Polycystic ovarian syndrome also known as PCOS is one of the most predominant endocrinological disorders in females and commonly affects women in reproductive age groups between 15 and 45 years. It is a condition characterized by the presence of multiple cysts in the ovaries, hormonal imbalances, and irregular menses.
PCOS is a multifactorial condition that results from the interaction between genetic, endocrinological, and environmental factors. Dr. Sowmya DM, DGO, former OBGYN PG resident of Father Muller Medical College, Karnataka, India, suggests that there are several risk factors involved in the pathogenesis such as the transgenerational transmission of the condition, genetic variations, obesity, insulin resistance due to unhealthy diets and sedentary lifestyle, unfavorable intrauterine environment, and disorders such as congenital adrenal hyperplasia which causes hyperandrogenism. The striking feature of PCOS is anovulatory menstrual cycles which cause secondary amenorrhea, oligomenorrhea, cystic ovaries and infertility. Obesity, and insulin resistance lead to the development of comorbidities like diabetes, hypertension, dyslipidemia, and elevated estrogen levels at a very young age. Likewise, hyperandrogenism leads to acne and hirsutism which causes emotional distress. The individual will also suffer from hormonal imbalances such as high serum LH and high serum prolactin. Furthermore, PCOS has been associated with psychiatric disorders such as depression, anxiety, eating disorders, and body image issues. All these symptoms and comorbidities reduce the quality of life in a PCOS-affected individual and they should be aware of the adverse effects it causes and make changes to lifestyle accordingly.
To diagnose PCOS, there are no specific guidelines. However, the Rotterdam criteria have been established to simplify diagnosis. It is based on the presence of androgen excess, ovulatory dysfunction, and polycystic ovary morphology (presence of multiple follicles and ovarian volume) on ultrasound. Diagnosing using ultrasound is the major challenge in diagnosing as it varies with the technology utilized for numbering the follicles in the ovary. The technology has improved the ability to see more follicles on ultrasound due to high resolution and therefore previous cutoffs cannot be used anymore. Therefore, the Androgen Excess and Polycystic Ovary Syndrome Society made amendments in 2014 and set the range to 20 to 25 follicles in one ovary and an ovarian volume of >10ml.
Lastly, to manage PCOS there are various preventative and treatment strategies. Lifestyle interventions such as making changes in diet, adopting an exercise regimen consisting of aerobics and resistance exercises, and cessation of bad habits such as smoking, and alcohol consumption are the initial management of PCOS. Studies have shown that these strategies alone have improved the quality of life of many PCOS-affected women. These interventions have also improved the psychological profile of the women by improving their anxiety, depressed mood, and overall general well-being. Furthermore, cognitive behavioral therapy is also quite useful in enhancing an individual’s mental well-being. However if there are no improvements, secondary interventions can be adopted such as the use of medications. For instance, for obesity and insulin resistance, metformin and statins are prescribed and for hyperandrogenism, antiandrogens are prescribed. Progesterone is prescribed for amenorrhea and clomiphene for infertility. As a last resort to alleviate the symptoms of PCOS, surgical interventions are utilized. Bariatric surgery is performed in very obese individuals in whom the lifestyle interventions did not make a significant impact. Another rare surgery is laparoscopic ovarian drilling which is performed to improve ovarian function in an individual when other strategies have failed. It involves the use of a laser beam or a surgical needle to destroy ovarian tissue.
Even though the disorder is quite common, there are several challenges in the diagnosis and management due to research gaps, insufficient knowledge among practicing physicians, and the inability to cater to the specific needs of an individual patient. Attention must be called to early risk factors such as obesity to prevent PCOS from becoming very severe and untreatable.
Reference
Hoeger, K.M., Dokras, A., Piltonen, T. (2021). Update on PCOS: Consequences, Challenges, and Guiding Treatment. The Journal of Clinical Endocrinology & Metabolism, 106(3), pp. e1071-e1083. Doi: 10.1210/clinem/dgaa839. (Accessed on 19/02/2023)
Kumar, G. (2015). PCOS. Medicine at your fingertips, pp.363-364.
