Symptoms of PCOS usually begin to appear very soon after the time a young woman starts having her menstrual cycle. Sometimes, symptoms can also appear for the first time later during the reproductive years, especially if she has gained weight. The severity of PCOS symptoms may affect most women differently. It has many signs; these signs could be easily noticed or seen by the woman involved or her doctor. And the symptoms can also be noticed or felt by the person involved.
Gaining too much weight or obesity makes this situation worse. Before a woman is diagnosed with this condition, there are many signs which could be a red flag that the doctor needs to look out for. Irregular and abnormal menstrual periods is the most common distinguishing factor. This kind of irregular menstrual periods are known to have intervals lasting longer than 35 days, or even lesser than 8 menstrual cycles a year. Most times, these women may not menstruate for 4 months or even longer.
In some occasions, these prolonged menstrual periods may be heavier or less. Another symptom of PCOS is an increased level of androgens in these women, which leads to these affected women exhibiting the male physical features such as excess hair on the face and body referred to as hirsutism, the type of baldness regularly seen in males referred to as androgenic alopecia, and adult and/or adolescent type of acne. The ovaries become inflamed with fluid-filled sacs surrounding the egg, which is referred to as polycystic ovaries.
Audra, an 18-year-old American female came to our clinic with the complain of irregular menstrual cycles for the past 3 years, even though she stated that her periods had become regular 6 months after they started. She stated that her period comes only every 3 months and is very heavy, requiring her to change feminine pads every 2 hours. She is a young woman of reproductive age, with irregular menstrual cycle. She also complains of gaining weight fast, even though she exercises 4 hours per week and have not changed her eating habits. When asked, she confirms her mother had the same problem in the past.
For her mother to have these same problems in the past suggested that heredity or genetics could be involved. Further examination showed that she is alert and oriented, height is 5’6” tall, weight is 180 Lbs. , blood pressure is 145/95 mmHg. The weight of 180Lbs and blood pressure of 145/95 mmHg are obvious signs of weight increase and elevated blood pressure. This gave us the signal to do further tests. Temperature is 98. 6 F, pulse is 80 bpm. Growth of hair noted on the face and body, which is a sign of increased production of the male hormone called androgen.
Adult type of acne noted on the face, noted some loss of hair around the scalp. CBC was within normal values, which made us to rule out other disorders and diseases. The fasting blood glucose was 127 mg. /dl, this was abnormal because a normal fasting blood glucose should be less than 100 mg. /dl. This made us to confirm that she has type 2 diabetes mellitus. This is as a result of abnormal secretion of insulin and the inability of the insulin target cells to properly exhibit their functions in the body. With the presentation of all these symptoms, she was diagnosed with Polycystic Ovary Syndrome.
PCOS has no specific test that is used in the diagnosis. The diagnosis is mainly based on exclusions, in which the doctor rules out other related disorders by considering all the noted signs and symptoms. This involves the doctor looking into the medical, history such as menstrual periods, alteration or increase in body weight, and other related symptoms. The doctor performed a physical examination, which included information relating to the height, blood pressure, pulse rate, weight, and other vital signs.
The doctor also performed a pelvic examination, in which he physically looked at the reproductive organs to see if there were any changes. These changes will include any form of growth or abnormalities. Blood tests were performed to check the levels of several hormones in the body, in relation to the causes of abnormalities in the menstrual cycle and excess production of androgen. Fasting cholesterol, triglyceride levels, and glucose tolerance test were also performed. In order to obtain accurate results, glucose levels are checked while fasting and after eating or in most cases, drinking glucose -containing foods.
Another important test that needs to be done is an ultrasound examination. This examination is performed in order to see the appearance of the ovaries and the lining of the uterus. A transvaginal ultrasound is performed with the woman lying on the bed or examination table, then a transducer is placed into the vagina. This transducer will be able to emit silent sound waves that can be interpreted into images on the computer monitor. Treatment Treatment of PCOS should start with a lifestyle adjustment.
This may help to reduce all symptoms of PCOS and lessen the long-term risk of infertility and type 2 diabetes mellitus. This is the major line of PCOS treatment, such as improved exercise, diet modifications, and weight loss can help to decrease the metabolic irregularities associated with PCOS. Weight loss has been known to correct oligo anovulation and advance the ability of women with PCOS to have successful pregnancies. Treatment of acne, hirsutism and irregular menstrual cycles has been successfully done with estrogen and progestin oral contraceptive therapy.
This type of therapy can be used to control androgen levels and reduce the signs of hyperandrogenism as well as to control menstrual cycles which will also help to diminish the risk of heavy and irregular menstrual bleeding related to the loss of normal estrogen and progesterone levels in the body. Treatment of acne and hirsutism can be successfully done with anti-androgens such as spironolactone, finasteride, and flutamide. Spironolactone and flutamide inhibits dihydrotestosterone and testosterone by binding to their receptors in outer cells such as hair follicles.
Finasteride hinders the conversion of testosterone to the more effective dihydrotestosterone in the outer cells. Treatment of glucose intolerance, hyperinsulinemia, and anovulation can be achieved with Metformin. Decreasing circulating insulin levels may likely reduce ovarian androgen synthesis. Metformin diminishes glucose intolerance and hyperinsulinemia by increasing insulin sensitivity at the insulin target cells and decreasing hepatic gluconeogenesis and lipogenesis. It can also be used to avoid and control type 2 diabetes mellitus.
When all these measures are taken, ovulation can be induced adequately. Clomiphene citrate has been used for inducing ovulation. It is a selective estrogen receptor modulator used to induce ovulation by interfering with estrogen feedback to the brain thereby increasing FSH release. This type of therapy has increased risk of multigestational pregnancy, such as twins or triplets because of the numerous number of antral follicles in polycystic ovaries. With this therapy, most women will ovulate, but only half will truly conceive.
This might be in relation to the antiestrogenic effects of clomiphene, which could lead to the thinning of the endometrium. As a result, Clomiphene citrate therapy should be restricted to about 12 cycles because longer-term therapy is associated with more frequent risk of ovarian cancer due to increased stimulation of the ovary. Metformin and Clomiphene citrate can be used together in the treatment this disorder. Using both of them together has been known to be more effective in inducing ovulation than using them separately.
Another form of therapy is the recombinant FSH and hCG therapy. This therapy can also be used to induce ovulation in some cases where therapy with clomiphene citrate and metformin has not been successful. This is referred to as Gonadotropin therapy. Exogenous gonadotropins can also be administered to act like the physiological mechanisms of follicle development. FSH is administered to enhance the growth of a dominant follicle to a certain size. Then the human chorionic gonadotropin hCG is used to induce ovulation.
In order to diminish the risks of multigestational pregnancy and ovarian hyperstimulation, this therapy should be monitored very closely with various forms of laboratory studies, together with imaging. In some situations where therapy with Clomiphene citrate was not successful, a laparoscopic surgical procedure is likely to be used to treat clomiphene citrate-resistant anovulation, this is referred to as Ovarian drilling. This type of procedure involves the creation of several holes in the ovary using either cautery or laser.
The surgical removal of some of the ovarian theca is known to help induce ovulation by reducing androgen production. This procedure is likely to have comparable effectiveness of the gonadotropin therapy. Surgical complications are likely to occur, such as adhesion formation, which is a serious concern. As a result of the complications associated with this procedure, it is important that it is used specifically in patients with additional current signs for laparoscopy. When all other therapies and procedures have proved unsuccessful, In vitro fertilization IVF is likely to be used to induce ovulation in infertile women.
This involves the retrieval of oocytes from the ovaries and in vitro mixture with sperm to produce embryos. Viable embryos are then transported and implanted into the uterus. This could be very successful if the viable embryo is well implanted into the uterus. There are risks associated with this procedure. This includes multigestational pregnancy. This is because of the transfer of several embryos and over stimulation of the ovary, which is as a result of gonadotropin therapy, which is normally used preceding oocyte retrieval in order to encourage the development of the follicles.
