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PCOS

PCOS (Poly Cystic Ovarian Syndrome)-Causes, Diagnosis and its Treatment

 

Introduction

Poly Cystic Ovarian Syndrome or PCOS is a condition observed in 5% – 10% of women, wherein multiple cysts are formed on one or both ovaries. While these cysts are themselves benign and not directly harmful, they cause a significant hormonal imbalance in the body. Ovaries produce minute quantities of androgens in every normal female. But in case of PCOS, the level of androgen production increases drastically thereby inhibiting the female reproductive hormones. As a result of this hormonal imbalance, PCOS patients can suffer from menstrual problems, reduced fertility and other health related complications. PCOS is mostly seen in women between the age of 18-35 years.

Risk Factors

The risk factors associated with PCOS are primarily pertaining to reduced fertility. However, as a result of hormonal imbalance, metabolic syndrome can also develop in women suffering from PCOS and can lead to obesity, insulin resistance and diabetes. In addition to weight fluctuations, PCOS also put women at a risk of physical disfiguration. Excessive facial and body hair growth, acneare the initial syndrome of PCOS. Missing menstrual cycle or very heavy menstruation are also associated syndromes with PCOS. Advanced stages of PCOS can also cause clinical depression in women.

Causes

PCOS is a complicated disorder and a specific cause for PCOS is not determined for sure. However, there are many genetic and environmental factors that are known to contribute to PCOS.

  • Genetic factors: Genetic variations or inconsistencies have a 50% likelihood of passing from a mother to a daughter. Hence, women with hereditary history of PCOS and known cases in her mother or sister are at a higher risk of developing PCOS.
  • Obesity:Although the hormonal imbalance associated with PCOS is known to increase the rate of weight gain, obesity is also considered as a cause of PCOS. Women who are chronically overweight or obese and are at a greater risk of developing cysts in their ovaries or develop hormonal imbalance leading to PCOS.
  • Effect of drugs:Some birth control drugs are known to tweak the natural hormonal balance in women. In addition, environmental exposure to drugs such as bisphenol A and industrial endocrine disruptors can also cause onset of PCOS.
  • Metabolic syndrome:Excessive insulin production in blood stream due to insulin resistance being developed by cells of various organs can also be a pre-cursor of PCOS. Just like metabolic syndrome, some symptoms of PCOS are also reversible if certain lifestyle changes are made. This commonality associates both syndromes and thus dictates a cyclic causal nature.

Even though the name indicates that ovaries are the primary culprit behind this disorder, ovaries are in fact the primary victims of PCOS. The cysts are not the primary cause of the 28+ symptoms of PCOS but are also a symptom in itself of PCOS. Even when both ovaries are removed, symptoms of PCOS can persist. This is a clear indicator that PCOS is a result of hormonal imbalance in the hypothalamus and have stronger genetic causes than endocrine.

Diagnosis

PCOS is most commonly suspected by clear symptoms such as irregular and heavy periods, excessive facial hair and acne, pain in pelvic region, inability to get pregnant. A complete clinical diagnosis is performed by procedures such as –

  1. Sonography: Using the Rotterdam criteria of detecting cystic formations on the ovary, PCOS can be diagnosed in women. A typical ovary is expected to have 25 or more small follicles in a stage of ‘follicular arrest’ which are commonly referred to as cysts.
  2. Blood androgen level assessment: A direct impact of cyst formation in ovaries is heightened release of androgens or male reproductive hormones in the blood stream. Therefore, a key diagnostic tool for PCOS is blood serum analysis for androgens and androgenic activity.
  3. Laparoscopy: Although not the primary diagnostic tool, laparoscopy is known to reveal PCOS symptoms upon inspection of ovaries for other causes. PCOS ovaries have a white, thickened outer layer which can be clearly diagnosed with laparoscopy.

Treatment for PCOS

As obesity is considered as a primary underlying cause as well as resultant symptom of PCOS, weight management is considered to be the best treatment for PCOS. Diet control and regular exercising to reduce weights is the initial step towards alleviating symptoms of PCOS such as excessive acne and irregular menstrual cycle. Weight management can also be assisted by fixing the metabolic syndrome using medicines like metformin and thiazolidinedione. However, many women suffering from PCOS find weight management increasingly difficult and can also be given hormonal therapy to correct the androgen imbalance in blood.