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Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS)

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Written by Roman Lester Rosales, Guardian Pharmacist

Infertility, irregular menses and excessive hair growth – these are some of the common symptoms of women suffering from polycystic ovarian syndrome (PCOS). PCOS is a hormonal disorder which usually occurs in women of child-bearing age. Although there is currently no known treatment for this disorder, early diagnosis and management of the symptoms prove to be beneficial in reducing the risk of long-term complications.

Causes and symptoms
While the exact cause of PCOS is unknown, it is postulated that the development of PCOS may be at least partly caused by certain factors such as genetics, hormonal imbalance and elevated insulin levels. Women with PCOS typically have higher androgen (male sex hormone) levels that affect the development and release of an egg during ovulation. Insulin resistance may lead to increased amounts of insulin in the bloodstream, thus increasing testosterone production by the ovaries.

As a result of high androgen levels, especially testosterone, patients with PCOS may have symptoms such as infertility, irregular menstrual cycle, facial or body hair growth, acne, weight gain, male-pattern baldness or the presence of numerous cysts (fluid-filled sacs) along the outer edge of the ovaries.

Complications
Women with PCOS are at increased risk of developing long-term conditions such as diabetes, high cholesterol and high blood pressure. Also, they may be more prone to developing cancer of the uterus lining or suffer from some psychological disorders (e.g. anxiety, depression).

Women with PCOS who eventually become pregnant are at a higher risk of developing gestational diabetes or pregnancy-related high blood pressure. If not managed properly, they may also risk having a premature delivery or even miscarriage.

Diagnosis
There are currently no tests that specifically confirm a PCOS diagnosis. Therefore, PCOS is usually diagnosed based on clinical signs or symptoms; medical history (e.g. menstrual period, symptoms, weight changes); and physical examination.

Other common tests for the diagnosis of PCOS include a pelvic examination to check for abnormalities of the ovaries and blood tests to examine androgenic and insulin hormone levels. A pelvic ultrasound to check the appearance of the ovaries and thickness of the uterus lining may be performed as well to rule out the possibility of other health conditions.

Management
As there is no treatment for PCOS, early management of the symptoms can prevent further complications.

Hormone-regulating medications (e.g. contraceptive pills containing low doses of oestrogen and progesterone) are commonly given to regulate menstrual cycles, reduce androgenic hormones and at the same time, clear acne.

In women with elevated insulin levels, metformin, a medication for diabetes, may be given to reduce insulin levels, reduce testosterone production and hence, promote ovulation and menses regulation.

For women trying to conceive, clomiphene, which is an ovulation-stimulating medication, is commonly prescribed. Clomiphene may be given alone or sometimes in combination with metformin. Although uncommon, surgery is usually the option for women who do not respond to medications. 'Laparoscopic ovarian drilling' is performed to induce ovulation by first inserting a scope into the abdomen to get an image of the ovaries and surrounding organs. Subsequently, the follicles in the ovaries are punctured to induce ovulation.

In order to manage increased hair growth and excessive male hormones, anti-androgen medicines (e.g. spironolactone) may be prescribed. These are usually taken in combination with contraceptive pills and are not recommended for women who want to conceive. Laser hair removal or waxing may be also done to facilitate hair removal.

Lifestyle modifications help in managing weight issues such as obesity may aggravate insulin resistance. Healthy diet, in combination with exercise, proves to be useful in weight-control and hence, promoting ovulation. In addition, this may also help in preventing long term complications such as high blood pressure or diabetes which are associated with obesity.

Even though PCOS has no direct cure, the effects of PCOS can be minimised if the condition is diagnosed early and managed well. It is therefore important that women who notice symptoms suggestive of PCOS seek medical advice early.

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