### Date : 2024-05-29 10:56 ### Topic : Polycystic Ovarian Syndrome (PCOS) #medicine #endocrinology ---- Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. It is characterized by a combination of symptoms and signs related to hormonal imbalances, metabolic issues, and ovarian dysfunction. Here are the full details: ### Definition PCOS is a condition in which **the ovaries produce an abnormal amount of androgens**, which are male sex hormones that are usually present in women in small amounts. The condition is named for the small cysts that form in the ovaries. ### Diagnostic Criteria The diagnosis of PCOS is typically made based on the presence of at least two of the following three criteria ([[Rotterdam criteria]]): 1. **Irregular or absent menstrual periods**: This can include oligomenorrhea (infrequent periods) or amenorrhea (absence of periods). 2. **Hyperandrogenism**: Clinical signs include hirsutism (excessive hair growth), acne, and androgenic alopecia (male-pattern hair loss). Biochemical evidence includes elevated serum levels of androgens. 3. **Polycystic ovaries**: Detected by ultrasound, defined as having 12 or more follicles in each ovary measuring 2–9 mm in diameter, and/or increased ovarian volume (>10 cm³). ### Symptoms - **Menstrual Irregularities**: This includes amenorrhea, oligomenorrhea, or heavy menstrual bleeding. - **[[Hyperandrogenism]]**: Manifestations include hirsutism, acne, and androgenic alopecia. - **Polycystic Ovaries**: Ultrasound reveals multiple small cysts. - **Weight Gain**: Many women with PCOS are overweight or obese. - **Insulin Resistance**: Increased risk of developing type 2 diabetes. - **Infertility**: Difficulty conceiving due to anovulation or irregular ovulation. - **Skin Changes**: [[[[Acanthosis nigricans]]]] (dark, thickened skin patches). - **Mood Disorders**: Higher prevalence of depression and anxiety. ### Causes The exact cause of PCOS is unknown, but several factors are believed to play a role: - **Genetics**: PCOS tends to run in families. - **Insulin Resistance**: Many women with PCOS have insulin resistance, leading to higher insulin levels that may increase androgen production. - **Inflammation**: Chronic low-grade inflammation is common in women with PCOS and may contribute to increased androgen levels. ### Complications - **Infertility**: Due to anovulation or irregular ovulation. - **[[Metabolic Syndrome]]**: Increased risk of type 2 diabetes, hypertension, dyslipidemia, and cardiovascular diseases. - **Endometrial Cancer**: Increased risk due to prolonged exposure to unopposed estrogen. - **Sleep Apnea**: Higher prevalence among women with PCOS. - **Depression and Anxiety**: Higher rates in women with PCOS. ### Diagnosis Diagnosis typically involves: - **Medical History and Physical Exam**: Including menstrual history, symptoms of hyperandrogenism, and physical signs. - **Blood Tests**: To measure hormone levels (androgens, LH, FSH, glucose, insulin). - **Pelvic Ultrasound**: To visualize ovaries and check for the presence of cysts. ### Treatment Treatment is tailored to individual symptoms and reproductive goals and may include: - **Lifestyle Changes**: Weight loss through diet and exercise can improve symptoms and metabolic parameters. - **Medications**: - **Oral Contraceptives**: To regulate menstrual cycles and reduce androgen levels. - **Anti-androgens**: Such as spironolactone to reduce hirsutism and acne. - **Metformin**: To improve insulin resistance and lower insulin levels. - **Clomiphene Citrate or Letrozole**: To induce ovulation in women seeking to become pregnant. - **Fertility Treatments**: Including assisted reproductive technologies if initial treatments fail. ### Management Ongoing management includes regular monitoring of metabolic health, addressing specific symptoms, and providing psychological support. Weight management, regular physical activity, and a balanced diet are crucial components of long-term management. In summary, PCOS is a complex condition with a wide range of symptoms and potential complications. Early diagnosis and a comprehensive management plan are essential to improve outcomes and quality of life for women affected by PCOS.