14. Polycystic Ovarian Syndrome ( PCOS ) : Obstetrics and Gynaecology Lecture

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Polycystic Ovarian Syndrome ( PCOS ) -
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Polycystic Ovarian Syndrome (PCOS): A common endocrine disorder affecting women of reproductive age, characterized by hormonal imbalances, irregular menstrual cycles, and the presence of multiple small cysts on the ovaries. PCOS is a leading cause of infertility and is associated with various metabolic complications.

Etiology -
Hormonal Imbalance:
Hyperandrogenism: Elevated levels of male hormones (androgens), such as testosterone, leading to symptoms like hirsutism (excessive hair growth), acne, and alopecia (hair loss).
Insulin Resistance: Insulin resistance is a key feature of PCOS, contributing to hyperinsulinemia, which exacerbates androgen production and disrupts normal ovulation.
LH/FSH Imbalance: An increased ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH) disrupts normal ovarian function, leading to anovulation and the formation of ovarian cysts.
Clinical Features

Menstrual Irregularities:
Oligomenorrhea: Infrequent menstrual periods.
Amenorrhea: Absence of menstrual periods.
Menorrhagia: Heavy menstrual bleeding.

Hyperandrogenism:
Hirsutism: Excessive facial and body hair growth.
Acne: Persistent acne, especially along the jawline and back.
Alopecia: Thinning hair or male-pattern baldness.

Ovarian Cysts:
Multiple small, fluid-filled sacs on the ovaries, visible on ultrasound. These cysts result from follicles that fail to mature and release an egg.

Metabolic Complications:
Obesity: Many women with PCOS struggle with weight gain, particularly around the abdomen.
Insulin Resistance: Can lead to type 2 diabetes and metabolic syndrome.
Dyslipidemia: Abnormal cholesterol levels, including elevated LDL ("bad" cholesterol) and low HDL ("good" cholesterol).

Infertility:
Anovulation (lack of ovulation) is a common cause of infertility in women with PCOS. The hormonal imbalances disrupt the normal menstrual cycle, making it difficult to conceive.

Diagnosis
Clinical Criteria:
Rotterdam Criteria: Diagnosis of PCOS requires two of the following three criteria:
Oligo- or anovulation.
Clinical or biochemical signs of hyperandrogenism.
Polycystic ovaries on ultrasound.

Laboratory Tests:
Elevated androgen levels (testosterone).
Abnormal LH/FSH ratio.
Fasting glucose and insulin levels to assess insulin resistance.

Ultrasound:
Transvaginal ultrasound showing enlarged ovaries with multiple small follicles arranged in a "string of pearls" pattern.

Management -

Lifestyle Modifications:
Diet and Exercise: Weight loss through a healthy diet and regular exercise can improve insulin sensitivity, reduce androgen levels, and restore ovulation.
Behavioral Therapy: Support for emotional and psychological well-being, as PCOS can lead to anxiety, depression, and body image issues.

Medications:
Oral Contraceptives: Used to regulate menstrual cycles, reduce androgen levels, and control hirsutism and acne.
Metformin: An insulin-sensitizing drug that helps manage insulin resistance and can promote ovulation.
Anti-Androgens: Medications like spironolactone to reduce androgenic symptoms such as hirsutism.
Fertility Treatments: Clomiphene citrate, letrozole, or gonadotropins may be prescribed to induce ovulation in women trying to conceive.

Surgical Interventions:
Ovarian Drilling: A laparoscopic procedure where small holes are made in the ovarian surface to reduce androgen production and promote ovulation.

Complications
Long-Term Risks:
Cardiovascular Disease: Increased risk due to metabolic syndrome, insulin resistance, and dyslipidemia.
Type 2 Diabetes: Due to persistent insulin resistance.
Endometrial Cancer: Chronic anovulation leads to unopposed estrogen exposure, increasing the risk of endometrial hyperplasia and cancer.

Conclusion -
Polycystic Ovarian Syndrome (PCOS) is a multifaceted disorder that affects not only reproductive health but also metabolic and psychological well-being. Early diagnosis, lifestyle changes, and targeted medical treatments are key to managing symptoms and reducing long-term health risks. 🩺🌸


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