Polycystic ovary syndrome (PCOS)
is a common functional disorder of the ovaries, affecting about 4–6% of premenopausal women in the United States.
Some women may not have symptoms. In others, symptoms may appear between the ages of 15-30 years.
Characteristics and symptoms of PCOS include:
- Hirsutism: hirsutism accounts for at least 50% of all cases of clinical hirsutism.
- Hair loss
- Irregular menstrual periods or no menstrual period (oligomenorrhea or amenorrhea) with anovulation
- Both adrenal and ovarian androgen hypersecretion
- Insulin resistance; fasting insulin levels are elevated in 70% of cases
- Diabetes mellitus is present in about 13% of cases
- Hypertension and hyperlipidemia are often present, increasing the risk of cardiovascular disease.
Diet - Where PCOS is associated with overweight or obesity, successful weight loss and diet adjustments, especially to reduce the intake of simple carbohydrates, are associated with resumption of natural ovulation.
- For women who don't want to get pregnant, birth control pills can control menstrual cycles, reduce male hormone levels and help to clear acne. Low-dose combined oral contraceptives, particularly those containing drospirenone as the progestogen component. Drospirenone is a derivative of spironolactone and hence has anti-androgenic activity together with anti-mineralcorticoid activity. For this reason, COCs containing drospirenone may be preferred in the management of PCOS.
- Flutamide and spironolactone can also give some improvement in hirsutism
- Metformin - in patients experiencing insulin resistance, use of insulin sensitisers lowers testosterone blood levels and increases ovulation
- Clomifene (Clomid) is an anti-estrogen and it induces gonadotrophin release by occupying estrogen receptors in the hypothalamus. Cautions to its use include risk of ovarian cancer (recommendation that therapy should be limited to six cycles); cysts may enlarge during therapy and multiple births.
- Letrozole (Femara): Letrozole, a selective aromatase inhibitor, prevents the conversion of androgens to estrogen, thus releasing the hypothalamo-pituitary axis from the negative feed back of estrogen.Unlike clomiphene, letrozole is devoid of any anti-estrogenic peripheral action; it does not adversely affect either the endometrium or the cervical mucus.
- Gonadotropins and IVF: For women not responsive to clomiphene and diet and lifestyle modification, there are options available including assisted reproductive technology procedures such as controlled ovarian hyperstimulation with follicle-stimulating hormone (FSH) injections followed by in vitro fertilisation (IVF). IVF offers the best chance of becoming pregnant in any given cycle. It also gives doctors better control over the chance of multiple births.
Surgery - Ovarian drilling, done during laparoscopy, is a procedure in which a laser fibre or electrosurgical needle punctures the ovary 4 to 10 times. This surgery may increase the chance of ovulation.