Polycystic Ovary Syndrome
|What Is Polycystic Ovary Syndrome (PCOS)?
Polycystic ovary syndrome (PCOS) is a condition where there is an imbalance in a woman's female sex hormones. This imbalance can cause changes in her menstrual cycle as well as leading to multiple fluid filled blisters to form on her ovaries (ovarian cysts - image), difficulties getting pregnant and skin problems like acne.
Most women with PCOS begin menstruation at a normal age but between the ages of about 15 and 30 their periods become irregular and sometimes stop altogether (amenorrhea). In addition they often become infertile, gain weight, develop excess facial hair, male balding-patches and acne. These are the common cluster of symptoms which a doctor will look out for when diagnosing the condition. Formerly known as Stein-Leventhal syndrome, PCOS is also known as polycystic ovary disease (PCOD), ovarian hyperthecosis, sclerocystic ovary syndrome, hyperandrogenism, androgen excess syndrome and functional ovarian hyperandrogenism. PCOS is caused by an underlying hormone imbalance which affects the ovaries ability to develop and release eggs during ovulation. Women with PCOS do not ovulate and hence suffer infertility. Recent research indicates that the condition puts women at long term risk of serious health complications including type 2 diabetes, obesity, heart disease and endometrial cancer. There is no cure for PCOS, so treatment is aimed at managing symptoms. However, with the correct treatment pregnancy is still possible. ‘Discovered’ in 1935 PCOS is believed to affect nearly 10 percent of women.
In the normal reproductive menstrual cycle, eggs are produced in a woman's ovaries and the ovaries are lined with tiny fluid-filled sacs called cysts or follicles. The eggs grow and the follicles build up fluid. When the egg matures, the follicles break apart and the egg is released into the fallopian tube on its journey to the womb for fertilization. In women with PCOS however, instead of bursting open, the follicles remain as cysts and the egg is not released. Fertilization and eventual pregnancy is not possible as a result. Also, as ovulation does not occur, this has the additional knock-on effect of stopping the production of the hormone progesterone. Without progesterone, a woman experiences irregular periods where bleeding is frequently absent.
Experts are still not sure what causes PCOS but suspect a number of factors. The main likely cause of PCOS is a hormone imbalance, in particular the excess production of the male hormone androgen. This accounts for many of the side effects of PCOS including increased facial and body hair. Genetic factors are also a consideration. Women whose mother or sisters have the condition are more likely to develop the condition. Although women with PCOS frequently have lots of small cysts on their ovaries (hence the name poly-cystic ovary) cysts can also appear in women without PCOS. In other words, cysts do not appear to be a cause but rather a symptom. There are some suggestions that PCOS may be linked to increased insulin production. Many women with PCOS have too much insulin in their blood, which appears to increase their production of androgens.
1. The main symptom of PCOS is menstruation cycle irregularity: There may be irregular periods (oligomenorrhea), painful periods (dysmenorrhea) or missed periods (amenorrhea). Where menstruation does occur it may result in heavy bleeding.
There is no specific test which can definitely diagnose the presence of PCOS. Rather PCOS diagnosis is only possible by gradually excluding other disorders which show similar clinical features such as Cushing’s syndrome and adult-onset congenital adrenal hyperplasia. The usual diagnosis process involves:
PCOS treatment depends on the severity of the symptoms and the woman's goals. Diet and weight loss are usually the first approach recommended by a doctor,which can sometimes reduce or reverse symptoms (see natural treatment for PCOS). Oral contraceptives can help regulate menstruation and reduce excessive hair growth. Hormone creams are also available to rub directly onto the skin (e.g. Vaniqa) to help reduce excess hair but creams may have side effects. Alternatively electrolysis is an option for long-term hair removal. Infertility is treated with the fertility medication clomiphene citrate (brand names Serophene and Clomid) which stimulates ovulation. If clomiphene citrate does not work, metformin may be prescribed to help induce ovulation. Where infertility drugs fail, an outpatient surgery called laparoscopic ovarian drilling (image) may be an option. See also, is there a cure for PCOS?
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