What is PCOS:
Polycystic Ovarian Syndrome is one of the most common endocrine issues faced by most women in our society.
How does normal ovulation work:
In normal menstrual cycle with ovulation, a mature follicle (cystic structure ) develops from each ovary and is released during ovulation ( 14th day from first day of periods ).
The size of a mature follicle ready to ovulate -18 to 28mm diameter.
- 14 days after ovulation the woman would be expected to get her period if she is not pregnant
- The basic difference between polycystic and normal ovaries is :
- Polycystic ovaries do not release an egg (ovulate) regularly
- Ovaries contain many small cystic structures, about 2-9 mm diameter
- Since women with polycystic ovaries do not ovulate regularly, they do not get regular menstrual periods
Symptoms of PCOS :
- Irregular menstrual cycles and sometimes a total lack of periods
- Excess facial and body hair growth - hirsutism, in the teens or early 20s
- Excess amount of male hormones ( testosterone )
Incidence rate :
8-10% of women in reproductive age
Infertility rate incidence in PCOS :
Polycystic ovary syndrome is responsible for 25-30% of infertility in women,
Chances of pregnancy with PCOS :
The good news is that the chance of getting pregnant with polycystic ovarian syndrome using fertility treatments is very good.
For young women under age 35 with PCOS, the real question is more about- WHICH treatment will be effective and not about whether ANY treatment can ever work.
Associated health risks for PCOS :
- Diabetes ( TYPE 2 )
- Endometrial cancer
- Heart attack.
Diagnosing PCOS :
1. Clinical or laboratory signs of androgen excess (high levels of male hormones)
- Hirsutism (excess male pattern hair growth)
- Elevated serum testosterone
2. Irregular Periods
3. ULTRASOUND :
- Numerous small cystic structures, called antral follicles, gives ovaries a characteristic "polycystic" appearance .
- At least one ovary has 12 or more antral follicles
PCOS treatment options :
- LIFESTYLE MODIFICATIONS
- Weight loss (Obese women 3 times more likely to have infertility )
- 80% PCOS have ↑ BMI
- Weight loss is recommended as the first line therapy for all PCOS patients who are obese
- PRE CONCEPTION COUNSELLING
- INSULIN SENSITIZERS
- Insulin Resistance (IR) is present in 50% of women with PCOS.
- IR exacerbates ovulation dysfunction.
- Commonest drug used - Metformin.
- OVULATION INDUCTION
- Involves the use of medication to stimulate development of one or more mature follicles in the ovaries of women who have ovulation problems and infertility.
- Commonest drug used is CLOMIPHENE CITRATE (oral )
- Injectable medications - GONADOTROPHINS
- LAPARASCOPIC OVARIAN DRILLING
- This surgery increases the chance of ovulation13and may be considered if lifestyle changes and medications have been used without success.
- In ovarian drilling the surgeon introduces a laparoscope into the abdomen to puncture all the cysts in the ovary which improves ovulation and in turn fertility issues .
- IUI (Intra Uterine Insemination )
- Medical procedure whereby the partner's sperms are placed directly into the woman's uterus..
- Advantage - large number of sperms are placed into the uterus at one time. This amount is significantly larger than would be placed during normal intercourse.
- Success rate -15%.
- IVF ( In Vitro Fertilization )
- In conclusion , PCOS is a hormonal imbalance disorder which can be corrected along with early diagnosis and treatment in order to avoid infertility issues and health risks later in life .