PCOS is an enigmatic and heterogeneous disorder, constituting the commonest cause of hormonal imbalance in women of reproductive age group, presenting with various arrays of hormonal, menstrual, reproductive and metabolic disorders. Its spectrum of presentation is so wide that while in many women, it may be so mild that it can easily be missed, in many others it may be very severe with full expression of numerous symptoms. It is however defined by the presence of at-least two out of the following three conditions in any woman;
1. Absence and irregular or infrequent menstruation, suggesting the absence or infrequent occurrence of ovulation.
2. Features of high levels of androgens or male sex hormones demonstrated physically and or following results of blood investigations.
3. An ultrasound scan which demonstrates the presence of polycystic ovary in one or both of the ovaries.
POLYCYSTIC OVARY (PCO)
This is defined as the presence of 12 or more tiny cysts each less than 10mm in a slightly enlarged and thickened ovary. The term cysts are hypothetical in this context. This is because these tiny cyst like structures are not actual or real cysts. Ovarian cysts are fluid containing cavities located within the ovary, that often increases albeit at varying rates over time. Not so in the case of polycystic ovaries, which are immature ovarian follicles that got stuck early in their growth. Early at the beginning of each normal menstrual cycles, some groups of cells, each surrounding an oocyte, are recruited to grow gradually until the largest one known as the dominant follicle eventually outgrows the others and releases a mature egg or oocyte, at ovulation. The others however, gradually die off, with none except the dominant follicle making it to ovulation. In the case of PCO, these follicles as mentioned earlier, remain stuck in their growth, refusing to develop further, thus none making it to ovulation. Hence, due to their appearance when viewed by an ultrasound scan, such ovaries are reffered to as polycystic ovaries. However, not all women with ultrasound scan features of polycystic ovaries have polycystic ovarian syndrome; in fact about 20 to 30 percent of normal women will have ultrasound features of polycystic ovaries following a transvaginal scan.
It is believed that PCOS is caused by a combination of genetic factors i.e. inherited genes and environmental factors. Although, it has been observed in about 50% of off springs of parents with PCOS, different children may inherit different parts or components of the disorder. Similalry, many women who inherit the disorder may not show any symptoms until some specific external factors influence the expression of the disorder e.g. weight gain may expose the disorder in some women who ordinarilly do not have any symptoms.
The commonest complain or symptom of PCOS seems to be irregular menses. This is then followed by obesity and absent menses. Others include symptoms due to high levels of male sex hormones. It is important to know that women with PCOS may present with sets of symptoms different from others. Below is a list of the common symptoms of PCOS.
1. Irregular menses
2. Absent menses
3. Heavy inter-menstrual bleeding
6. Acne or pimples
8. Balding or Alopecia
As mentioned above, the diagnosis is usually made following the fulfillment of two out of the three criteria mentioned above. This entails a detailed clinical history, physical examination and some investigations. After confirming the various symptoms from the history, a physical examination must be done to confirm features such as obesity and hirsutism. The BMI and the Waist:Hip ratio must be calculated as PCOS is closely related to obesity and an increased distribution of fat around the waist. Signs such as excessive acne and male pattern of hair distribution e.g. the presence of mustache or beards, the presence of hair on the neck, the chest, nipples, back and abdomen must be noted. Clinical investigations such as transvaginal scan and hormone profile may help confirm the diagnosis.
Since the presentation is highly variable and no definite cause is known, the treatment is mainly symptomatic. This simply means that the treatment is geared towards the relief of the symptoms or complaints of the patient. Hence any woman with infertility will be treated for it while a woman complaining of excessive hair growth and any complaining of irregular menses will be treated respectively for their complaints with different treatment methods. Having mentioned that, various lifestyle changes have been noticed to relieve or reverse the symptoms of PCOS in some instances. This include, exercise and dietary control of weight. In other words, weight loss is often of benefit especially in women who are obese in reversing the symptoms of menstrual irregularity and infertility in some patients with PCOS. Medications that are often used include those for the management of infertility, hirsutism, menstrual disturbances and occasionally obesity. Surgical management is reserved for failed medical management of PCOS, or PCOS that is non responsive to any other treatments. Occasionally obesity may also be treated with surgery.
PCOS has been associated with many metabolic disorders especially Diabetes. About 40% of women with PCOS go on to develop diabetes mellitus later in life. Similarly, a specific class of drug used in the management of diabetes has been shown to help reverse some of the symptoms of PCOS. Therefore a close link exists between diabetes and PCOS.
2. Abnormal cholesterol level in the blood
4. Hypertension and heart attack
5. Anaemia from irregular heavy bleeding