Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian Syndrome

Hey ladies, let’s talk about one of our most suffered issues – Polycystic Ovarian Syndrome (PCOS). The men are not left out, it could be an awareness for you regarding your sisters and wives, stay glued😁😁.

For quite a long time now, in the female system, it’s been thought that monthly cycle was necessary to remove old cells and reduce the risk of build-up of the uterus lining which was thought to potentially increase the risk of endometrial cancer, well new research shows that this isn’t entirely true after all.

Recently, there has been several oral contraceptives approved that only cause menstrual cycle to occur about 4 times a year and another that is reported to suppress the period indefinitely until it is stopped. (Thinking out loud🤔, this could be it for single ladies that go through excruciating pain monthly just to tick “thank God I am not pregnant ” box.) Las las this period itself is not necessarily needed every month.

Well, in a scenario where a woman does not see her monthly cycle and she’s not pregnant… some pathologies like the following could be suspected until confirmatory diagnosis is carried out.

  • Chronic Anovulation basically refers to lack of ovulation.
  • Oligomenorrhea refers to monthly cycles that occur infrequently.
  • Amenorrhea is a condition in which a woman’s periods have stopped completely. The absence of a period for 90 days or more is considered abnormal unless a woman is pregnant, breastfeeding, or going through menopause (which generally occurs for women between ages 45 and 55). Young women who haven’t started menstruating by age 15 or 16 or within three years after their breasts begins to develop are also considered to have amenorrhea.
  • Polycystic Ovarian syndrome.

What is Polycystic Ovarian Syndrome?

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age that may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

Is there a known cause of Polycystic Ovarian Syndrome? No known exact cause has been proven yet, but these could be causative factors:

  • Hereditary
  • Excess Androgen
  • Excess insulin
  • Low-grade inflammation.

Possible Complications of Polycystic Ovarian Syndrome:

  • Infertility.
  • Gestational diabetes or pregnancy-induced high blood pressure.
  • Miscarriage or premature birth.
  • Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver.
  • Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increases risk of cardiovascular disease.
  • Type 2 diabetes or prediabetes.
  • Sleep apnea.
  • Depression, anxiety and eating disorders.
  • Abnormal uterine bleeding.
  • Cancer of the uterine lining (endometrial cancer).

Types of Polycystic Ovarian Syndrome:

There are known four types of Polycystic Ovarian Syndrome: Insulin-resistant PCOS, Inflammatory PCOS, Hidden-cause PCOS, and Pill-induced PCOS.

  1. Insulin-resistant PCOS
    This is the most common type of PCOS. This type of PCOS is caused by smoking, sugar, pollution and trans-fat. In this, high levels of insulin prevent ovulation and trigger the ovaries to create testosterone.

TIP- QUIT SUGAR! just shun the sugar, it should be the first step. A little amount of sugar is healthy but by taking it in large quantities one is contributing to the insulin resistance. To prevent insulin resistance PCOS one can take inositol. A period of almost six to nine months is needed to improve from this type of PCOS as it is a slow process.

2.Pill-induced Polycystic Ovarian Syndrome 

This type is the second most common PCOS. It gets developed due to the birth control pills which suppress ovulation. For most of the women, these effects do not last long and they resume ovulating after the effect of the pill is over. But some women do not resume with ovulating for months and years even after the effects of pills get over. During that time women should consult the doctor.

If you experience regular and normal periods before starting with the pills then this might be a sign of Pill-induced PCOS. Or if your levels of LH are increased in the blood test then this could be a sign too.

3.INFLAMMATORY PCOS

In PCOS due to inflammation, ovulation is prevented, hormones get imbalanced and androgens are produced. Inflammation is caused due to stress, toxins of environment and inflammatory dietary like gluten.

If you consistently have symptoms such as headaches, infections or skin allergies and your blood tests show that you are deficient of vitamin D, your blood count is not normal, increased levels of thyroid then you might be having inflammatory PCOS.

TIP- REDUCE STRESS! Stop consuming inflammatory foods like dairy products, sugar or wheat. Start taking supplements of magnesium as it has anti-inflammatory effects. The process of improvement takes about nine months as it is a slow process.

4.HIDDEN PCOS

This is a simpler form of PCOS, once the cause is addressed then it takes about three to four months to get resolved. Causes of Hidden PCOS: Thyroid disease, deficiency of iodine (ovaries need iodine), vegetarian diet (it makes one zinc deficient and the ovaries need zinc) and artificial sweeteners.

If you are already done with numerous natural treatments for PCOS and nothing seems like working, then consult the doctor and gather more information about it

Signs and Symptoms of Polycystic Ovarian Syndrome: 

PCOS can’t be diagnosed based on just one symptom or hearsays. Two or more of the following symptoms aids in diagnosis.

  • Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS especially when there are fewer than nine periods a year or more than 35 days between periods and abnormally heavy periods.
  • Excess androgen. Elevated levels of male hormone may result in physical signs like excess facial and body hair (hirsutism) and occasionally severe acne and male-pattern baldness (please don’t go thinking that every woman with bald hair has PCOS, some can be physiological 😁😁).
  • Polycystic ovaries. Basically, enlarged ovaries that contain follicles which surround the eggs resulting in failure of the ovaries to function normally.

Diagnosis of Polycystic Ovarian Syndrome:

No test to definitively diagnose PCOS yet but a visit to the doctor and the following could be done.

  1. Medical history taking that includes menstrual periods and weight changes.
  2. A physical exam will include checking for signs of excess hair growth, insulin resistance and acne.
  3. A Pelvic Examination. The doctor will visually and manually inspect reproductive organs for masses, growths or other abnormalities.
  4.  Blood Test: Blood may be analyzed to measure hormone levels. This testing can exclude possible causes of menstrual abnormalities or androgen excess that mimics PCOS.
  5. Ultrasound: This checks the appearance of ovaries and the thickness of the lining of uterus.

Polycystic Ovarian Syndrome Diagnostic Criteria:

Criteria for Polycystic  Ovarian syndrome Culled from Medscape, A 1990 expert conference sponsored by the National Institute of Child Health and Human Disease (NICHD) of the United States National Institutes of Health (NIH) proposed the following criteria for the diagnosis of PCOS:

  • Oligo-ovulation or anovulation manifested by oligomenorrhea or amenorrhea
  • Hyperandrogenism (clinical evidence of androgen excess) or hyperandrogenemia (biochemical evidence of androgen excess)
  • Exclusion of other disorders that can result in menstrual irregularity and hyperandrogenism

In 2003, the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) recommended that at least 2 of the following 3 features are required for PCOS to be diagnosed:

  • Oligo-ovulation or anovulation manifested as oligomenorrhea or amenorrhea
  • Hyperandrogenism (clinical evidence of androgen excess) or hyperandrogenemia (biochemical evidence of androgen excess)
  • Polycystic ovaries (as defined on ultrasonography)

A research analysis by Copp et al pointed out that since the expanded criteria for PCOS diagnosis from the Rotterdam consensus, the estimated number of diagnoses in women of reproduction age increased from 4-6.6% to 21%.

The Androgen Excess and PCOS Society (AE-PCOS) published a position statement in 2006 and its criteria in 2009 emphasizing that, in the society’s opinion, PCOS should be considered a disorder of androgen excess, as defined by the following:

  • Clinical/biochemical evidence of hyperandrogenism
  • Evidence of ovarian dysfunction (oligo-ovulation and/or polycystic ovaries)
  • Exclusion of related disorders

The Society of Obstetricians and Gynecologists of Canada (SOGC) indicated that a diagnosis of polycystic ovarian syndrome (PCOS) is made in the presence of at least 2 of the following 3 criteria, when congenital adrenal hyperplasia, androgen-secreting tumors, or Cushion syndrome have been excluded:

  • Oligo-ovulation or anovulation
  • Clinical/biochemical evidence of hyperandrogenism
  • Polycystic ovaries on ultrasonograms (>12 small antral follicles in an ovary)

Treatment of Polycystic Ovarian Syndrome:

Lifestyle Modification:

  • Maintain a healthy weight. Weight loss can reduce insulin and androgen levels and may restore ovulation.
  • Limit carbohydrates. Low-fat, high-carbohydrate diets might increase insulin levels.
  • Be active. Exercise helps lower blood sugar levels. Gym in obese situation or just to keep fit😁😁.

Pharmacological Therapy:

  • Combination birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen.
  • Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate periods and protect against endometrial cancer.
  • Clomiphene (Clomid). This oral anti-estrogen medication is taken during the first part of menstrual cycle.
  • Letrozole (Femara). Breast cancer treatment that works to stimulate ovaries.
  • Metformin (Glucophage, Fortamet, others). This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels.
  • Gonadotropins. These hormone medications are given by injection.
  • Birth control pills. These pills decrease androgen production that can cause excessive hair growth.
  • Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin. Spironolactone can cause birth defect, so effective contraception is required while taking this medication. It isn’t recommended if one is pregnant or planning to become pregnant.
  • Eflornithine (Vaniqa). This cream can slow facial hair growth in women.
  • Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle.

Surgical Treatment of Polycystic Ovarian Syndrome

Ovarian Drilling is a minimally invasive laparoscopic procedure performed under general anesthesia. The surgery is typically done on an outpatient basis with minimal recovery time.

Polycystic Ovarian syndrome is curable, discuss with a doctor and a confident. Don’t seal up for fear of judgment, remember when not treated, infertility can occur. Children are free gifts from God, treat and get your share of this gift.

Disclaimer: This is just for educational purposes, and to create awareness on Polycystic Ovarian Syndrome, not a form of treatment or diagnosis.

Thank you😍😁.

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