Pcos

nlakshmi

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#1
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[TD]Polycystic Ovary Syndrome[/TD]
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[TD="class: mainbody"]Polycystic ovary syndrome (PCOS), also called Stein-Leventhal Syndrome, is the most common endocrinologic disorder in women of reproductive age. Approximately 5-10% of reproductive age women have PCOS. This syndrome can have many symptoms. However, the two key components defining this disorder mustinclude chronic anovulation (inability to ovulate an egg) and clinical hyperandrogenism (elevated male type hormones).
The various symptoms of PCOS can be irregular or absent menstrual cycles, infrequent or absent ovulation, excess facial and body hair, male pattern balding, acne of face/back/chest, and infertility. Other findings can include an elevated FSH to LH hormone ratio, elevated levels of male hormones, multiple small cysts of the ovaries and elevated cholesterol.
Some women with PCOS also suffer from other subtle endocrine abnormalities. One is insulin resistance, which affects sugar and fat metabolism, and may increase the long-term risks of heart disease, diabetes and high cholesterol. Insulin resistance (IR), the precursor state to diabetes, is present in 35-40% of women with PCOS, even if they are not overweight. Insulin resistance is diagnosed by blood testing, either as fasting glucose to insulin ratio, or as a complete glucose tolerance test (GTT). Long term follow up of women with PCOS reveals that up to 40% develop impaired glucose processing or diabetes by age 40. The prevalence of diabetes in women with PCOS is seven times higher than for the non-PCOS population. Excessive insulin production is thought to promote excess male hormone production, though the actual mechanism explaining this observation is still unclear.
The causes of PCOS are unknown. We do know that the imbalance of the ovarian hormones exists, which prevents the eggs from growing and ovulating every month. Additionally, this imbalance contributes to an excess of male hormone production by the ovaries, which can be worsened by insulin resistance. There is no cure for PCOS, though the various symptoms can be addressed and managed, and therefore help reduce the risk of long-term health consequences.
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Pacific Fertility Center
 

Ganga

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Polycystic ovary syndrome is a condition in which a woman has an imbalance of a female sex hormones. This may lead to menstrual cycle changes, cysts in the ovaries, trouble getting pregnant, and other health changes.

Causes, incidence, and risk factors

PCOS is linked to changes in the level of certain hormones:


  • Estrogen and progesterone, the female hormones that help a woman's ovaries release eggs
  • Androgen, a male hormone found in small amounts in women

It is not completely understood why or how the changes in the hormone levels occur. The changes make it harder for a woman's ovaries to release fully grown (mature) eggs. Normally, one or more eggs are released during a woman's period. This is called ovulation. In PCOS, mature eggs are not released from the ovaries. Instead, they can form very small cysts in the ovary.

These changes can contribute to infertility. The other symptoms of this disorder are due to the hormone imbalances.

Most of the time, PCOS is diagnosed in women in their 20s or 30s. However, it may also affect teenage girls. The symptoms often begin when a girl's periods start. Women with this disorder often have a mother or sister who has symptoms similar to those of polycystic ovary syndrome.

Symptoms

Symptoms of PCOS include changes in your period (menstrual cycle). Some changes are:


  • No period after you have had one or more normal ones during puberty (secondary amenorrhea)
  • Irregular periods, that may come and go and may be very light to very heavy

PCOS can cause you to develop male-like characteristics. This is called virilization. Symptoms include:


  • Body hair growing on the chest, belly, face, and around the nipples
  • Decreased breast size
  • Enlargement of the clitoris
  • Thinning of the hair on the head, called male-pattern baldness
  • Voice gets deeper
You may also have skin changes:

  • Acne that gets worse
  • Dark or thick skin markings and creases around the armpits, groin, neck, and breasts
Signs and tests

Your doctor or nurse will perform a physical exam. This will include a pelvic exam. This may reveal:


  • Swollen ovaries
  • Swollen clitoris (very rare)

The following health conditions are common in women with PCOS:
Diabetes

  • High blood pressure
  • High cholesterol
  • Weight gain and obesity
Your doctor or nurse will check your weight and body mass index (BMI) and measure your belly size.

Blood tests can be done to check hormone levels. These tests may include:


  • Estrogen level
  • FSH level
  • LH level
  • Male hormone (testosterone) level
  • 17-ketosteroids

Other blood tests that may be done include:


  • Fasting glucose (blood sugar) and other tests for glucose intolerance and insulin resistance

  • Lipid level
  • Pregnancy test (serum HCG)
  • Prolactin level
  • Thyroid function tests

Your doctor may also order the following imaging test or surgeries to look at your ovaries:


  • Vaginal ultrasound
  • Pelvic laparoscopy

Treatment

Weight gain and obesity is common in women with PCOS. Losing weight can help treat the hormone changes and health conditions such as diabetes, high blood pressure, or high cholesterol.

Losing just 5% of your body weight can help your hormone imbalance and may make it easier to get pregnant. For an 160 pound woman, that's just 8 pounds!

Your doctor may recommend birth control pills to make your periods more regular. Such medicines may also help reduce abnormal hair growth after you take them for a few months.

A diabetes medicine called glucophage (metformin) may also be recommended to:


  • Make your periods regular
  • Prevent type 2 diabetes
  • Help you loss weight when you follow a healthy diet

Other medicines that may be prescribed to help make your periods regular and help you get pregnant are:


  • LH-releasing hormone (LHRH) analogs
  • Clomiphene citrate, which helps your ovaries grow and release eggs

Your doctor or nurse may also suggest other treatments for abnormal hair growth. Some are:


  • Spironolactone or flutamide pills
  • Eflornithine cream

Permanent hair removal options include:


  • Electrolysis
  • Laser hair removal - works best on very dark hair that covers large areas

Treatments can expensive and multiple treatments may be needed.

A pelvic laparoscopy may be done to remove to remove or alter an ovary to treat infertility. The effects are temporary.

Expectations (prognosis)

With treatment, women with PCOS are usually able to get pregnant. There is an increased risk of high blood pressure and gestational diabetes during pregnancy.

Complications

Women with PCOS are more likely to develop:


  • Endometrial cancer
  • Infertility
  • Breast cancer (slightly increased risk)

Reference : Pubmedhealth
 
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