Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a common hormonal condition that affects women of reproductive age. It affects an estimated 8–13% of reproductive-aged women among which 70% of affected women remain undiagnosed worldwide. Stein and Leventhal reported the classic symptomatology in 1935.

They described a group of women with amenorrhea, infertility, hirsutism, and enlarged polycystic ovaries. The authors found that, after ovarian biopsy, the women began to menstruate regularly.

PCOS can cause hormonal imbalances, irregular periods, excess androgen levels, and cysts in the ovaries. Irregular periods, usually with a lack of ovulation, can make it difficult to become pregnant. PCOS is a leading cause of infertility worldwide.

// Signs and symptoms:

1. Menstrual disorders: Heavy, long, intermittent, unpredictable or absent periods.
2. Infertility: This may be due to chronic anovulation.
3. Acne or oily skin.
4. Hyperandrogenism: Excessive hair on the face or body.
5. Alopecia: Male-pattern baldness or hair thinning.
6. Acanthosis Nigricans: Dark, thick, and velvety patches can form especially under skin folds for eg: posterior and lateral folds of the neck, the armpits, groin, navel, forehead, etc.
7. Metabolic Syndrome: Central obesity (weight gain, especially around the belly), insulin resistance.

// People with PCOS are more likely to have other health conditions including:

1. Type 2 diabetes
2. Hypertension (High Blood Pressure)
3. High Cholesterol
4. Heart Disease
5. Endometrial Cancer (cancer of the inner lining of the uterus).

// Diagnosis criteria

Presence of two out of three:

1. Anovulation/ oligomenorrhea
2. Clinical or biochemical evidence of hyperandrogenism — hirsutism/acne/raised testosterone/ androstenedione/DHEAS and FAI
3. Polycystic ovaries →10cc and more than 12 follicles of 2–9mWomen with

// Polycystic ovary syndrome may have elevated levels of:

• Testosterone
• Estrogen
• Luteinizing
• Insulin
• Anti-müllerian hormone (AMH)

// Treatment

PCOS has no cure. Palliative treatment can be given as follows:

1. Lifestyle changes
   Management of lifestyle habits should be the first-line therapy for all women with Polycystic Ovary Syndrome (PCOS) and the target should be weight loss (5–10 %) in women with a body mass index (BMI) ≥ 25 kg/m2 and prevention of weight gain in women with a BMI 18.5–24.9 kg/m2. The program should include both reduced dietary energy intake and regular exercise.
2. Oral Contraceptive Pill (OCP).
   To regulate the menstrual cycle by medication to treat hormonal imbalance and insulin resistance
3. Cyclic Progestogens
   They should be used when contraception is not required and there are no signs of hyperandrogenism. Dydrogesterone and Medroxyprogesterone Acetate is usually used for 10–14 days every two to three months.
4. Metformin and Thiazolidinedione (glitazones) are not as efficient as initially shown.
5. Fertility treatment for infertility
6. Skin treatment for ache and hair growth
7. Laparoscopic procedure -ovarian drilling to destroy androgen-producing tissue in the ovaries if the patient does not respond to hormonal treatment.