Polycystic Ovary Syndrome (PCOS)

1. Polycystic Ovary Syndrome (PCOS) - is one of the most common female endocrine disorders affecting approximately 5%-10% of women of reproductive age (12–45 years old) and is thought to be one of the leading causes of female infertility. The exact cause of polycystic ovary syndrome is unknown. -PCOS can present in any age during the reproductive years. Due to its often vague presentation it can take years to reach a diagnosis.

2. Symptoms • Menstrual abnormality This is the most common characteristic. Examples of menstrual abnormality include Oligomenorrhea, amenorrhea — irregular, few, or absent menstrual periods • Excess androgen Elevated levels of male hormones (androgens) may result in physical signs, such as excess facial and body hair (hirsutism); adult acne or severe adolescent acne . • Enlarged ovaries containing numerous small cysts can be detected by ultrasound. To be diagnosed with PCOS, you must also have abnormal menstrual cycles or signs of androgen excess. • Infertility PCOS is the most common cause of female infertility. • Obesity About half the women with polycystic ovary syndrome are obese women • type 2 diabetes. Many women with polycystic ovary syndrome are insulin resistant, which impairs the body's ability to use insulin effectively to regulate blood sugar. This can result in high blood sugar and type 2 diabetes. • Acanthosis Nigerians. This is the medical term for darkened, velvety skin on the nape of your neck, armpits, inner thighs, vulva or under your breasts. This skin condition is a sign of insulin resistance.

3. Causes The exact cause of polycystic ovary syndrome is unknown. -normal reproductive cycle is regulated by changing levels of hormones produced by the pituitary gland in brain and by ovaries. The pituitary gland produces follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which control the growth and release of eggs (ovulation) in the ovaries. During a monthly cycle, ovulation occurs about two weeks before period. ovaries secrete the hormones estrogen and progesterone, which prepare the lining of the uterus to receive a fertilized egg. The ovaries also produce some male hormones (androgens), such as testosterone. If pregnancy doesn't occur, estrogen and progesterone secretion decline and the lining of the uterus is shed during menstruation. -In polycystic ovary syndrome, the pituitary gland may secrete high levels of LH and the ovaries may make excess androgens. This disrupts the normal menstrual cycle and may lead to infertility, excess body hair and acne.

4. Risks factors of (PCOS) Excess insulin. The excess insulin is thought to boost androgen production by your ovaries. Low-grade inflammation. body's white blood cells produce substances to fight infection in a process called inflammation. white blood cells produce substances that can lead to insulin resistance and cholesterol accumulation in blood vessels (atherosclerosis). Atherosclerosis causes cardiovascular disease. Heredity. If mother or sister has PCOS, you might have a greater chance of having it. Abnormal fetal development. New research shows that excessive exposure to male hormones (androgens) in fetal life may permanently prevent normal genes from working the way they're supposed to — a process known as gene expression. This may promote a male pattern of abdominal fat distribution, which increases the risk of insulin resistance and low-grade inflammation. Research continues to establish to what extent these factors might contribute to PCOS.

5. Tests and diagnosis • The diagnosis is one of exclusion, which means your doctor considers all of your signs and symptoms and then rules out other possible disorders. • Medical history. • Physical examination. During your physical exam, your doctor will note several key pieces of information, including your height, weight and blood pressure. • Pelvic examination. During a pelvic exam, your doctor visually and manually inspects your reproductive organs for signs of masses, growths or other abnormalities. • Blood tests. Your blood may be drawn to measure the levels of several hormones to exclude possible causes of menstrual abnormalities or androgen excess that mimic PCOS. Additional blood testing may include fasting cholesterol and triglyceride levels and a glucose tolerance test, in which glucose levels are measured while fasting and after drinking a glucose-containing beverage. • Pelvic ultrasound. A pelvic ultrasound( abdominal and trans-vaginal ultrasound ) can show the appearance of the ovaries and the thickness of the lining of the uterus.

6. Treatments and drugs Polycystic ovary syndrome treatment generally focuses on management of individual main concerns, such as infertility, hirsutism, acne or obesity. Schedule regular checkups Long term, managing cardiovascular risks, such as obesity, high blood cholesterol, type 2 diabetes and high blood pressure, is important. To help guide ongoing treatment decisions. Adjusting lifestyle habits Making healthy-eating choices and getting regular exercise is the first treatment approach your doctor might recommend, particularly if you're overweight. Obesity makes insulin resistance worse. Weight loss can reduce both insulin and androgen levels, and may restore ovulation. Regulate menstrual cycle doctor may prescribe low-dose birth control pills that contain a combination of synthetic estrogen and progesterone. They decrease androgen production and give your body a break from the effects of continuous estrogen. This decreases risk of endometrial cancer and corrects abnormal bleeding.

7. Treatments,cont. An alternative approach is taking progesterone for 10 to 14 days each month. This regulates periods and offers protection against endometrial cancer, but it doesn't improve androgen levels. doctor also may prescribe metformin (Glucophage, Glucophage XR), an oral medication for type 2 diabetes that lowers insulin levels. This drug improves ovulation and leads to regular menstrual cycles. Metformin also slows the progression to type 2 diabetes Reduce excessive hair growth doctor may recommend birth control pills to decrease androgen production, or another medication called spironolactone (Aldactone) that blocks the effects of androgens on the skin. Because spironolactone can cause birth defects, effective contraception is required when using the drug, and it's not recommended if you're pregnant or planning to become pregnant. Eflornithine (Vaniqa) is another medication possibility; the cream slows facial hair growth in women.

8. Shaving, waxing and depilatory creams are nonprescription hair removal options. Results may last several weeks, and then you need to repeat treatment. For longer lasting hair removal, your doctor might recommend a procedure that uses electric current (electrolysis) or laser energy to destroy hair follicles and control unwanted new hair growth. -Use medication to induce ovulation If woman trying to become pregnant, may need a medication to induce ovulation. Clomiphene citrate (Clomid, Serophene) is an oral anti-estrogen medication that taken in the first part of your menstrual cycle. If Clomiphene citrate alone isn't effective, may add metformin to help induce ovulation. Treatments,cont.

9. Also may recommend using gonadotropins — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications that are administered by injection. surgery If medications don't help you become pregnant, an outpatient surgery called laparoscopic ovarian drilling is an option for some women with PCOS In this procedure, a surgeon makes a small incision in the abdomen and inserts a tube attached to a tiny camera (laparoscope). The camera provides the surgeon with detailed images of the ovaries and neighboring pelvic organs. The surgeon then inserts surgical instruments through other small incisions and uses electrical or laser energy to burn holes in follicles on the surface of the ovaries. The goal is to induce ovulation by reducing androgen levels.

10. Complications Having polycystic ovary syndrome makes the following conditions more likely, especially if obesity also is a factor: Type 2 diabetes High blood pressure Cholesterol abnormalities, such as high triglycerides or low high-density lipoprotein (HDL) cholesterol, the so-called "good" cholesterol Elevated levels of C-reactive protein, a cardiovascular disease marker Metabolic syndrome, a cluster of signs and symptoms that indicate a significantly increased risk of cardiovascular disease Sleep apnea Abnormal uterine bleeding Cancer of the uterine lining (endometrial cancer), caused by exposure to continuous high levels of estrogen Gestational diabetes or pregnancy-induced high blood pressure, if you do become pregnant