Polycystic Ovarian Syndrome (PCOS)

At different stages of life, it can express itself in different ways, for example, in adolescence: absence or infrequent menstruation may be a single sign associated with increase in weight and excessive hair growth. In women past adolescence, it can express itself as an irregular ovulation cycle, leading to pregnancy issues, unexplained weight gain and/ or difficulty in losing weight and difficulty in falling pregnant.

Polycystic Ovaries/ Causes

Large ovaries containing numerous small cysts: This can be detected by ultrasound. The exact cause of PCOS is unknown.

Excessive insulin: This condition causes insulin resistance so the pancreas has to produce more insulin, which can increase the production of androgen, therefore leading to acne, excessive hair growth and weight gain.

Excessive Androgen: This condition can cause male pattern hair growth and acne and this can prevent the ovaries from releasing an egg each month (missed ovulation) that can lead to infertility.

What are the health risks for women with PCOS ?

PCOS affects all areas of the body, not just the reproductive system. It increases a woman’s risk of serious conditions that may have lifelong consequences.

Insulin resistance increases the risk of type 2 diabetes mellitus and cardiovascular disease.
Women with PCOS tend to have a condition called endometrial hyperplasia, in which the lining of the uterus (the endometrium) becomes too thick. This condition increases the risk of endometrial cancer.

In conclusion: This is a lifetime condition that can lead to a higher risk of obesity, Type 2 Diabetes, high blood pressure, high cholesterol and lipids, sleep apnoea, heart attack and stroke and endometrial cancer. Further complications may include abnormal uterine bleeding, gestational diabetes and subfertility.

Tests and diagnosis

A thorough medical history, physical examination, pelvic examination, blood tests for androgen/insulin levels, a BSL lipid profile and a pelvic ultrasound looking for pearl necklace appearance of the ovaries.

Treatments and drugs

Life style changes: Only 5% reduction in body mass may help a woman to ovulate. Consider dietary changes, such as: low fat and low carbohydrate diet, which will decrease insulin levels and help, weight reduction. Lastly increase exercise, which can lower your blood sugar levels.

Medication 

1. Cyclical natural progesterone, progestogens (such as those in the oral contraceptive pill) or the mirena IUD are will regulate the periods and prevent an increase in the thickness of endometrial lining. These medications can simulate the natural production of progesterone that should occur after ovulation in a normal cycle. 
2. Clomid/Metformin can induce ovulation if the problem is infertility.
3. Spironolactone or contraceptive pills which decrease androgen production, therefore reduces excessive hair growth and acne

Surgery

Laparoscopic ovarian drilling or wedge resection, which can reduce androgen formation and improve ovulation and fertility.