We sincerely hope you are beginning to understand how our body functions as regards our reproductive system.
From our first article in this series on the ovaries – Don’t “Ovary-act”! Know your body. , it is clear that the proper functioning of the ovaries depends to a large extent, on the interactions of the reproductive hormones [Oestrogen, Progesterone, Follicle Stimulating Hormone (FSH), Lutenizing Hormone (LH)]. Hormones are chemical ‘messengers’ that are released by the body to trigger different processes.
Polycystic Ovarian Syndrome (commonly called PCOS) occurs when there is a disproportion in the amounts of the female reproductive hormones produced. The ovaries usually produce small amounts of male reproductive hormones (called androgens), but in ladies with PCOS the quantity is increased slightly.
It derives its name from the fact that most women with PCOS will have numerous small cysts (a cyst is a fluid filled sac) on both ovaries. It is important to note that this is a different condition from when a woman has ‘ovarian cysts’, where there is usually a single large cyst on either (or both) of the ovaries.
In PCOS, there is a disruption in the process of egg development – the immature follicles (a follicle is a fluid filled sac that contains the growing egg) are formed in the ovary, but do not develop further because they do not receive the right ‘message’ from the hormones. After a while, these immature follicles become small cysts (containing fluid only but no egg, and they develop a thick covering. The word ‘Poly – cystic’ means many cysts. Therefore, ovulation doesn’t occur regularly or occurs after a long time (can take up to months to occur).
*You can read up about the normal process of ovulation here Don’t “Ovary-act”! Know your body.
Some of the symptoms of PCOS include the following:
- Irregular periods: The cycle length is usually unpredictable, and can last longer than 35 days; sometimes it can take months before a period starts. A woman with PCOS will therefore have fewer periods in a year.
- Numerous small cysts seen on the ovary in a scan
- An imbalance in the amount of female hormones shown by a blood test
- An increase in the amount of androgens (male hormones) shown by a blood test – it is normal for all females to have small amounts of male hormones
- Difficulty in getting pregnant
- Weight gain and difficulty in losing weight
- Hirsutism – increased hair on the face and body
- Excess acne (numerous pimples on the skin, especially on the face)
- Oily skin
- Thinning hair
A diagnosis of PCOS can be made when one has at least two of the first three symptoms. The exact cause of PCOS is not known. However, we do know that PCOS can be hereditary, so if your mother or sister has been diagnosed with it, there is a higher chance of you having it. The syndrome is also related to the body’s inability to use a hormone called insulin, which is very important for the breakdown of glucose (sugar). Women with PCOS are at a higher risk of developing Type II Diabetes, gestational diabetes (pregnancy induced diabetes), obesity, high blood pressure, and hyperlipidemia (raised levels of fat in the blood).
It is common to associate PCOS only with women who are overweight, so ladies who are lean may think it isn’t a problem they can have. This is not the case, as up to half of ladies who have PCOS are lean or even underweight.
The treatment of PCOS is as follows:
Lifestyle changes: If you are discovered to be overweight, as a first step you will be advised to lose some weight (especially if you observed that the symptoms developed or worsened when you gained weight). Weight loss alone (even as little as a 5% reduction) can be effective enough to make periods regular again and relieve other symptoms. Regular exercise and a low calorie diet also help to manage symptoms.
Oral contraceptives: The combination oral contraceptive (COC) pill can be prescribed, and this will address the hormonal imbalance and cause your periods to be regular again. This option is used for someone who is not trying to get pregnant.
Metformin: This is a drug that is also used to treat diabetes, and it works by increasing the body’s ability to use the hormone insulin.
Ovulation induction and follicular tracking: This is used to address infertility that is caused by PCOS. Medications (tablets or injections) are given to stimulate the ovaries to ovulate (i.e to release an egg). After this, the ovaries are scanned regularly to monitor the growth of the follicle (the small sac on the ovary that contains the egg), and to confirm when ovulation occurs, so that sexual intercourse can be timed to take place after ovulation.
Laparoscopic ovarian drilling: This is a surgical procedure that can be done if all the other treatments have been unsuccessful. A laparoscopy is done – the insertion of thin, rodlike instruments into the abdomen through small cuts. A camera is attached to them and the images are projected on a screen. The surgeon identifies the ovaries and uses the same instruments to make tiny holes in the cysts on the ovary. This can help to reduce the amount of androgens (male hormones) the ovary produces.
In Vitro Fertilization (IVF): Women who have PCOS and are trying to conceive might need to have assisted reproduction with IVF to be able to get pregnant if other methods of treatment have not succeeded.
Kindly note that all this information is to educate you. For a proper diagnosis to be made, please see your Doctor.
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