Polycystic Ovarian Syndrome (PCOS): Causes, Symptoms, Diagnosis, Treatment and Complications

PCOS (Polycystic Ovary Syndrome) is a metabolic condition that affects women between the ages of 12 and 51, who are in their reproductive years because of hormonal imbalance.

Increased amounts of male hormones may result in women skipping menstrual cycles, experiencing unpredictable ovulation that makes it challenging to become pregnant, and simultaneously developing abnormal body and facial hair development.

Diabetes and heart problems may eventually develop from this. Surgery or the right medical care is required to treat PCOS, a serious medical condition.

Read this blog further to get a quick overview of this important topic Polycystic Ovarian Syndrome for OBSTETRICS AND GYNECOLOGY to ace your NEET PG exam preparation.

Symptoms of PCOS

A lot of women don't even know they have PCOS. Ovulation and the ovaries are impacted by the symptoms listed below:

• Cysts in pregnancy
• Elevated amounts of the male hormone testosterone missing or irregular menstruation

Some women realize they have symptoms when they get their first period, while others don't until they've put on a lot of weight or are having difficulties getting pregnant. The following are the most typical PCOD or PCOS symptoms in females:

• Menstruation that is irregular (oligomenorrhea)
• Menstruation skipped or absent (amenorrhea)
• Menorrhagia, or excessive menstrual bleeding
• Excessive Body and facial hair growth(hirsutism) including on the back, belly, and chest
• Acne on the upper back, chest, and face
• Gaining weight
• Hair loss (thinning and shedding of the scalp's hair)
• Skin darkening (beneath the breasts, in the groin, and on the neck)

Causes of PCOS

It is unknown exactly how PCOS affects women, although the following are some key contributing factors:

• Overproduction of insulin may boost the body's production of androgen, a male hormone that is very low in females and interferes with ovulation.
• Extra androgen production: The ovaries produce excessive amounts of androgen hormones, which can cause acne and hirsutism (excessive body and facial hair development).
• Low-grade inflammation- According to a new study, women with PCOS experience low-grade inflammation that results in an increase in androgen production, which can create problems with the heart or blood vessels.
• Women with PCOS have specific genetic correlations related to heredity.

Diagnosis of PCOS

Polycystic ovarian syndrome (PCOS) cannot be diagnosed by a single test. A discussion of your symptoms, medications, and any other medical conditions will probably be the first thing your doctor does. As well as your doctor will inquire about the weight changes and menstruation cycles. An examination of the body includes looking for indications of excessive hair growth, insulin resistance, and acne.

Following that, your doctor might suggest:

• Examination of the Pelvis. Your healthcare professional might examine your reproductive organs during a pelvic exam to look for lumps, growths, or other changes.
• Testing with blood. Hormone levels can be assessed by blood tests. This examination can rule out other reasons of irregular periods or androgen overproduction that resemble PCOS. Other blood tests, like ones to check your triglyceride and cholesterol levels while you fast, may be performed.
• You can assess your body's tolerance to glucose by doing a glucose tolerance test.
• Ultrasound. With the use of ultrasound, you may determine how your ovaries look and how thick your uterus' lining is. Your vagina is inserted using a wand-like device called a transducer. Images are displayed on a computer screen as a result of the transducer's sound waves.
• Your doctor could suggest additional tests if PCOS has been diagnosed in order to rule out any issues. These examinations might involve:

1. Monitoring your cholesterol and triglyceride levels, blood pressure, and glucose tolerance on a regular basis
2. Anxiety and depression testing
3. Examination for obstructive sleep apnea

Treatment of PCOS

Anovulation Treatment

• Weight reduction leads to ovulation [in 30% of cases], and loss of even 5-10% weight increases insulin sensitivity and can regularize cycles
• Insulin sensitizer [metformin] causes ovulation in 30% of cases, however, it is not a first-line treatment
• Clomiphene Citrate causes ovulation in 80% of cases out of which pregnancy may be achieved in 40% of cases.
• Excess estrogens in PCOS give negative feedback on the hypothalamus causing low FSH and thus less follicle development. Clomiphene acts as a hypothalamic estrogen receptor blocker, thus causing high FSH and follicle development
• It is given from day 2-6 in doses of 50 mg-250 mg and is combined with follicular monitoring
• Side effects include vasomotor flushing, headache, visual scotomas
• The incidence of twinning is 8-10 %
• Mild-moderate OHSS, cysts
• Aromatase Inhibitors → Letrozole [1^st line Drug]
• It inhibits the conversion of androgens to estrogens. This causes less negative feedback to the hypothalamus which increases FSH and thus follicular development
• Letrozole (vs Clomiphene)
  • Higher birth rate
  • Less multiples
  • Better endometrial health (CC is anti-estrogenic on endometrium)
  • Better cervical mucus
  • Lesser anomalies
  • Lesser abortions
  • Lesser OHSS
• Injection Recombinant FSH
• Injection of Human Menopausal Gonadotropin (LH + FSH)

Irregular Cycles Treatment

• Combined Oral Contraceptive Pills (drug of choice) give artificial cycles, given for as long as regular cycles are desired
• Progesterone Pills: makes endometrium secretory
• For 10 days [From the 14^th day/mid-cycle] 
• For 5 days [day 20-25]

Hirsutism Treatment

1. Anti-Androgens
   • Spironolactone [1^st line drug]: 50-100 mg/day
   • Cyproterone acetate
   • Finasteride
   • Flutamide
2. Cosmetic Treatment For hair → Prevents Depression

Surgical Treatment: Laparoscopic Ovarian Drilling

It is used for non responders. It uses cautery to burn ovarian stroma and drill 4-6 holes. Thick Stroma in PCOS increases the local production of androgens, which makes follicles harder. Ovarian drilling decreases androgenic stroma such that there is a better response to ovulation-inducing drugs, ultimately resulting in better follicular growth.

Lifestyle Modifications

• Healthy eating and regular physical activity
• 5-10% weight loss
• Adhere to lifestyle interventions

Complications of PCOS

PCOS complications can include:

• Infertility
• Gestational diabetes or high blood pressure brought on during pregnancy
• Pregnancy loss or an early birth
• Non-alcoholic steatohepatitis: Severe liver inflammation brought on by hepatic fat accumulation
• Excessive blood pressure, excessive blood sugar, and bad cholesterol or triglyceride levels are all parts of the metabolic syndrome, which greatly raises your risk of cardiovascular disease.
• Diabetes type 2 or prediabetes
• Slumber apnea
• Anxiety, depression, and eating problems
• Endometrial carcinoma, a type of uterine lining cancer

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