Polycystic ovarian syndrome (PCOS)

Endocrine disorders among women are of various types, but the most common is Polycystic Ovarian Syndrome (PCOS), which is basically a hereditary disorder and can be received from either parent. The chances of occurrence of this disorder varies from 5 to 10% among women in the age group of 12 to 45 years, resulting in female subfertility. This endocrine disorder can be identified by anovulation which is diagnosed by irregular menses, amenorrhea, polycystic ovaries, ovulation related infertility, excessive secretion of androgenic hormones causing hirsutism and acne. High cholesterol level, type 2 diabetes, insulin resistance are other known symptoms. All of these symptoms vary between different individuals. The disorder is known by other names, including polycystic ovary disease, functional ovarian hyperandrogenism, ovarian hyperthecosis, and Stein-Leventhal syndrome. A polycystic ovary has an abnormal number of ovules that can be seen near its surface that resemble cysts.

Polycystic ovarian syndrome is generally described by two definitions. The first definition was given by the NIH or NICHD in 1990, which suggests that if a woman suffers from oligoovulation, shows signs of androgen excess, and other entities that result in polycystic ovaries, then the woman suffers from this endocrine disorder. The second definition was given at an ESHRE/ASRM sponsored workshop held in Rotterdam in 2003 which predicts that if a woman suffers from oligoovulation or anovulation, she has excess androgen activity and symptoms of polycystic ovary disease, then she suffers from ovarian disease. polycystic. The second definition seems to be broader and more acceptable. The main symptoms of PCOS include menstrual disorders, mainly amenorrhea and oligomenorrhea, but other menstrual disorders can also occur. Chronic anovulation results in infertility. High androgen levels cause acne and hirsutism. Hypermenorrhea and other symptoms can also make their appearance. About three quarters of women with this endocrine disorder usually suffer from hyperandrogenemia. Central obesity and insulin resistance are also noted. Serum insulin and homocysteine ​​levels are significantly higher in women with this disease.

It is not always necessary that women suffering from PCOS may have PCOS and a similar condition is that all women with PCOS may not have PCOS. The syndrome can be easily diagnosed using pelvic ultrasound, but other diagnostic tools are also available. A person’s history based on menstrual pattern, obesity, hirsutism, and lack of breast development can help the medical professional. A gynecologic ultrasound can be performed which helps in the detection of small ovarian follicles. It is believed that these small follicles are formed due to impaired ovarian function where ovulation has not occurred due to the absence of menstruation. In a normal menstrual cycle, a single egg is released from the dominant follicle. After ovulation, the remnant of the follicle develops into a characteristic structure known as the corpus luteum formed by the action of progesterone. This structure finally disappears after 12-14 days. In PCOS, although several follicles are formed, none of them grow more than 5-7 mm in length and fail to enter the preovulatory stage of the menstrual cycle. According to the Rotterdam criteria there must be 12 or more than 12 small follicles detected on ultrasound. These small follicles are usually present near the periphery of the ovarian wall giving it the appearance of a string of pearls. The ovary grows and reaches a size of 1.5 to 3 times its normal size and this is due to the presence of these abnormal follicles.

Laparoscopic examinations show the presence of a smooth white outer surface of the ovary. Serum (blood) levels of androgens, specifically androstenedione and testosterone, are elevated. Dehydroepiandrosterone sulfate levels are also higher. Free testosterone levels are also high and give the best clue to the presence of this syndrome. The free androgen ratio of testosterone to sex hormone binding globulin (SHBG) ratio is generally higher, but is a poor indicator. Some blood tests are also suggested, but they are not good indicators of the diagnosis of PCOS. The ratio of LH (luteinizing hormone) to FSH (follicle stimulating hormone) is greater than 1:1 as tested on the third day of menses. Among obese women, levels of sex hormone binding globulin (SHBG) are generally low. Fasting biochemical screening and lipid profile of the individual can be performed while looking for this syndrome. A 2-hour oral glucose tolerance test (OGTT) can be performed on suspected individuals indicating glucose intolerance in 15-30% of patients with this syndrome. Insulin resistance is very common in patients with polycystic ovarian syndrome. Other clinical disorders may also be associated with menstrual abnormalities, namely Cushing’s syndrome, hypothyroidism, congenital adrenal hyperplasia, and pituitary disorders.

Polycystic ovarian syndrome (PCOS) is a generically hereditary condition. It is inherited in an autosomal dominant system with a higher risk of occurrence in women. The chances of inheriting the gene responsible for this syndrome are 50% if the father is a carrier of the gene. Although the gene responsible for this syndrome can be inherited from the father or the mother and the gene can be passed on to sons, but the symptoms may arise only in daughters. The gene responsible for this disorder has not yet been identified. Polycystic ovaries usually develop when the ovaries are stimulated to produce excessive amounts of male hormones, particularly testosterone. This can happen due to the release of excessive amounts of luteinizing hormone (LH) from the anterior pituitary gland or elevated levels of insulin in the blood of women who are sensitive to insulin or reduced levels of sex hormone binding globulin (SHBG) in the blood resulting in an increased level of free androgens. The syndrome has acquired its name polycystic due to the resemblance of the small follicles to cysts. Follicles develop from primordial follicles but their development ceases at the antral stage due to impaired ovarian function. These cyst-like follicles are organized on the periphery of the ovarian wall. Most patients with this disorder typically show insulin resistance, and this can cause abnormalities similar to those seen in the hypothalamic-pituitary-ovarian axis.

The symptoms of polycystic ovarian disease are very complex and may not be the same for all patients. In many cases it can be characterized by hyperandrogenism and insulin resistance. Most cases of this disease have a genetic basis. Excessive amounts of adipose tissue in obese individuals also increase androgen and estrogen levels. Adipose tissue carries an enzyme identified as aromatase that is involved in the conversion of androstenedione to estrone and testosterone to estradiol. Hyperinsulinemia causes an increase in the GnRH pulse rate, increased ovarian androgen production, decreased follicular maturation, and decreased levels of sex hormone-binding globulin, ultimately resulting in polycystic ovarian disease. . Chronic inflammations can also give rise to this syndrome. A study conducted in the United Kingdom indicated that the incidence of polycystic ovary disease is higher in lesbian women than in heterosexual women. Medications administered to patients with this disease generally focus on lowering insulin levels, restoring fertility, treating hirsutism or acne, and preventing endometrial hyperplasia, endometrial cancer, and restoring the menstrual cycle. regular. In cases where the disease is associated with obesity, weight loss is the effective strategy for the onset of regular menstruation. A low carbohydrate diet and regular exercise can help you lose weight.

All women with Polycystic Ovarian Disease may not face the difficulty of getting pregnant, only those who suffer from anovulation may face the problem. Patients with anovulation problems can be treated with clomiphene citrate and FSH injections. Patients who fail clomiphene and FSH treatments are treated with assisted reproductive technology procedures such as controlled ovarian hyperstimulation with follicle-stimulating hormone (FSH) injections followed by in vitro fertilization (IVF). Surgery is usually not done in case of polycystic ovary, but a laparoscopic procedure known as ovarian drilling is usually done. Hirsutism can be treated with an effective standard birth control pill. The key ingredient in birth control pills is cyproterone acetate, which is a progestogen. This compound has antiandrogenic action and blocks the activity of male hormones that are responsible for acne and unwanted hair growth on the face and the rest of the body. Other medications that have antiandrogen effects include flutamide and spironolactone which can effectively reduce hirsutism. Spironolactone is the most widely used drug in the United States. Menstrual problems can be regulated by using birth control pills, but these drugs can cause additional problems if continued for a long time. Two isomers of inositol, namely D-chiro-inositol and myo-inositol, have given promising results against this syndrome.

Women suffering from PCOS are at risk of being affected by endometrial hyperplasia and endometrial cancer. These clinical manifestations can arise due to the excessive accumulation of the uterine lining and the absence of progesterone, which is responsible for the prolonged stimulation of uterine cells by estrogen. These symptoms set a positive background for the appearance of other health problems such as obesity, hyperinsulinemia, hyperandrogenism, type 2 diabetes and insulin resistance. A 2010 study highlighted that women with polycystic ovarian disease are at increased risk of being affected by type 2 diabetes and insulin resistance. High blood pressure, depression or depression with anxiety, miscarriage, excessive weight gain, cardiovascular disease, acanthosis nigricans, autoimmune thyroiditis are other risks associated with this syndrome.