Polycystic ovarian syndrome (PCOS) is the most common hormone disorder in women of reproductive age. The prevalence of PCOS is estimated to affect 6-7% of women in Australia.
PCOS is caused by an ovulation dysfunction or impedance to the normal growth and release of eggs from the ovaries. Additionally, the ovaries may have multiple small cysts and the patient may have a slight increase in testosterone that results in acne or hair growth. It is commonly seen in women of child bearing age and is rare after menopause.
The exact cause of polycystic ovarian syndrome is unknown. However, several factors including genetics have been implicated to play a role in the development of PCOS. Women with a family history of polycystic ovarian syndrome are at a higher risk of developing this condition. Researchers have also found an association between excessive insulin production and the development of PCOS.
Symptoms can vary from person to person and depend upon the nature and severity of the condition. Some signs and symptoms of PCOS include;
- absent or irregular menstrual cycle
- obesity or accumulation of fat, usually around the waist
- abnormal facial and body hair
- adult acne
- male pattern baldness or hair thinning
A diagnosis of PCOS is based on medical history along with a physical and pelvic examination. Blood tests are requested to determine hormone levels. Additional tests such as a glucose tolerance test and evaluation of blood cholesterol may also be conducted in these patients due to the increased risks of diabetes and cardiovascular disease in those with PCOS. Pelvic ultrasound is performed to evaluate the appearance of the ovaries and evaluate the uterine lining.
The treatment of polycystic ovarian syndrome is based on the symptoms and individual concerns such as infertility, irregular menstrual cycle, acne or obesity. There is a potential role for both medications and surgical treatment for the management of PCOS.
Oral contraceptives may be prescribed for the management of irregular menstrual cycles. Oral contraceptives effectively reduce the level of male hormone and are also effective in reducing excessive body hair growth and also minimizing the risks of uterine cancer. Hormone implants including the Mirena IUCD may be used to decrease the risk of developing abnormalities of the endometrium (lining of the womb). Lifestyle modifications and anti-diabetic medications may be prescribed for the management or prevention of obesity and diabetes mellitus.
Infertility issues may be addressed through medication and lifestyle modification. Induction of ovulation using agents such as clomiphene or letrozole. Surgery may be recommended in patients who do not wish to take clomiphene or hormonal injections. Laparoscopic ovarian drilling, an outpatient surgical procedure, may be used to treat the condition and induce ovulation. Women who remain resistant to ovulation despite dietary modification, weight loss and oral treatment will be referred for specialist IVF assistance.
Over time, patients with PCOS frequently develop other serious medical conditions such as Type 2 diabetes, cardiovascular diseases, uterine cancer, anxiety and depression. When pregnant, patients with PCOS have higher rates of miscarriage, gestational diabetes, gestational hypertension, and premature delivery. Women with PCOS should be referred for early Obstetric care once pregnancy is confirmed.