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Home :: Polycystic Ovary Syndrome
Polycystic Ovary Syndrome - Symptoms And Treatment
Alternative names :- Polycystic ovaries; Polycystic ovarian syndrome (PCOS); Stein-Leventhal syndrome; Polyfollicular ovarian disease.
Polycystic ovary syndrome (PCOS) is also known as hyperandrogenic anovulation and Stein-Leventhal syndrome. It's a metabolic disorder characterized by a chronic hyperandrogenic state and multiple ovarian cysts. It's the most common endocrine disorder in women. About 5% to 10% of women in their reproductive years are affected. It's also the leading cause of infertility in women. Among those women who seek treatment for infertility,more than 75% have some degree of PCOS, usually manifested by anovulation alone. Other implications of PCOS include obesity, amenorrhea, oligomenorrhea, diabetes, cardiovascular disease, endometrial cancer, and excessive body hair (hirsutism).
Causes of Polycystic Ovary Syndrome
The precise cause of PCOS is unknown. However, it has been associated with many factors, including:
- obesity
- enlarged ovaries
- abnormal uterine bleeding
- irregular or absent menstruation
- oily skin
- acne.
Some theories about the cause of PCOS include:
- abnormal enzyme activity triggering excess androgen secretion from the ovaries and adrenal glands
- endocrine abnormalities (such as increased insulin production, which also increases male hormone levels), which cause or worsen all of the signs and symptoms of PCOS
- heredity
Signs and symptoms of Polycystic Ovary Syndrome
PCOS tends to begin soon after the onset of menarche. A general feature of all anovulation syndromes is a lack of pulsatile release of gonadotropinreleasing hormone. Initial ovarian follicle development is normal. Many small follicles begin to accumulate because there's no selection of a dominant follicle. These follicles may respond abnormally to hormonal stimulation, such as by forming cysts instead of releasing an egg each month. These cysts eventually fill up the ovaries.
Signs and symptoms of classic PCOS include:
- mild pelvic discomfort that lasts longer than 6 months
- abdominal pain or bloating
- lower back pain
- dyspareunia
- abnormal uterine bleeding secondary to irregular menstrual cycle (usually menstrual cycle greater than 3 S days or less than 8 cycles per year to complete absence of menses (amenorrhea)
- polycystic ovaries (not definitively diagnostic of PCOS, although seen in 67% to 86% of patients with PCOS)
- elevated luteinizing hormone
- cervical discharge
- obesity (usually centered around the midsection)
- increased androgen levels, such as testosterone
- increased insulin levels (diabetes) . hirsutism (excess hair on the face and body)
- increased blood pressure, cholesterol. or lipid levels
- acne
- male-pattern hair loss.
- Certain complications occur in patients with PCOS.
Diagnosis of PCOS includes:
- history and physical examination showing bilaterally enlarged polycys tic ovaries and menstrual irregularities, usually dating back to menarche . visualization of the ovary through ultrasound,laparoscopy, or surgery, commonly for another condition (may confirm ovarian cysts)
- slightly elevated urinary 17 -ketosteroid levels and anovulation (shown by basal body temperature graphs and endometrial biopsy)
- elevated ratio ofluteinizing hormone to follicle-stimulating hormone (usually 3:1 or greater) and elevated levels of testosterone and androstenedione (androgen)
- unopposed estrogen action during the menstrual cycle due to anovulation
- direct visualization by laparoscopy to rule out paraovarian cysts of the broad ligament, salpingitis, endometriosis, and neoplastic cysts
- absence of any other underlying causative disorders, such as ovarian cancer and tumor of the adrenal gland.
Polycystic Ovary Syndrome treatment
There's no cure for PCOS, so the focus of treatment is to prevent further problems and control symptoms'. Treatment of pcos includes monitoring the patient's weight to maintain a normal body mass index in order to reduce risks associated with insulin resistance, which may cause spontaneous ovulation in some women. Treatment also depends on the patient's lipid and glucose levels.
Treatment of PCOS may include the administration of such drugs as:
- metformin (Glucophage) to decrease insulin levels, which will increase ovulation
- clomiphene (Clomid) to induce ovulation
- medroxyprogesterone (Provera) for 10 days each month for a patient who wants to become pregnant
- low-dose hormonal contraceptives to treat abnormal bleeding for the patient who requires reliable contraception; also to regulate the menstrual cycle, reduce androgen levels, and help clear acne
- progestin to protect the endometrium from estrogen exposure, although no contraceptive protection is provided (usually prescribed to women who aren't candidates for hormonal contraceptives due to smoking, hypertension,or other contraindications)
- topical creams or antiandrogens (spironolactone) to decrease hair production
Complications
- Sterility
- Obesity-related conditions, like high blood pressure and diabetes
- Increased the risk of endometrial cancer -- this is because the endometrium (lining of the uterine wall that sheds when you menstruate) can get thicker and thicker (hyperplasia) due to the lack of ovulation
- Possible increased risk of breast cancer
Special considerations
Preoperatively, watch for signs of cyst rupture, such as increasing abdominal pain, distention, and rigidity. Monitor vital signs for fever, tachypnea, or hypotension (possibly indicating peritonitis or intraperitoneal hemorrhage).
- Provide emotional support, offering appropriate reassurance if the patient fears cancer or infertility.
- Assure the patient that unwanted excess hair may be removed by a variety of methods and can even be removed permanently.
- For those women who are infertile but still wish to conceive, provide them with information on alternative options such as in vitro fertilization.
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