Thursday, July 31, 2008

Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal abnormalities experienced by women during their reproductive years. It is a common problem affecting about 7% of young adults women. Hormonal cycling is disrupted and the ovaries become enlarged. Women with PCOS have follicles in their ovaries, which fail to rupture. Cysts present in ovaries are not harmful but do cause hormonal imbalances. PCOS, though may occur in women without ovarian cysts and is the most common cause of infertility in women. Hormones like androgen is excessively. Normally ovaries make only a tiny amount of this male hormone androgen. Plus, the ratio of LH to FSH is often abnormally high. Levels of LH ratio increases to FSH mainly because of decreased level of FSH.
PCOS is a hormonal condition in which excess testosterone results in irregular ovulation and benign cyst, jeopardizing fertility. It is directly caused by excessive weight gain & obesity brought on by insulin resistance. when a body has problem regulating insulin, insulin resistance occurs. With enhanced obesity,insulin production increases, which in turn increases testosterone level that may trigger PCOS. when a body does not use insulin well, blood glucose level shoots up causing impaired glucose tolerance. Overtime, the chances of getting diabetes increases.
Obesity increases the chances of developing polycystic ovary syndrome. Obesity, thus, is a major risk factor for PCOS and a realistic achievable weight loss can be sufficient to restore regular ovulation and improve fertility in obese women with this disorder. If you are obese, get to a healthy weight. Body weight can affect one's ability to conceive.
In addition to weight, genetics too might have role to play. Although the causes of PCOS is unknown, some women might be genetically more predisposed than others. Researchers say that a combination of genes plays a part in PCOS.
All cases of PCOS might not have all the symptoms. Symptoms tend to be mild at first. Women start having irregular periods, and in some cases, or miss it altogether. Some may have no periods while others may suffer from very heavy bleeding. Studies have shown that menstrual history is an accurate marker for PCOS in both epidemiological and genetic studies.
If you have it, sisters and daughters have 50% chance of developing it during their reproductive age.
Forty percent of the adult women with PCOS have impaired glucose tolerance and elevated LDL or bad cholesterol and markedly increased prevalence of a condition called metabolic syndrome. Associated syndromes increase risk for cardiovascular syndrome tremendously.
In other words, health risks associated with PCOS are diabetes, heart diseases, reproductive problems. Infertility is caused by increased androgen, which blocks ovulation. Repeated miscarriages cause is unknown may be due to high insulin level, delayed ovulation or by the quality of egg or how egg attaches to the uterus. The risk for Gestational diabetes is greater in women with PCOS than a normal ovulating women. For pregnant women, PCOS can cause miscarriages, gestational diabetes mellitus, pregnancy induced high blood pressure, pre- eclampsia, increased higher risk of delivery by caeserian section. Endometrial hyperplasia occurs because the uterus lining is not cleared each month due to lack of menstrual cycle. However, birth control pills reduces risk. women with PCOS are at risk of abnormal uterine bleeding and endometrial cancer. skin and hair disorder can be substantial in women with pcos and are physically and psychologically very damaging.
PCOS is mostly diagnosed when a women is having difficulty becoming pregnant. Physical examination ,USG, blood test can help diagnosis this condition.There is no single test to diagnose polycystic ovarian syndrome, diagnosis also depends on past history of the disease. Pelvic ultrasound helps find if there is any cyst on the ovaries (polycystic ovaries). Hormones levels tested for increased androgen level, this increased level of testosterone and androgen blocks ovulation. Test for Prolactin level is done. If increased prolactin level it lacks menstrual cycle or results in infertility. GTT and Insulin level which shows insulin resistance. Test for high blood glucose level, high lipid level. Lipid profile increases in pcos. chemical screening like kidney function test and liver function test. TSH level for thyroid activity. DHEAS or 17-oH progesterone(adrenal gland hormones) may give same symptoms so to exclude pcos. other test includes, checking blood for HCG this excludes pregnancy.
PCOS leads to serious health condition. When it comes to diagnosis, sooner the better. If trying to conceive, treatment regimen can begin with fertility drug like clomiphene. Clomiphene usually induces ovulation, 50-60% conceive in first 6 months of treatment. Those who will not ovulate in response to clomiphene are at increased risk of ovarian hyper-stimulation. Birth control pills can be used if not trying to get pregnant. This combined pills will control bleeding and reduced risk of unopposed estrogen on the endometrium. Unwanted hair growth in body may be treated cosmetically or with an anti-androgen drugs. Cosmetically by use of chemical hair removers or by waxing, tweezing or shaving. Laser hair removal, electrolysis, bleaching is also done. Metformin helps control insulin and blood glucose level.
There is no cure for PCOS, but controlling it lowers your risks for infertility, miscarriages, diabetes, heart disease and uterine cancer. Associated conditions can be managed through medications and lifestyle changes. Low carbohydrate diet might be helpful. Limit foods high in saturated fats(meat, cheese, fried foods). Go for lots of vegetables, fruits, nuts, beans,whole grains.Healthy eating habits is the key treatment for PCOS associated ailments. Loosing weight may help get hormones in balance and regulate menstrual cycle.
Surgery for PCOS isn't necessary. It is recommended only if women doesn't respond to any other treatment. Surgical treatment is occasionally done for women with infertility caused by pcos and who do not ovulate after taking medicine. Ovarian function is improved by reducing the number of small cysts. One of the more common ones is laparoscopic ovarian drilling also called as band-aid surgery because of small incision.This surgical treatment can trigger ovulation in women with PCOS who have not responded to weight loss and fertility medicine. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But these effects may only last a few months. It is important to treat your PCOS even if not trying to get pregnant. Having pcos results in higher risks for many disease , but if it is treated properly,then those risks are lowered.

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