Polycystic ovarian syndrome (PCOS) is a hormonal imbalance that causes small cysts on ovaries, leading to irregular menstrual cycles and fertility problems. It affects 10% of women of childbearing age and can be managed but not cured. Treatment includes weight loss, medication, and surgical options.
Polycystic ovarian syndrome (PCOS), also known as Stein-Leventhal syndrome, is a hormonal imbalance that causes women to develop a series of small cysts on their ovaries. Cysts are abnormal growths that aren’t usually harmful in and of themselves, but they can cause problems when it comes to things like keeping menstrual cycles regular and enabling fertility. In most cases, women with the condition produce too much male hormones and too little female hormones, causing irregular ovulation. It affects approximately 10 to 10% of women of childbearing age. It can be treated but not readily cured, although there are a number of things women can do once it has been diagnosed to manage their condition and prevent it from interfering with their lives.
Importance of hormonal balance
The female reproductive system is governed largely by hormones, chemical signals that act as messengers in the body. Hormones control menstruation, which is a monthly shedding of the uterine lining, as well as ovulation, which is when an egg is released from the ovaries. Polycystic ovary syndrome usually has a more profound impact on ovulation.
Under normal circumstances, ovulation occurs when a follicle containing the egg grows, then releases the mature egg. The ovaries produce estrogen, which is the female sex hormone, as well as small amounts of androgen, a male sex hormone. Polycystic ovary syndrome causes an imbalance in hormone production such that there is often more androgen than estrogen. This prevents the follicle from growing, which results in the accumulation of eggs in the ovaries. In most cases, small benign cysts that release estrogen in the ovaries occur.
This release of estrogen, along with the presence of the male hormones, prevents two other hormones, luteinizing hormone (LH) and follicle stimulating hormone (FSH), from being produced at the proper level. Without ovulation, male hormones remain at an elevated level, causing the cycle to repeat.
main symptoms
Common symptoms include obesity, high blood pressure, high cholesterol and diabetes, as well as high insulin levels and a condition known as “insulin resistance,” both of which are common precursors to diabetes. Patients may have patches of thicker, dark brown or black skin on the upper body, skin tags, and acne. Excessive hair growth is also very common, and sufferers may have hair growing on their chest, lower abdomen, and face. Patients with PCOS may also experience alopecia or thinning hair on the scalp. Most of this has more to do with having excess male hormones than any ovarian growth.
Non-existent or irregular menstrual cycles are also common. Women may also not ovulate regularly, if at all. Both can have a profound impact on fertility. Many women with this condition find that they are unable to conceive without hormone therapy or other medical interventions.
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Researchers aren’t entirely sure what causes polycystic ovary syndrome. There is some evidence of a genetic link, and the condition sometimes runs in families, but not always. Some have suggested that there may be a connection between the condition and a woman’s ability to produce insulin. It’s common for women who have PCOS to produce excess insulin, which prompts the ovaries to compensate with mass production of androgens in an attempt to balance things out.
How the problem is diagnosed
This condition is usually first suspected when a woman has irregular menstrual cycles, particularly if she is also overweight. However, many things can cause menstrual irregularities; health care providers usually do a physical exam and do blood tests to measure hormone levels in order to get a better picture of what’s going on internally. An ultrasound may also be performed to locate any cysts in the ovaries.
Common treatment options
Treatment typically begins with advice to lose weight. Staying at a healthy size is often one of the easiest ways to correct hormonal imbalances. Pharmacological therapy is also often very effective. Metformin, an insulin sensitizing drug, helps women with PCOS ovulate on their own.
Fertility drugs such as clomiphene and gonadotropins typically have a 70-90% success rate in causing ovulation, and many women are also able to conceive within about a year of starting treatments. However, conception is not always the end of the battle, as as many as one in five of these pregnancies end in miscarriage. If a woman with polycystic ovarian syndrome isn’t trying to get pregnant, taking birth control pills can help balance hormones, resulting in less acne and sparser hair growth.
Surgical possibilities
Ovarian perforation is a common surgical treatment for PCOS. The doctor who performs it inserts a small needle with an electric current into the ovary. This destroys a small part of the ovary, which hopefully reduces the production of male hormones. Possible side effects include the formation of scar tissue, which can sometimes actually make the condition worse. The procedure is also not always successful and is usually only recommended when the condition is seriously interfering with the patient’s life and no other treatment options work.
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