Polycystic ovarian syndrome (PCOS)
Polycystic ovarian Syndrome(PCOS), is a set of symptoms that result from a hormonal imbalance affecting women and girls of childbearing age.
PCOS, a heterogenous disorder is the most common endocrine abnormality among women of reproductive age.
PCOS can be described as an oligogenic disorder in which the interaction of a number of genetic and environmental factors determine the heterogenous, clinical, and biochemical phenotype.
Although the genetic etiology of PCOS remains unknown. The current literature suggests that the clustering of PCOS in families resembles an autosomal dominant pattern.
Environmental factors implicated in PCOS (eg. : obesity) can be exacerbated by poor dietary choices and physical inactivity; infectious agents and toxins may also play a role.
PCOS is the mos common cause of anovulatory infertility, meaning that the infertility results from the absence of ovulation, the process that releases a mature egg from the ovary every month.
PCOS can cause other problems as well, such as unwanted hair growth, dark patches of skin, acne, weight gain, and irregular bleeding.
Women with PCOS are also at higher risk for:-
- Obstructive sleep apnea, a disorder that causes pauses in breathing during sleep.
- Insulin resistance
- Type 2 diabetes
- Heart diseases and high blood pressure.
- Mood disorders
- Endometrial hyperplasia, a condition in which the lining of the uterus becomes too thick, and endometrial cancer.
The pathophysiology of PCOS involves primary defects in the hypothalamic-pituitary axis, insulin resistance and action, and ovarian function.
Although the cause of PCOS is unknown, it has been linked to insulin resistance and obesity.
Follicular maturation arrest is a hallmark sign that an ovarian abnormality exists.
Clinical signs of PCOS include elevated luteinizing hormone(LH) and gonadotropin- releasing horMone(GnRH) levels, whereas follicular-stimulating hormone(FSH) levels are muted or unchanged. As a result of the increase in GnRH, stimulation of the ovarian thecal cells, in turn, produces more androgens.
CLINICAL PRESENTATION :-
PCOS is a hormonal disorder with a potential to lead to various diseases. It also continues to be a common cause of infertility among women.
Although signs and symptoms vary, the three most common factors associated with PCOS include ovulation irregularities, increased androgen levels, and cystic ovaries.
If PCOS is suspected, a complete medical history, physical examination, blood tests, and a pelvic ultrasound should be performed.
During the assessment period, other potential causes associated with reproduction, endocrine, and metabolic dysfunction should be excluded. Moreover, a pregnant woman with PCOS should be informed is the increased rates of miscarriage, gestation diabetes, pre-eclampsia, and premature delivery.
Non-Pharmalogical Approaches :-
1) Weight reduction for obese patients with PCOS is beneficial in many ways. Weight loss helps to decrease androgen, luteinizing hormone(LH), and insulin levels. It also helps to regulate ovulation, thereby improving the potential for pregnancy.
2) Laproscopic ovarian drilling is an outpatient surgical intervention in which multiple perforations are created in the ovarian surface and stroma. It is thought that this intervention destroys androgen-producing tissue, which should lead to decreased androgen levels and also increases the risk of multiple pregnancies besides being effective as medical interventions.
Pharmalogical Approaches :-
- Anti-diabetic agents
- Aromatase inhibitors
- Oral Contraceptives.
- Medroxyprogesterone acetate
Polycystic ovary syndrome is a complex disorder for which multiple treatment approaches are required, depending on the reason a patient seeks treatment.
Clomiphene has shown that the best results in treating infertility, whereas data are limited regarding pharmalogical treatment of androgenic symptoms.
Long-term consequences of PCOS, which include Type-2 diabetes and cardiovascular disease can be treated with anti-diabetic drugs and statins.