Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is a common hormone disorder affecting around 10% of women.

Women diagnosed with PCOS usually suffer at least two of the following issues:
• lack of ovulation (anovulation)
• chronic high testosterone hormone levels (hyper-androgenism)
• ovaries with multiple follicles (over 20).

PCOS is diagnosed by taking a patient history and conducting an examination, pelvic ultrasound and blood test.

Symptoms of PCOS

• Irregular or missed menstrual periods
• Difficulty maintaining a healthy weight (50% of women with PCOS are overweight)
• Increased hair growth (hirsutism)
• Acne
• Infertility
• Thick endometrial lining (as the lining is not shed regularly which can lead to episodes of abnormal bleeding )
• Metabolic syndrome – which leads to elevated blood pressure, diabetes, increased risk of heart disease and obesity with increased weight around the abdomen

Investigations

• Hormone evaluation including male hormones such as testosterone often elevated
• Full blood examination with LFT (there is an increased risk of fatty liver)
• Lipid profile (often abnormal lipid profile is detected)
• Glucose testing

Treatment
  • If pregnancy is not desired the oral contraceptive pill with an antiandrogen is the best form of treatment and prevention
  • If pregnancy is desired, oral therapies such as clomid or letrozole can be used (although note there is 10% increased risk of a multiple pregnancy)
  • Lifestyle changes are important, and a low carbohydrate diet should be followed
  • Metabolic issues should be treated with metformin
  • Where there is resistance to the use of clomid – ovarian drilling may be considered – a surgical procedure to burn the follicles – this comes with risk of scarring and damage to the ovary and its function
  • Low dose Gonadotropins if oral agents do not induce ovulation (there is an increased risk of a multiple pregnancy of between 20-30 %)
  • IVF is generally considered if ovulation therapy fails or if the patient wishes to avoid a multiple pregnancy.

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