transvaginal ultrasound:A transvaginal ultrasound may be performed to obtain more details of the ovaries and check for cysts.
Endometrial biopsy:Performed to check for abnormal cells in the lining of the uterus, which can be a sign of hormonal imbalances associated with PCOS.
Hormone challenge test: In some cases, a hormone challenge test to check how the body responds to different hormones.
It is important to note that all of these investigations may not be necessary for every patient and specific investigations performed may vary based on the individual's signs and symptoms of PCOS
What is the treatment of PCOS?
The treatment of Polycystic Ovary Syndrome (PCOS) focuses on managing symptoms and reducing the risk of long-term health problems. The specific treatment for PCOS can vary from person to person depending on individual's signs and symptoms of the disease.
Lifestyle changes: Maintaining a healthy diet and exercise routine, can help manage weight, reduce insulin resistance, and regulate menstrual cycles.
Medications: There are several medications that may be used to treat PCOS symptoms, including
Birth control pills or other hormonal contraceptives to regulate menstrual cycles and reduce androgen levels.
Metformin, a medication used to treat type 2 diabetes, which can help reduce insulin resistance and regulate menstrual cycles.
Clomiphene citrate,and letrozole are the medications used to induce ovulation in women trying to conceive. clomiphene may not be suitable in pcos treatment for unmarried.
Anti-androgen medication: If symptoms 0f excess androgen like hair growth (hypertrichiosis) or acne are present in PCOS, anti-androgen medication may be prescribed to reduce the effects of androgen hormones.
Surgery: Surgery may be recommended to remove cysts or other abnormalities in the ovaries.
Fertility treatments: For women twith pcos trying to conceive, assisted reproductive technologies, such as in vitro fertilization (IVF) or intrauterine insemination (IUI), may be recommended.
PCOS treatment is often a lifelong process that may involve a combination of treatments. Regular follow-up with a healthcare provider is important to monitor symptoms and adjust treatment as necessary. Additionally, lifestyle changes, such as maintaining a healthy diet and exercise routine, can help manage symptoms and improve overall health.
what are the complications of PCOS?
Polycystic Ovary Syndrome (PCOS) if not treated timely and properly it can lead to several complications.
Infertility: PCOS can cause irregular or absent menstrual periods, making it difficult. Additionally, high androgen levels can interfere with ovulation.
Diabetes: Insulin resistance, which is common in PCOS, can lead to lifelong type 2 diabetes.
Metabolic syndrome: PCOS is often associated with metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and diabetes.
Sleep apnea: Women with PCOS are at an increased risk of sleep apnea, a condition that causes interrupted breathing during sleep.
Depression and anxiety: Women with PCOS may be at an increased risk of depression and anxiety, in part due to the hormonal imbalances and associated symptoms.
Endometrial cancer: Prolonged or irregular menstrual cycles, which are common in PCOS, can increase the risk of endometrial cancer.
Regular follow-up care and monitoring can help prevent or identify and manage any potential complications