Polycystic Ovary Syndrome


Polycystic Ovary Syndrome

Description, Causes and Risk Factors:

Abbreviation: PCOS.

The ovaries are two small organs, one on each side of a woman's uterus. A woman's ovaries have follicles, which are tiny sacs filled with liquid that hold the eggs. These sacs are called cysts. Each month about 20 eggs start to mature, but usually only one matures fully. As this one egg grows, the follicle accumluates fluid in it. When that egg matures, the follicle breaks open to release it. This egg then travles through the fallopian tube for fertilization. When the single egg leaves the follicle, ovulation take place.

PCOS is one of the most common endocrine disorders, affecting between 8% and 18% of women of reproductive age. This variability in prevalence of the syndrome is due to various logistical difficulties in diagnosing the syndrome and considerable heterogeneity in the presentation of symptoms resulting in lack of agreement over the diagnostic criteria used to define the condition. PCOS has an uncertain aetiology with recent studies pointing to a strong genetic basis. Some of the principal symptoms of PCOS include oligomenorrhea or amenorrhea, anovulation leading to infertility, high androgen levels resulting in acne and hirsutism, tendency towards obesity, insulin resistance, and evidence of multiple cysts within the ovary.

The phenotype varies widely depending on life stage, genotype, ethnicity and environmental factors including lifestyle and bodyweight. In United States about $4.36 billion is spent annually in diagnosis and treatment of the PCOS. Studies conducted in families in which PCOS is prevalent also indicate the presence of chronic disease such as diabetes mellitus (DM) and cardiovascular diseases (CVD).

The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.

A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.

Researchers also think insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen.

A recent study in Australia based on a community based cohort using a defined sampling frame reported that the parents of women who had been diagnosed with PCOS were more subject to chronic diseases than parents of women who had never been diagnosed with PCOS. Previous studies conducted in the first degree relatives of PCOS women have also revealed higher insulin resistance, serum androgen levels and type-2 diabetes as well as glucose tolerance disorder compared to the control groups. Together, the incidence of diabetes, impaired glucose tolerance, and impaired fasting glucose was 40% in the mothers and 52% in the fathers of PCOS women. Mothers, fathers, brothers, and sisters of PCOS women were found to have insulin resistance. In the family members of PCOS patients, hyperinsulinaemia and insulin resistance could act as important markers. Nowadays, PCOS has been acknowledged as a major risk factor for the development of type-2 diabetes.

Symptoms:

Not all women with PCOS share the same symptoms. These are some of the symptoms of PCOS:

    Infrequent menstrual periods, no menstrual periods, and/or irregular bleeding.

  • Infertility because of not ovulating.

  • Increased hair growth on the face, chest, stomach, back, thumbs, or toes.

  • Ovarian cysts.

  • Acne.

  • Weight gain or obesity, usually carrying extra weight around the waist.

  • Insulin resistance or type 2 diabetes mellitus.

  • High cholesterol.

  • High blood pressure.

  • Male-pattern baldness or thinning hair.

  • Patches of thickened and dark brown or black skin on the neck, arm, breasts, and thighs.

  • Skin tags, or tiny excess flaps of skin in the armpits or neck area.

  • Pelvic pain.

  • Anxiety or depression due to appearance and/or infertility.

  • Sleep apnea, excessive snoring.

Diagnosis:

There is no single test to diagnose PCOS. Your doctcor will take a medical history, perform a physical exam, and possibly take some tests to rule out other causes of your symptoms. During the physical exam the doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check out the areas of incresed hair growth, so try to allow the natural hair growth for a few days before the visit. Your doctor might want to do a pelvic exam to see if your ovaries are enlarged or swollen by the increased number of small cysts. A vaginal ultrasound also might be used to examine the ovaries for cysts and check out the endometrium, the lining of the uterus. The uterine lining may become thicker if your periods are not regular. You also might have blood taken to check your hormone levels and toe mesure glucose levels.

Treatment:

PCOS is a complex condition in women with manifestations across the lifespan and reflects a major health and economic burden in many countries. Therapy should target both short and long-term reproductive, metabolic and psychological aspects. Given the etiological role of insulin resistance and the impact of obesity on both hyperinsulinemia and hyperandrogenism, multidisciplinary lifestyle improvement aimed at normalizing insulin resistance, improving androgen status and aiding weight management is recognized as a critical initial treatment strategy. Loss in body weight of about 5% to 10% has been shown to improve many of the symptoms of PCOS. Management of PCOS should focus on medical therapy along with support, education, addressing psychological needs and encouraging healthy lifestyle. Monitoring and management of long-term metabolic complications is also an important part of routine clinical care. Screening high-risk family members for metabolic disorders should also be made a priority. More research efforts are needed to tackle this complex problem.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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