Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, affecting about10% in the age group.

• Infrequent or absent periods
• Infertility and miscarriage
• Acne
• Excess body hair
• Scalp hair loss
• Weight gain and obesity
• High blood pressure
• Elevated insulin levels and diabetes

Slightly enlarged ovaries containing at least ten cysts of 2-8 mm in diameter

The exact cause remains unknown, although it has been proposed to be a genetic disorder. Polycystic means “multiple cysts” and individuals with this condition have an imbalance of female hormones that prevents the ovaries form releasing an egg every month. The accumulation of unreleased eggs in the ovaries results in the characteristic polycystic appearance. Since both fertility and normal menstrual cycle rely on the regular release of an egg from the ovary each month, individuals with PCOS experience difficulties in conception, as well as low, irregular or absent periods. Additionally, most of these individuals tend to produce high levels of male hormones, leading to male pattern hair growth, including on the chin and chest inner thighs, and the development of acne. These individuals tend to gain weight rapidly, with the eventual obesity worsening the hormonal imbalance, resulting in a ‘chicken and egg' situation.

Hormonal blood tests and pelvic ultrasound scan are usually conducted to confirm diagnosis.

Lifestyle measures: There is evidence of most of the problems related to polycystic ovarian syndrome being alleviated through weight loss, which helps  to restore normal hormone balance. The therapeutic modality depends on the condition that the individual is most affected by. The conditions include:

• Irregular periods: The usual treatment is oral contraceptive pils which restore regular periods. This treatment, however, is snot suitable for women trying to conceive.

• Infertility: Ovulation can be induced artificially by medications, with the most commonly drug being clomiphene (Clomid) ,taken in tablet form for five days. If this treatment proves ineffective, hormone injections can be used to stimulate the ovaries. Careful supervision by a specialist is necessary as  there is a risk of the ovaries being overstimulated, leading to multiple pregnancies or ovarian hyperstimulation syndrome (OHSS), which can be life threatening. In unresponsive cases, surgical intervention in the form of laparoscopic ovarian drilling may be used to diathermise part of the ovary to correct hormonal imbalance to enable ovulation.

• Excessive hair growth: Local techniques such as depilatory creams, shaving, waxing, bleaching, plucking and electrolysis may be effective. However, repeated treatments are needed. Suppression of male hormone production with oral contraceptive pill or anti-male hormone drugs such as Cyproterone acetate may reduce excessive hair growth when taken for at least nine months. At present, laser hair removal is the best long-term method.
• Obesity: A change in lifestyle, paying particular attention to diet and exercise, can help weight loss. Studies have shown that irregular menstruations, risk of early death and debilitating complications can be significantly reduced if certain lifestyle changes are adopted. These include a controlled diet, vigorous exercise and weight reduction.

These include metformin and other insulin-sensitising drugs. Metformin improves insulin production and is used to treat  insulin abnormalities associated with PCOS in some patients. It decreases production of androgens in the ovaries and restores the body's normal hormone balance, resulting in improvement of certain signs and symptoms of PCOS.

Insulin Resistance Syndrome 

Individuals with PCOS are resistant to insulin, a hormone essential in metabolising carbohydrates and maintaining normal blood sugar levels. Consequently, these individuals are at higher risk of developing type 2 diabetes, heart attack and stroke at a much younger age.

Diabetes 

More than 50% of women with PCOS will have diabetes or pre-diabetes before the age of 40.

Heart Disease 

Individuals with PCOS have heart disease at an early age; 40% have calcification in the coronary arteries before age 45 (compared to 20% of women without PCOS). Additionally, these individuals have a 50% increase in coronary events such as heart attacks.

High Blood Pressure 

Women with PCOS are at a greater risk of high blood pressure, particularly in those age 40 years and over.

Cholesterol 

In women with PCOS, low-density cholesterol (bad) cholesterol levels are higher whereas high-density cholesterol (good) cholesterol levels are lower.

Cancer 

Women with PCOS are at a higher risk of endometrial (uterine) cancer if left untreated.