A typical case scenario commonly seen in our clinic is a young obese girl with intractable acne, irregular cycles, and increased facial hair. On ultrasound polycystic ovaries are seen, creating a lot of anxiety in her mind. But it is the most common endocrine disorder affecting 25 to 30% of young women. Approximately 75% of anovulatory women have polycystic ovaries.
About the disease
PCOS, as called as Stein-Leventhal syndrome is a syndrome of ovarian dysfunction along with features of increased male hormones and ovaries showing polycystic morphology in the absence of other explanatory endocrinopathy.
The etiology is complex with recent studies suggesting role of insulin resistance. Obesity exacerbates the signs and symptoms of PCOS by worsening insulin resistance symptoms. The symptoms may be as varied as irregular or missed periods, excessive hair growth on the face, around the nipples, and/or around the lower abdomen, obesity, thinning of the hair on the head, intractable acne, infertility, miscarriage, and type 2 diabetes or pre-diabetes.
Management
A good history, clinical examination, followed by pelvic ultrasound, and hormonal profile completes the diagnosis of PCOS. Ultrasound shows enlarged ovaries, with multiple small cysts generally oriented in the periphery, like "String of pearls". Hormonal profile reveals high levels of DHEA, LH, AMH, and a normal FSH level. High LH Levels with a normal FSH level is typical of PCOD
Goal of Treatment
Weight loss by diet and exercise is the most effective treatment. It lowers insulin resistance which restores regular cycles and ovulation. Anti-diabetic drugs like metformin, glitazone, newer drugs like D-chiro-inositol, Myo-inositol, Vitamin D3, and acupressure are other supportive therapies.
Restoration of fertility - Not all women have difficulty in conceiving. For those that do, ovulation is induced with drugs like clomiphene or HMG/FSH injections. Some might require laparoscopic ovarian drilling (A laser or cautery is used to drill 4-10 multiple holes through the thickened ovarian capsule). Those not responsive to these and diet and lifestyle modification, IVF (In-vitro fertilisation) is the option. Treatment results with PCOS are good
Treatment of hirsutism or acne
Restoration of regular menstruation, to prevent endometrial hyperplasia and endometrial cancer by using progesterone or combined contraceptive pill. If periods are occurring atleast every three months no treatment is needed.
Early diagnosis and treatment may reduce the longterm risk of type 2 diabetes and heart disease..
Is there a cure ?
There is no straightforward cure. Medical treatments reduce the symptoms and consequences of PCOS. Majority of women respond excellently to lifestyle modifications only
Author:
DR APRAJITA SINGH, MD,DNB,MNAMS
OBSTETRICS & GYNAECOLOGY
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