Polycystic ovary syndrome

Overview

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects people with ovaries, typically during their reproductive years. It is characterized by a combination of hormonal imbalances, irregular menstrual cycles, and the presence of multiple cysts on the ovaries. PCOS can affect fertility, metabolism, and appearance, and is one of the leading causes of infertility. The condition varies widely in its presentation and severity, and while its exact cause remains unclear, PCOS is believed to involve a complex interaction of genetic and environmental factors. Early diagnosis and proper management can significantly reduce the risk of long-term complications such as type 2 diabetes, cardiovascular disease, and endometrial cancer.

Causes

The exact cause of PCOS is unknown, but several factors are believed to contribute to its development:

• Hormonal imbalance: People with PCOS typically have elevated levels of androgens (male hormones) which interfere with the development and release of eggs during ovulation.

• Insulin resistance: Many individuals with PCOS have insulin resistance, which leads to elevated insulin levels that may contribute to increased androgen production and irregular menstrual cycles.

• Genetics: PCOS often runs in families, suggesting a genetic predisposition. Several genes related to insulin and hormone regulation may be involved.

• Low-grade inflammation: Chronic inflammation may stimulate polycystic ovaries to produce androgens, worsening the condition.

These factors interact in complex ways, making PCOS a multifactorial syndrome with diverse manifestations.

Symptoms

Symptoms of PCOS can vary significantly among individuals but commonly include:

• Irregular periods: Infrequent, prolonged, or absent menstrual cycles due to lack of ovulation.

• Excess androgen levels: Manifesting as hirsutism (excess facial and body hair), severe acne, and male-pattern baldness.

• Polycystic ovaries: Enlarged ovaries with multiple small follicles detectable via ultrasound.

• Weight gain: Especially around the abdomen, is common in people with PCOS.

• Fertility issues: Difficulty conceiving due to irregular or absent ovulation.

• Darkening of the skin: Particularly in body folds such as the neck, groin, and under the breasts (acanthosis nigricans).

• Mood changes: Increased risk of depression and anxiety is noted in many individuals.

Symptoms typically begin shortly after puberty, but they can also develop later, especially after significant weight gain.

Diagnosis

There is no single test for PCOS. Diagnosis is usually made based on the Rotterdam criteria, which require two out of the following three features:

• Irregular or absent ovulation

• Signs of hyperandrogenism (either clinically or biochemically)

• Polycystic ovaries seen on ultrasound

Diagnostic evaluation may include:

• Medical history and physical examination: Including assessment of menstrual patterns, weight, and signs of excess androgen.

• Blood tests: To measure hormone levels including testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), insulin, and glucose.

• Pelvic ultrasound: To check for the presence of multiple ovarian follicles.

Other conditions such as thyroid disorders, hyperprolactinemia, and congenital adrenal hyperplasia must be ruled out during diagnosis.

Treatment

Treatment for PCOS is individualized and depends on the person’s symptoms and whether they are trying to become pregnant. Common treatment strategies include:

• Lifestyle changes: Diet modification, regular exercise, and weight loss are first-line treatments and can restore ovulation in many individuals.

• Hormonal birth control: Oral contraceptives help regulate menstrual cycles, reduce androgen levels, and control acne and hirsutism.

• Anti-androgens: Medications such as spironolactone may be prescribed to reduce excess hair growth and acne.

• Metformin: Used to improve insulin sensitivity and may help regulate ovulation.

• Ovulation induction: For individuals seeking to conceive, medications such as clomiphene citrate or letrozole can stimulate ovulation.

• Fertility treatments: In vitro fertilization (IVF) may be considered if other methods fail.

• Hair removal treatments: Electrolysis, laser therapy, and topical creams may be used for managing hirsutism.

Early intervention and consistent management can help control symptoms and prevent complications.

Prognosis

The prognosis for PCOS varies depending on the severity of symptoms and the effectiveness of management. While it is a chronic condition without a definitive cure, most people with PCOS can manage their symptoms effectively with lifestyle changes and medical treatment. Fertility can often be restored with appropriate interventions, and many individuals go on to have healthy pregnancies.

Long-term risks associated with untreated PCOS include:

• Type 2 diabetes

• Hypertension and cardiovascular disease

• Endometrial hyperplasia and cancer due to unopposed estrogen

• Obstructive sleep apnea

• Psychological issues like anxiety, depression, and eating disorders

With proper care, individuals with PCOS can lead full and healthy lives. Regular follow-up and a comprehensive, multidisciplinary approach are key to long-term health.