Polycystic Ovarian Syndrome (PCOS) (Stein-Leventhal syndrome)

Polycystic ovary syndrome(PCOS) is one of the common condition I encounter in the clinics. Usually patients came in with periods of amennorhea (no menstruation), irregular menstruation or dysfunctional uterine bleeding.


What I usually advise patients when they present with the above symptoms is to have an ultrasound to check for the ovaries and most of the time they came back with results of PCOS.

What is PCOS?
PCOS is a problem in which a woman’s ovary have multiple immature follicles, usually the ovaries produces 1-3 eggs per cycle but only one of the 3 eggs mature and become dominant and ready for fertilization, the rest remains inactive. In PCOS, multiple follicles appear at the same time with no single egg becoming mature or dominant . This causes increase in the production of estrogen and androgen causing imbalance between the progesterone and estrogen ratio during the cycle..this results in irregular menstruation and when the period is irregular it is difficult to get pregnant. 

In more technical terms, it is not only the ovaries having problems but the whole body as well that is why it is called a " syndrome".PCOS may also cause unwanted changes in the way you look.  With the increase in androgen (male sex hormones) which is usually present in little amounts in the female secondary male characteristics appear in females with PCOS. They would present unwanted and excessive hair growth, deepening of voice, decsreasing breast size.


Causes and Risk Factors
Cause is unknown but probably genetic since females with PCOS has sisters and parents with PCOS.


One of the risk factor is obesity. The ovaries are not the only source of estrogen. Peripheral fats are converted to a form of estrogen called estrone that is why obese or overweight people often have irregular cycles due to hormonal imbalances and are sometimes difficult to get pregnant than average built women. When these people lose weight their cycle becomes normal, they ovulate and resumes fertility. 


There is also lack of sensitivity to the hormone insulin(known as insulin resistance) which controls blood sugar levels. As a result the body pumps out high and higher amounts of insulin, which in turn causes raised level of blood fats and an increased risk of thrombosis.


Sometimes it is a question of which comes first the PCO or the hormonal imbalance?


Effects of PCOS:
1. Infertility- due to irregular menstrual cycle
2. Predisposition to Diabetes later in life- due to insulin resistance
3. Increase risk for endometrial cancer- periods of no menstruation causes thickening of the endometrium(lining of the uterus) which may lead to Endometrial Cancer 


Treatment:
Depends on the age and the desire for fertility. 


When a woman with PCO as incidental finding in ultrasound but with regular menstruation and have had previous pregnancies and deliveries and are no longer desirous of pregnancy then PCO can remain untreated.


If the patient is with PCO and is obese with irregular cycles, losing weight (which can be difficult) has been shown to help with diabetes, high blood pressure, and high cholesterol.Metformin, a medication that increases the body's sensitivity to insulin, can improve the symptoms of PCOS and sometimes will cause the menstrual cycles to normalize. For some women, it can also help with weight loss.


Patients who have irregular cycles and desirous of pregnancy. Induction of cycle using progesterone for 6 months is recommended. Treatment with clomiphene citrate causes the egg to mature and be released. Sometimes women need this or other fertility drugs to get pregnant.


Patients who have irregular cycles and not desirous of pregnancy birth control pills is the treatment of choice.

Pelvic Laparoscopy with Ovarian Drillingto remove a section of the ovary or drill holes in the ovaries is sometimes done to treat the absence of ovulation (anovulation) and infertility. The effects are temporary.

                                                          Post Ovarian Drilling in PCOS

NOTE: Better consult an OB-GYN to discuss which treatment is the best for you :)