Polycystic ovary syndrome or PCOS, is a medical condition where in the ovary and the adrenal glands produce abnormally high amounts of the male sex hormones in the body. Male sex hormones, also called androgens, are normally present in lesser quantities in females.
In PCOS, there is the presence of several cysts in the ovary. However, certain people do develop ovarian cysts even though they don’t suffer from PCOS. PCOS is becoming increasingly common affecting around 4-20% of women in their reproductive years. Scientists and doctors have increased their efforts in figuring out the pathophysiology of PCOS in order to help with better diagnosis and management.
The definition of PCOS by the Rotterdam Consensus states that a person has PCOS if any two of the following three features are present-
- Ovulatory dysfunction
- Polycystic ovarian morphology in an ultrasound.
Anti Mullerian Hormone or AMH is a serum marker that correlates with the number of follicles in females with PCOS. Studies suggest that the serum AMH can be used instead of an ultrasound to detect polycystic ovarian morphology (PCOM) and hence, confirm PCOS.
PCOS at different stages of life
Scientists from the Erasmus University Medical Centre, Rotterdam, The Netherlands, studied the effects of ageing on the features of PCOS. Ageing in females comes with more regular menstrual cycles, lowered serum androgen, and reduced insulin resistance which help to improve the phenotype and symptoms of PCOS. Hence, the manifestation of PCOS phenotype varies as one ages.
PCOS in childhood might take place due to certain genes, prenatal events and postnatal environmental factors. A higher-than-normal level of androgens during the intrauterine period of pregnancy and/or intrauterine growth restriction can cause increased glucocorticoid secretion. This in turn can make the foetus more susceptible to developing PCOS.
The prevalence of PCOS is the highest during adolescence and it commonly manifests as acne, hirsutism, and menstrual irregularity. (Note: it is important to note that these symptoms may overlap with that of regular adolescence).
Some of the predisposing factors to adolescent PCOS include
- A family history of PCOS,
- A lower or higher birth weight,
- Increased exposure to androgens in the gestation period
- Obesity, precocious puberty, and insulin resistance.
Diagnosis of PCOS is more vigilant for adolescents than it is for adult women. The determining factors for PCOS includes
- unequivocal hyperandrogenism with moderate to a severe hirsutism or persistently high serum testosterone levels or both
- ovulatory dysfunction that stays for more than two years after the onset of the menstrual cycle or menarche.
Studies have shown that PCOS in the adolescent period can also cause obesity, hyperinsulinemia, and can even progress to multiple sclerosis. Doctors advise the patients to practice healthy lifestyle habits during this age so as to prevent further complications.
In postmenopausal women
Women who were previously diagnosed with PCOS, still continue to show symptoms well after menopause. Hyperandrogenism and its associated risks of multiple sclerosis and cardiovascular diseases are seen in these women. This shows that the manifestations of PCOS do not end with the reproductive age.
Management of PCOS should not only tackle the symptoms, but also aim at preventing potential future complications. Oral contraceptives combined with antiandrogens is the most sought-after treatment plan to reduce symptoms, protect the endometrium and lower androgens.
The goals of management should be lower hyperandrogenic symptoms, lower the risk of type 2 diabetes and cardiovascular disease, prevent endometrial hyperplasia, plan for a safe pregnancy if the patient desires, and improve their overall quality of life.
Sanjana Raman graduated from D Y Patil University with a degree in dentistry. She believes in the power of promoting dental education and learning through discussing various related medical topics.