Introduction:
Polycystic ovarian syndrome (PCOS) is a complex condition in females of reproductive age group. It is characterised by unilateral or bilateral ovarian cysts along with markedly elevated androgen levels and menstrual irregularities. According to the National Institutes of Health Office of Disease Prevention, in United States polycystic ovarian syndrome affects approximately 5 million women of childbearing age. It is the most common endocrine abnormality in females affecting approximately 5% to 10% of females from 18 to 44 years of age in United States. It costs billions of dollars every year to treat polycystic ovarian syndrome and related manifestations in United States. Polycystic ovarian syndrome is usually underdiagnosed and results in comorbidities making the condition more severe.
Causes of polycystic ovarian syndrome:
Polycystic ovarian syndrome is a multifactorial disease. Several factors have been identified including:
1. Genetic predisposition
2. Family history
3. Obesity
4. Insulin resistance
5. Physical inactivity
Clinical presentation:
Polycystic ovarian syndrome is an endocrine disorder and signs and symptoms can vary greatly. However there certain factors which are though to be the hallmark of polycystic ovarian syndrome. These factors include:
Ovulation irregularities
Hyperandrogenism
Polycystic ovaries
Diagnostic criteria:
For the diagnosis of polycystic ovarian syndrome, complete history and physical exam play vital role. A well known and widely accepted criteria for diagnosis of PCOS has to met requires two out of three following criterias:
1. Hyperandogenism
2. Polycystic ovaries
3. Oligo ovulation / an ovulation
Management of polycystic ovarian syndrome:
Depending upon the age and clinical presentation of the disease following treatment/management modalities are widely used:
Hormonal contraceptives:
Hormonal contraceptive specially combined oral contraceptive pills are the first line treatment for polycystic ovarian syndrome manifestation. This management protocol is used to treat various conditions associated with PCOS including menstrual abnormalities, acne and hirsutism.
Metformin:
Patients with contraindications for using hormonal contraceptives are prescribed metformin and it is second line therapy for menstrual irregularities. Metformin also improves other symptoms associated with PCOS.
Lifestyle modifications:
In women with higher body mass index (BMI) having PCOS, exercise and lifestyle modifications are the best therapy. Low calorie diet along with exercise can greatly improve the outcomes. Hirsutism, ovulation abnormalities and menstrual abnormalities greatly improve with lifestyle modifications.
Conclusion:
Polycystic ovarian syndrome is a multifactorial disorder affecting a large number of females worldwide. Polycystic ovaries, elevated androgen levels and menstrual irregularities are the characteristic hallmarks of the disease. Patient with PCOS are usually underdiagnosed and it takes multiple visits for diagnosis. Patients with positive family history, diabetes, overweight and sedentary lifestyle are at higher risk of developing PCOS. History and physical examination of the suspected patients is necessary. Two of the three criteria for PCOS ( menstrual irregularities and symptoms of hyperandrogenism ) can be found through history and physical examination. Management of patients with PCOS includes lifestyle modifications and pharmacological prescriptions. Oral contraceptives have shown excellent improvement in PCOS and are thought to be the first line therapy for PCOS. Metformin is suggested by endocrine society as the second line therapy for patients with PCOS.
