What is Polycystic Ovary Syndrome (PCOS) - Symptoms, Causes and Treatment of PCOS

Polycystic ovary syndrome (PCOS) is one of the most common hormonal endocrine disorders affecting a woman's hormone levels and causing enlarged ovaries with small sacs on the outer edges and failure to release eggs regularly. 
Women with PCOS produce a higher amount of male hormones than normal. This hormone imbalance causes them to skip their menstrual cycle, increases androgen (sex hormone) levels, acne, excess hair growth, and obesity and makes it difficult for them to become pregnant. 

Polycystic ovary syndrome (PCOS) is a hormonal disorder

Polycystic Ovary Syndrome (PCOS) - Symptoms, Causes, Complications, Diagnosis and Treatment

PCOS: Introduction

Before we proceed further, it is important to know some important things which are very helpful in understanding polycystic ovary syndrome (PCOS) well. Let’s start!

Androgens

What are androgen hormones?

Androgens are the group of sex hormones needed for different processes like growth, reproduction, and well-being. 
Androgens are male hormones that give men their 'male' characteristics and are responsible for the emergence and development of male traits and reproductive activity, but they are produced in both female and male bodies. 
Androgens play a different role in both the female and male bodies. Androgen deficiency means the man has lower levels of sex hormones, particularly testosterone. 

The male testicle secretes the most important hormone called testosterone from the androgen hormone group. 
While the adrenal cortex secretes other androgen hormones in small amounts, as other androgens support the function of testosterone. 

In women, androgens are produced in the ovaries, adrenal glands, and fat cells. 
As for the role of androgen hormones in the female body, it is secreted in small quantities before puberty, and after puberty, more quantities of androgen hormones are secreted that lead to the emergence of hair in the armpit and pubic area. 
Also, these hormones have many other functions in a woman's body, the most important of which is to be converted into female hormones called estrogens.

Naturally, androgens are excreted in a man’s body more than in a woman’s body. The occurrence of any defect in the proportion of these hormones, whether increase or decrease leads to the emergence of a defect in the body. 
When the secretion rate of androgens decreases in a woman’s body, there is a gradual decrease in the woman’s sexual desire and breast atrophy, and the menstrual cycle stops. 
This is what happens naturally in a woman's body when she reaches menopause, as the secretion of androgens decreases from the adrenal cortex and ovaries.

Increased secretion of androgens in a woman’s body affects a woman’s aesthetic appearance, and causes problems in her psyche and health, as increased levels of androgens lead to an increase in unwanted hair on the body and face, and occurrence of acne, this creates for women a feeling of lack of self-confidence, anxiety, and frustration. 
The increase in androgen in the body increases the insulin resistance that may pave the way for the onset of diabetes due to other health problems it carries.

Read More: Glands in Endocrine System and Mechanism of Hormone Action

Ovaries

What are ovaries in the female reproductive system?

The ovaries are the female gonads - the primary female reproductive organs. 
Ovaries are part of the female reproductive system and are located in the area between the hips specifically in the lower part of the abdomen. 
The ovaries work to produce the estrogen and progesterone hormones, in addition to protecting the eggs, a female is born with and releasing eggs into the female reproductive tract at the mid-point of each menstrual period. 
The fate of produced eggs is either fertilization or descending in the form of blood as part of the monthly cycle. 
The ability of the ovaries to do their job is affected as you age and approach menopause.

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is an endocrine system disorder common among women of reproductive age that affects a woman's hormone levels, causing enlarged ovaries with small cysts on the outer edges. 
PCOS causes a loss of hormonal balance in a woman's body so that the percentage of androgen and estrogen hormones increases, which causes many problems. 
High androgen levels lead to interference with the prevalent ovarian follicles process, and high estrogen leads to anovulation, in addition, PCOS is the most common cause of Hirsutism or - Excess hair in women (or men) on parts of the body where the hair is usually absent or minimal.

There are four types of polycystic ovary syndrome: Insulin-resistant PCOS, Hidden-cause PCOS, Inflammatory PCOS, and Pill-induced PCOS.

Read more: Hormone Interactions with Target Cells - How Do Hormones Control Your Life?

Symptoms of Polycystic Ovary Syndrome

The most common symptoms experienced by women with PCOS include:

➤Irregular menstruation or no periods at all, this differs from one woman to another, as some of them suffer from the low number of menstrual periods per year and some of them suffer from the absence of the menstrual cycle. Others suffer from heavy blood flow during the menstrual cycle.
➤Hirsutism, i.e. excessive body and facial hair growth, usually on a woman’s body in the chest, face, abdomen back or buttocks and the nature of facial hair is darker and denser than usual.

➤Difficulty getting pregnant, women with PCOS may experience infertility (because of failure to ovulate or irregular ovulation)

➤Weight management difficulties including weight gain or having difficulty losing weight, as there are about 50-60% of women with PCOS suffering from obesity.

➤Type 2 diabetes, 8% of women with PCOS have type 2 diabetes.

➤Changes in the tone of the voice as it becomes rougher.

➤Thinning hair and hair loss from the head area.

➤Acanthosis nigricans, or dark patches of skin

➤High cholesterol and triglycerides

➤Acne, oily skin, and dandruff

➤Other symptoms of PCOS may include:

• Decreased sexual desire.
• Female pattern balding
• Excess androgen levels
• Depression and anxiety
• High blood pressure
• High stress levels
• Insulin resistance
• Decreased libido
• Sleep apnea
• Pelvic pain
• Infertility
• Skin tags
• Fatigue

Read more: The Most Common Diseases of the Endocrine System

Causes of Polycystic Ovary Syndrome 

Doctors believe that an increase in the androgens - the generic name for a group of male hormones - in a woman's body has a role in polycystic ovary syndrome, as it affects the ability of the ovaries to do their job as required, and this case may be accompanied by the occurrence of hirsutism and the appearance of acne. 
The problem of increasing androgen levels is one of the most frequently discussed problems for women - who are still in their childbearing age.

In fact, the exact cause of PCOS is unknown, but there are many factors that may contribute to an increase in the androgens and the occurrence of the ovarian cyst problems, including the following:

Hereditary and genetic factors: Some genes contribute to the occurrence of polycystic ovary syndrome, as it is noted that more than one case of polycystic ovaries appears within the same family.

Insulin resistance: The occurrence of insulin resistance is mostly due to weight gain. This resistance means that the body produces sufficient quantities of insulin, but the cells are unable to use them properly. 
In this case, the body's need for insulin increases, which stimulates the pancreas to produce more of this hormone. 
The increase in the hormone insulin contributes to stimulating the ovaries to increase the secretion of androgens. In fact, obesity and insulin resistance increase the risk of developing type 2diabetes.

Infections: Women who are overweight are more likely to develop infections and thus increase the level of androgens. 
It should be noted that the occurrence of infections is linked to the emergence of other problems related to the heart and blood vessels.

Androgen Excess Medication: Taking some androgen excess medications as Danazol in a large quantity may cause PCOS.

Othe causes of PCOS: Other risk factors for PCOS may include:

• Androgen-secreting tumors such as ovarian and adrenal tumors.

• Congenital adrenal hyperplasia.

• Cushing's syndrome.

• Hyperprolactinemia.

• Hypothyroidism.

Complications of Polycystic Ovary Syndrome

The incidence of polycystic ovary syndrome makes women more likely to experience multiple complications, including the following:

Weight gain: The percentage of women with polycystic ovaries who suffer from obesity is about 75%, and most of the body fat, in this case, is concentrated in the abdominal area. 
Obesity also increases the risk of many problems including insulin resistance, type 2 diabetes, reproductive problems, and infertility, in addition to cardiovascular problems such as high blood pressure. 
This can be monitored and inferred at the level of weight gain and how it relates to these problems, by measuring the body mass index (BMI) and waist circumference.

Prediabetes or type 2 diabetes: The risk of developing pre-diabetes or type 2 diabetes increases in cases of polycystic ovary syndrome by 4 to 7 times. It is worth noting that women who suffer from obesity and polycystic ovaries are more likely to develop gestational diabetes.

Metabolic Syndrome: This syndrome represents a group of health conditions that are linked to each other. 
These health problems may include type 2 diabetes, obesity, cardiovascular disease, high cholesterol level, and high blood pressure, in addition to a problem of impaired glucose tolerance.

Cardiovascular diseases: Polycystic ovaries can contribute to the occurrence of many factors that increase the risk of occurring when developing cardiovascular diseases, including high fats and cholesterol, especially harmful cholesterol, and high blood pressure, in addition to the high level of inflammatory proteins.

Endometrial cancer: In this case, the occurrence of endometrial cancer is due to the effect of polycystic ovaries in the menstrual cycle so that it becomes irregular; this in itself may cause a condition called Chronic Anovulation, which causes the thickness of the endometrium to increase, resulting in an increased risk of developing abnormal cells that will develop into cancerous cells over time.

Diagnosis of Polycystic Ovary Syndrome

The symptoms that the patient suffers from are recognized first, then a clinical examination to detect the location of excess hair, a blood pressure check, and a knowledge of the length and weight of the patient to calculate the body mass index, as it is possible for the doctor to notice through the clinical examination swelling in the ovaries in the pelvic region, or see an enlarged or swollen clitoris.

 Also, the doctor may ask to do some tests, such as a blood test to find out the percentage of sexual hormones in a woman, an examination of thyroid hormones, and an examination of the percentage of sugar and fat in the blood.

Sonar should be done to the pelvis to detect the presence of ovarian cysts, and to exclude any other problems.

Criteria for the diagnosis of PCOS

According to the Rotterdam consensus criteria and the National Institutes of Health (NIH) criteria, the diagnosis of PCOS involves two of the following three features of the syndrome:

Oligo- or anovulation, this is recognized by irregular menstruation.

Clinical and/or biochemical signs of hyperandrogenism.

Polycystic ovaries, where this is revealed by making a Transvaginal Scan Ultrasound (TVS Ultrasound) with pelvic echo.

Treatment of Polycystic Ovary Syndrome

A set of tests are conducted to ensure that a woman has polycystic ovary syndrome, including physical examination, pelvic examination, ultrasound scan and blood test. 
After the woman is diagnosed with PCOS, a treatment plan appropriate to the patient's condition is established. The treatment includes the following:

Lifestyle Changes

Reducing weight through a low-calorie diet in addition to moderate exercise will contribute to improving symptoms of PCOS, improving cholesterol levels, reducing insulin, reducing the risk of heart and diabetes, and regulating the menstrual cycle. 
Weight loss has a role in increasing the effectiveness of medications recommended by the doctor for the treatment of PCOS. 
Many women with this syndrome benefit from losing their extra weight, so this step works to restore balance to their hormones and regulate their menstrual cycle.

It is worth noting that smoking increases the androgen hormones in the body, so stopping smoking is also an important step in treatment.

Medications

The doctor prescribes some medications to help regulate the menstrual cycle and regulate ovulation in addition to controlling symptoms of the disease. The most prominent of these medications are:

Oral contraceptives (birth control pills): Taking medications that contain the estrogen and progestin hormones daily helps restore normal hormonal balance, reduce androgen production, relieve symptoms, regulate ovulation, as well as prevent endometrial cancer. These hormones may come in the form of patches, or pills or vaginal rings.

Progestin treatment: Taking progestin for a period of 10 to 14 days every month or two has a role in organizing the menstrual cycle and protecting against endometrial cancer, and it should be noted that this type of treatment has no effect in preventing pregnancy or controlling androgen levels.

Clomiphene: Clomiphene is a fertility medication that is taken during the first part of the menstrual cycle to help pregnancy occur in women with PCOS. 
If the patient wants to become pregnant, getting rid of excess weight along with taking Clomiphene citrate can help the patient and increase her chances of becoming pregnant.

Anti-androgen medications: Anti-androgen drugs such as Spironolactone and Finasteride, primarily work to prevent excess androgenic hormones from being bound to its receptors in the body; thus, they are useful in treating skin problems and excessive hair growth.

Metformin (Glucophage): This medicine is used to treat type 2 diabetes and PCOS by improving insulin levels in the body.

Gonadotropins: A gonadotropin is a form of hormonal medication that is given by injection.

Letrozole: Letrozole is considered a treatment for breast cancer and is used in cases of PCOS to stimulate the ovaries.

Surgery

A simple surgical procedure called Laparoscopic ovarian drilling can be used to treat fertility problems associated with PCOS, by slitting a small needle in the abdomen attached to an electric current and inserting a small endoscope up to the ovaries, so that the tissues responsible for the production of androgen hormone are destroyed by heat or laser, in order to promote ovulation and reduce the levels of androgen hormones in the woman's body. 
The surgical solution is a short-term solution.

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