Polycystic Ovarian Syndrome

What is it?
It is the commonest cause of ovulation disorders in women of reproductive age and it is a familial condition. PCOS is a primary ovarian condition characterised by many minute cysts in the ovaries and excess production of androgens.

Associated Symptoms
It is frequently associated with the following:
. Weight gain
. Excessive hair growth in the face and body
. Irregular and infrequent periods or absent periods
. Infrequent or absent ovulation
. Miscarriage
. Infertility

Long Term Risks
. Type 2 diabetes
. Cardiovascular disease
. Endometrial cancer

Diagnosis
LAPAROSCOPY - allows direct inspection of the ovaries; the ovaries are enlarged and polycystic. However, polycystic ovaries may appear normal at examination

VAGINAL ULTRASOUND SCAN (better then abdominal) - This may show the typical PCOS appearance but reliability varies with expertise.

BLOOD HORMONE LEVELS (LH,FSH, androgens and SHBG) - Ideally these tests should be performed during the first four days of the cycle. If the woman has no periods then the test can be performed anytime, and repeated if the results do not provide a clear picture.

FSH levels are low or normal , LH levels are often raised. However, just to complicate matters, a normal level does not exclude diagnosis of PCOS. The levels of androgens and testosterone may be raised.

Treatment in women who wish to conceive
Weight loss if the woman is overweight. This simple measure may restore menstruation and ovulation in patients with PCOS.

Medication with clomiphene (clomid) tablets to induce ovulation. Successful in about 70% of women and some 30% will conceive within three months of treatment. The clomiphene may be combined with steroid tablets to suppress androgen production. Monitoring of treatment is essential because these patients are susceptible to develop ovarian hyperstimulation syndrome and multiple pregnancy.

Surgery if medical treatment fails and this may be ovarian drilling or ovarian wedge resection. It is not clear why women with PCOS ovulate after this procedure. There is no increased risk of multiple pregnancy.

Treatment in women who do not wish to conceive
Low dose contraceptive pills are the best option to restore menstrual regularity. It will decrease ovarian hormone production and help reverse the effects of the excessive androgen levels. In women with hirsutism or severe acne, treatment with oestrogens and anti-androgen such as cyproterone acetate (dianette) may be used.

Elevated levels of insulin are common in women with PCOS. Some experts believe that this excess insulin is the underlying cause of PCOS because insulin stimulates androgen production and effects follicular development. Research is being done into treating women with PCOS with Metformin.

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