Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome also called PCOS is an imbalance of female sex hormones.

If you have polycystic ovary syndrome your pituitary gland may release abnormally high amounts of luteinizing hormone into your bloodstream disrupting your normal menstrual cycle. This results in lack of a dominant developing follicle during the monthly cycle and ovulation does not occur, which can lead to infertility.

Some of the immature follicules do not dissolve and remain as fluid filled sacs or cysts.

Diagnosis of PCOS requires that a woman must have at least 2 of the following 3 criteria:
  • Polycystic appearing ovaries on ultrasound
  • No periods or irregular periods (anovulation or oligo-ovulation)
  • High male hormones or clinical signs of androgenization (acne and hair growth on face, back, chest etc)

High plasma levels of insulin and glucose due to insulin resistance are part of the syndrome, as is central obesity. High insulin levels cause the pituitary gland to make too much luteinizing hormone (LH), and too much LH causes the overproduction of testosterone, thus hindering ovulation.

Having Polycystic Ovary Syndrome raises your risk for:
  • type 2 diabetes because of excess insulin and insulin resistance
  • heart disease
  • high blood pressure
  • cholesterol abnormalities
  • Endometrial cancer

Management:
The primary treatments for PCOS include: lifestyle changes, medications and surgery.
  • Lifestyle changes: Increased physical activity and decreased calorie ingestion. A high-protein and low-carbohydrate caused a significant increase in insulin sensitivity.
  • Hormonal birth control: Menstrual regulation with cyclic contraceptive hormonal treatment is a common approach and may lead to resumption of ovulation.
  • Anti-androgen medications (flutamide, and spironolactone) which reduce abnormal hair growth and acne
  • Diabetes medications: Metformin is an excellent pharmacologic choice as it reduces insulin resistance and aids in weight loss.
  • Fertility medications: For those women that after weight loss still are anovulatory or for anovulatory lean women, then the ovulation-inducing medications Clomiphene and Letrozole are the principal treatments used to promote ovulation
  • Assisted reproduction technologies, including IVF
  • Laparoscopic ovarian drilling: Surgery is usually the last effort in the treatment of polycystic ovary syndrome. Doctors may recommend laparoscopic ovarian drilling, during the procedure the surgeon will insert a small needle into the ovary and use an electric current to destroy small areas of ovarian tissue where testosterone is produced. Over time, testosterone production diminishes and ovulation may occur.

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