Polycystic ovary syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS)
Synonyms	Stein-Leventhal syndrome, Hyperandrogenic anovulation
Pronounce	N/A
Specialty	N/A
Symptoms	Irregular menstruation, Anovulation, Hirsutism, Acne, Weight gain, Infertility
Complications	N/A
Onset	Puberty to early adulthood
Duration	N/A
Types	N/A
Causes	Multifactorial (genetic, hormonal, metabolic, environmental)
Risks	Obesity, Diabetes mellitus type 2, Cardiovascular disease
Diagnosis	Clinical assessment, Ultrasound, Blood test
Differential diagnosis	N/A
Prevention	N/A
Treatment	Lifestyle modifications, Hormonal therapy, Metformin, Fertility treatment
Medication	N/A
Prognosis	N/A
Frequency	5-15% of women of reproductive age worldwide
Deaths	N/A

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting individuals with ovaries, characterized by a hormonal imbalance that impacts menstrual and reproductive health, metabolism, and various systemic functions. It is a leading cause of anovulatory infertility and is associated with long-term health risks such as diabetes mellitus type 2, obesity, cardiovascular disease, and endometrial cancer. PCOS manifests with a variety of symptoms, including irregular menstruation, hirsutism, acne, insulin resistance, and metabolic disturbances.

Signs and Symptoms

The clinical presentation of PCOS varies among individuals, but common features include:

• Menstrual and Reproductive Health:
• Oligomenorrhea or amenorrhea (infrequent or absent menstrual periods)
• Anovulation, leading to infertility
• Multiple ovarian cysts visible on transvaginal ultrasound

• Hormonal Imbalance:
• Elevated levels of androgens (male hormones) leading to:
• Hirsutism (excessive hair growth, especially on the face, chest, and back)
• Acne
• Androgenic alopecia (hair thinning or male-pattern baldness)

• Metabolic Changes:
• Insulin resistance, often leading to hyperinsulinemia
• Increased risk of diabetes mellitus type 2
• Weight gain or difficulty losing weight
• Increased risk of non-alcoholic fatty liver disease

• Cardiovascular and Systemic Effects:
• Increased risk of hypertension
• Dyslipidemia (high cholesterol and high triglycerides)
• Chronic low-grade inflammation
• Higher risk of cardiovascular disease

Causes and Risk Factors

The exact cause of PCOS is unknown, but it is believed to be multifactorial, involving genetic, metabolic, and environmental components.

• Genetic Factors:
• PCOS tends to run in families, suggesting a genetic predisposition.
• Multiple gene variants associated with insulin signaling and androgen production have been identified.

• Hormonal Imbalance:
• Increased production of luteinizing hormone (LH) and androgens by the ovaries.
• Decreased levels of sex hormone-binding globulin (SHBG), leading to higher free androgen levels.
• Dysregulation of follicle-stimulating hormone (FSH) affecting ovarian follicle development.

• Metabolic Factors:
• Insulin resistance leads to increased insulin levels, which in turn stimulate ovarian androgen production.
• Obesity exacerbates insulin resistance and worsens symptoms.

• Environmental and Lifestyle Factors:
• Poor dietary habits, sedentary lifestyle, and exposure to endocrine-disrupting chemicals (EDCs) have been implicated.

Diagnosis

PCOS is diagnosed based on clinical symptoms, laboratory tests, and imaging studies. The most widely accepted criteria for diagnosis are the Rotterdam Criteria, which require at least two of the following three features:

1. Oligo- or anovulation (irregular or absent ovulation) 2. Clinical or biochemical hyperandrogenism (elevated androgens, hirsutism, acne) 3. Polycystic ovaries on ultrasound (presence of 12 or more follicles in at least one ovary)

Laboratory Tests

• Hormonal Testing:
• Elevated testosterone and dehydroepiandrosterone sulfate (DHEAS)
• Increased luteinizing hormone (LH) to follicle-stimulating hormone (FSH) ratio
• Low or normal progesterone levels

• Metabolic Assessments:
• Fasting glucose and oral glucose tolerance test (OGTT) to assess insulin resistance
• Lipid profile to evaluate cardiovascular risk factors

• Imaging:
• Transvaginal ultrasound to detect multiple ovarian follicles arranged in a "string of pearls" pattern.

Treatment

There is no cure for PCOS, but symptoms can be managed through a combination of lifestyle modifications, medications, and supportive therapies.

Lifestyle Modifications

• Dietary Changes:
• A low-glycemic index (GI) diet helps improve insulin resistance.
• Increased intake of fiber-rich foods, lean proteins, and healthy fats.

• Exercise:
• Regular aerobic exercise and resistance training improve metabolic health.
• Weight loss of just 5-10% can significantly improve symptoms and fertility.

Medications

• Hormonal Therapy:
• Combined oral contraceptives regulate menstrual cycles and reduce androgen levels.
• Anti-androgens (e.g., spironolactone, finasteride) help with hirsutism and acne.

• Metformin:
• A biguanide drug used to treat insulin resistance and reduce androgen levels.
• Helps restore ovulation in some individuals.

• Fertility Treatments:
• Ovulation induction agents such as clomiphene citrate or letrozole.
• In vitro fertilization (IVF) may be necessary in some cases.

Complications

PCOS is associated with several long-term health risks, including:

• Metabolic Disorders:
• Type 2 diabetes mellitus
• Obesity
• Non-alcoholic fatty liver disease

• Cardiovascular Disease:
• Hypertension
• Atherosclerosis

• Reproductive Complications:
• Infertility due to chronic anovulation
• Increased risk of pregnancy complications such as gestational diabetes and preeclampsia.

• Cancer Risk:
• Prolonged exposure to unopposed estrogen increases the risk of endometrial hyperplasia and endometrial cancer.

Prognosis

PCOS is a lifelong condition, but its symptoms and complications can be effectively managed with proper treatment and lifestyle modifications. Early diagnosis and intervention improve outcomes and reduce the risk of complications.

See Also

• Endocrine disorders
• Menstrual disorders
• Reproductive endocrinology
• Obesity
• Diabetes mellitus type 2

External Links

• World Health Organization (WHO) - PCOS Overview
• National Institute of Child Health and Human Development - PCOS Research

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