PCOS/PCOD

Polycystic ovary syndrome (PCOS) management guidelines

Polycystic ovary syndrome (PCOS) or polycystic ovarian syndrome is a commonly observed health problem that is caused by imbalances of reproductive hormones leading to problems in ovaries. The ovaries make the egg which is released every month as part of the menstrual cycle. With PCOS, the egg may either not develop properly or may not be released during ovulation.

About 5% and 10% of women aged 15 to 44 years, or during the reproductive age, suffer from PCOS. The risk of PCOS is higher among obese women and women with positive family history. PCOS can lead to irregular or missed menstrual periods. Irregular periods can further lead to infertility and the development of cysts in the ovaries. Further, the risks of health disorders such as heart attacks and diabetes increase with age and may be greater among women with PCOS.

Symptoms of PCOS

  • Irregular periods. Women with PCOS may either have missed periods or fewer periods (<8 per year). Women may have periods more often than every 21 days or may stop having periods.
  • Excessive hair growth (hirsutism) on the chin, face, or body parts where males have hair usually.
  • Acne on the upper back, chest and face
  • Hair loss or thinning on the scalp and/or male-pattern baldness
  • Weight gain or difficulty in losing weight
  • Skin darkening especially along creases of the neck, underneath the breasts and in the groin
  • Skin tags or small excess flaps of skin in the neck or armpits

Causes of PCOS

The exact cause of PCOS is unknown and is considered an interplay of several factors which are as follows:

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Elevated levels of androgens (commonly referred to as male hormones) Androgens control the development of male traits like pattern baldness. Elevated androgen levels can prevent the ovaries from releasing eggs (during ovulation) and can cause excessive acne and hair growth.

Elevated levels of insulin, the blood-sugar regulating hormone. Insulin resistance is a condition in which the body cells don’t respond to insulin normally and as a result, elevated blood sugar levels are observed. Women with PCOS have insulin resistance, especially those who are obese, consume unhealthy food, lack exercise, and have a positive family history of diabetes.

PCOS does not eliminate the chances of pregnancy although ovulation difficulties are observed. However, there are several ways to improve your chance of getting pregnant and an ovulation calculator may be used to indicate days in the menstrual cycle when you are most likely to be fertile.

Diagnosis of PCOS

There is no single test to diagnose PCOS and usually, doctors rule out other causes of symptoms and correlate with a medical history and physical examination findings for PCOS diagnoses. Doctors check waist size, body mass index (BMI) and blood pressure. The skin is examined for excessive hair on the face, back or chest skin darkening and acne, hair loss and/or thinning and signs of other health disorders such as thyroid enlargements.

In addition, pelvic examinations are performed for signs of elevated androgen (for example, clitoris enlargement) and check for ovarian enlargements. Further, pelvic ultrasound and blood tests (androgen and cholesterol levels) may be performed.  In addition, imaging for thyroid disease and diabetes may be performed.

Management of PCOS

There is no specific cure for PCOS, but the symptoms can be managed. At-home measures include losing weight by healthy eating and regular physical activity, hair removal by laser, hair removal creams or electrolysis. A skin therapy (eflornithine hydrochloride cream) can be used to decelerate hair growth in undesired areas.

Medications for PCOS include hormonal birth control therapy, including pills, patches, shots, vaginal rings, and intrauterine devices (IUD). Anti-androgen medicines block the effect of androgens and can help in reducing scalp hair loss, acne and excessive hair growth on the face and body; however, they are not authorized by the Food and Drug Administration (FDA) for PCOS treatment.

Metformin is commonly used to treat diabetes and may help women with PCOS although it is not authorized by the FDA to treat PCOS. Metformin improves insulin’s ability to reduce blood sugar levels and can, therefore, reduce insulin levels. In addition, metformin may also help restart ovulation, lower body mass and improve cholesterol levels.

Women with PCOS have higher rates of miscarriage, preeclampsia, gestational diabetes, and Cesarean section delivery. PCOS also increases the risk of neonatal macrosomia and prolonged neonatal intensive care unit (NICU) admission. To improve pregnancy chances, weight loss, diabetes management and medicines such as clomiphene (Clomid) are effective measures. In vitro fertilization (IVF) or surgery can be considered if medicine does not work.

The outer shell (or cortex) of the ovaries is thickened in PCOS and is thought to play a key role in preventing spontaneous ovulation. Ovarian drilling is a surgery in which a few holes are made in the ovarian surface which restores ovulation, although only for six to eight months.

Author

Pooja Toshniwal Paharia

Dr. Pooja Toshniwal Paharia is a Consultant Oral and Maxillofacial Physician and Radiologist, M.DS (Oral Medicine and Radiology) from Mumbai. She strongly believes in evidence-based radiodiagnosis and therapeutic regimens for benign, potentially malignant, or malignant lesions and conditions either arising from the oral and maxillofacial structures or manifesting in the associated regions.

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