Melomed Articles


13 February 2019 - Dr. Jayeshnee Moodley

Do you have Polycystic ovarian syndrome?


Do you often miss your periods? Are you struggling to lose weight despite exercising and eating well? Are you conscious of excessive hair growth and acne?

You could have Polycystic ovarian syndrome!

Polycystic ovary syndrome (PCOS) is a reproductive endocrine disorder that affects approximately 5-10% of reproductive age women. Despite years of research looking into the cause of this syndrome, it continues to remain an enigma. PCOS may have a multifactorial aetiology involving genetics, environmental factors as well as fetal and childhood exposures. Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain. While PCOS can have a wide spectrum of manifestations and symptoms, the common denominators are:

1.    Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than 4 periods a year, more than 35 days between periods and abnormally heavy periods.
2.    Excess male hormone
Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
3.    Insulin resistance (which makes you pre-diabetic)
4.    Polycystic ovaries
Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.
5.    Weight gain (thin women can have PCOS as well)

PCOS can be associated with many long term complications and concerns. Thus, early diagnosis and management of your condition is essential. Some of the concerns include:

1.    Infertility
2.    Gestational diabetes or pregnancy-induced high blood pressure
3.    Miscarriage or premature birth
4.    Liver inflammation caused by fat accumulation in the liver
5.    Metabolic syndrome †a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease
6.    Type 2 diabetes or prediabetes
7.    Sleep disturbances
8.    Depression, anxiety and eating disorders
9.    Cancer of the uterine lining (endometrial cancer)

Obesity is associated with PCOS and can worsen complications of the disorder.

An accurate diagnosis of PCOS is essential. Based on the diagnosis, the treatment of polycystic ovaries takes place.
Your gynaecologist will ask you about the pattern of your menstrual cycle and whether you are facing any of the symptoms like excessive vaginal bleeding, cramps in the lower abdomen, acne and hair fall or hair thinning. Observe the changes in your body carefully and give accurate answers to all your queries.

Your blood pressure, body mass index (BMI) and glucose levels will be assessed. Your gynaecologist will also check the areas of abnormal hair growth, acne and darkening of the skin.

A pelvic examination is usually performed to exclude any other gynaecological conditions and assess the size of your ovaries. If you have never been sexually active, please inform your doctor at the beginning of the consultation to avoid this examination.
Confirmation of PCOS will be made with ultrasound imaging and blood tests. An ultrasound can determine the size of your uterus, thickness of the endometrial lining, size of your ovaries and the presence of ovarian cysts.  PCOS is associated with approximately 20-25 cysts all arranged to look like a pearl necklace within the ovaries. Blood tests will check the ovulation hormones, levels of androgen or male hormone, glucose and insulin levels.

Treatment

Unfortunately, there is no cure for PCOS. PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication. As your needs change, your treatment will change

Your gynaecologist may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight might improve your condition. Losing weight may also increase the effectiveness of medications recommended for PCOS, and can help with infertility.

To regulate your menstrual cycle, your doctor might recommend one of the following:

Combination birth control pills.
Pills that contain oestrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you could also use a skin patch that contains a combination of oestrogen and progestin.

Progestin therapy

Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesnt improve hair growth or acne and wont prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.

Ovulation induction agents like Clomiphene Citrate (Clomid) is often prescribed for women wanting to fall pregnant. This oral anti-oestrogen medication is taken during the first part of your menstrual cycle and induces ovulation. It is usually prescribed under supervision and must be monitored closely.

Metformin (Glucophage) is an oral medication for type 2 diabetes. IN PCOS, it improves insulin resistance and lowers insulin levels. This has a knock-off effect to improve hormone levels and assist with ovulation. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss.

Cosmetic options for excessive hair growth will include depilatory creams, waxing and electrolysis.
PCOS affects so many women who feel hopeless and helpless, yet there are options to manage this condition - Let’s start talking about it! Let’s start educating and empowering ourselves and other women. Don’t be ashamed of your story… it will inspire others.



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