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Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) occurs when there is a disproportion in the amounts of the female sex hormones oestrogen and progesterone. It is sometimes referred to as ‘hormonal imbalance’, but this term is sometimes used indiscriminately. 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, but it is important to note that this is different from having a single cyst on any of the ovaries. The symptoms of PCOS include the following:

  1. 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.
  2. Numerous small cysts seen on the ovary in a scan
  3. An imbalance in the amount of female hormones shown by a blood test
  4. 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)
  5. Hirsutism – increased hair on the face and body
  6. Excess acne (numerous pimples on the skin, especially on the face)
  7. Weight gain
  8. Difficulty in getting pregnant

A diagnosis of PCOS is 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).

The treatment of PCOS is as follows:

  • Lifestyle changes: 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. This alone (even as little as a 5% reduction) can be effective enough to make your periods regular again and relieve other symptoms. Other things that help are regular exercise and a low calorie diet.
  • 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. However, this is only an option for someone who is not trying to get pregnant.
  • Metformin: This is a drug that is used to treat diabetes. Because PCOS is also associated with inability to use insulin, it helps to reduce this and is effective in treating PCOS.
  • 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.
  • Ovarian drilling: This is a surgical procedure that is done if all the other treatments have been unsuccessful. A laparoscopy is done - the insertion of thin, rod like 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 remove the cysts on the ovary by puncturing them.

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