Essay: Polycystic ovary syndrome

The syndrome was known as Stein-Leventhal Syndrome, after the one who discovered it in 1930s.(Allahbadia) It could be present in young women or adolescents, and usually they have irregular symptoms like absent period and excess facial/body hair growth. It affects an estimated 5 percent to 10 percent of females and is associated with an increased risk of diabetes and obesity, and possibly an increased risk of stroke and cardiovascular disease. The disorder often characterised by ovary enlargement with small multiple cysts, and from there came the name “Polycystic ovary syndrome”. If POS not treated or diagnosed properly, overtime it may lead to cardiovascular or diabetes diseases (Ruffin).
Etiology
The causes of PCOS remain unknown, there is no single factor to point at as the causative of this syndrome. Doctors believe that the symptoms are caused by imbalanced hormones, mainly androgens, in a women’s body. There are also strong evidence that it could be genetics, due to some studies that found if a mother has PCOS, there is a 50% chance that her daughter will have PCOS. Researchers also think insulin may be linked to PCOS, approximately 40% of patients with diabetes or glucose intolerance between the ages of 20-50 have PCOS. Some recent data support that the prevalence of PCOS may increase with obesity.(“What Is PCOS”)
Hormones & PCOS
Hormones are chemical messengers in the blood, which carried out to organs and tissues of the body to exert their function. They take control of many different processes including growth and development, sexual function and reproduction. Men and women make both male and female hormones in different amounts in order for their bodies to work correctly, and any disruption in any hormone function will lead to abnormal condition or health problem(Eden). In case of PCOS the disturbance will be in the male hormone (androgens), such as testosterone, secreted in excess amount above the normal. High level of these hormones will affect the development and release of eggs during ovulation.
Insulin resistance & PCOS
Insulin is a hormone that is important for making glucose available for cellular metabolism. Women with PCOS their cells usually don’t response well to insulin, which make it difficult for the insulin to work in their bodies resulting in insulin resistance, and more insulin will be secreted. Excess of insulin appears to increase production of androgen which lead to acne, excessive hair growth, weight gain and problems with ovulation. If the pancreas can’t produce enough insulin to compensate for the insulin resistance, glucose builds up in the blood, eventually leading to type 2 diabetes. Insulin resistance causes an abnormal response in the ovary that results in an increase in the amount of circulating androgens that lead to hyperandrogenism (Fritz). 75 percent of women with PCOS have insulin resistance and about 10 percent develop type 2 diabetes by age 40. Insulin resistant in Ovulatory women with PCOS seem to be less than anovulatory women with PCOS (Adams et al., 2005). Confirmation of insulin resistance can be obtained by simple biochemical test (Mendoza).
Obesity & PCOS
Obesity has known effects on the clinical, hormonal and metabolic features. In massively obese women, the prevalence of PCOS may be higher than expected. In some studies, approximately 60% to 70% of women with PCOS in the United States were found to be obese (Azziz et al.). Obese PCOS women characterised by significantly low sex hormones and hyperandrogemia (particularly total and free testosterone) in comparison to normal weight PCOS women. Menstrual abnormalities could be more frequent in obese than normal weight PCOS women, And they are invariably more insulin resistant (Sakurai et al.).
Symptoms
The symptoms of PCOS can vary from woman to woman. The common  symptoms of PCOS include:
Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
Infrequent, absent, and/or irregular menstrual periods.
Hirsutism – increased hair growth on the face, chest, stomach, back, thumbs, or toes.
Cysts on the ovaries.
Acne, oily skin, or dandruff.
Weight gain or obesity, usually with extra weight around the waist.
Male-pattern baldness or thinning hair.
Acanthosis nigricans (patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black).
Pelvic pain with Anxiety or depression.
Sleep apnoea (breathing stops for short periods of time while asleep).
Infertility
PCOS is often the primary reason for an-ovulation and infertility. A sperm needs a mature egg to fertilise, women with PCOS some of them occasionally ovulate and some of them do not release the egg. There when infertility starts to happen (Costello and Ledger). The menstrual irregularity of PCOS is demonstrated in the peripubertal period, despite the fact that some women may have regular cycles at first and then subsequently develop some irregularity. Menses irregularity may be mild or sever oligomenorrhea (cycle length more than 35 – 40 days) or amenorrhea (no cycle for 6 months or more). Uterine bleeding and infertility are the consequences of anovulatory menstrual cycles (Lucidi).
Menstrual abnormalities
Normal ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus for fertilization. In women with PCOS, the ovaries doesn’t make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur, alternatively some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made, and Without progesterone, a woman’s menstrual cycle will be irregular or absent (womenshealth.Gov).
Skin
Increased facial and body hair is one of the most common symptoms for PCOS. A study showed 92 percent of women suffering from hirsutisim had PCOS on ultrasound. Presence of patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black such as Acanthosis nigricans.
Sleep apnea
Recent studies have shown that PCOS women may be at higher risk of having obstructive sleep apnoea syndrome (OSAS). It could be diagnosed questionably or by over night polysomnography (Diamanti-Kandarakis and Panidis). This sleeping disorder is more common to happen in the presence of obesity.
consequences
PCOS does not only affect the reproductive system, it can cause damage to many areas of the body. Insulin resistance can lead to type 2 diabetes millets and cardiovascular diseases. Also PCOS could be associated with metabolic syndrome, which contributes both diabetes and heart diseases. When the lining of the uterus becomes too thick due to the increased number of endometrial glands, it is called endometrial hyperplasia. This condition increase the risk of having endometrial cancer.   The American College of Obstetricians and Gynecologists (ACOG) recommends screening with 17-hydroxyprogesterone levels in women suspected of having PCOS (ACOG, 2009).
Diagnosis
PCOS has a wide range of symptoms which make it hard to be diagnosed. Women with PCOS are predisposed to type 2 diabetes or develop cardiovascular disease (Lakhani et al., 2004). Clinical manifestations show menstrual disorders and signs of hyperandrogenism. Insulin resistance and obesity are  extremely common accompaniments of this syndrome, even though they are not universal and not part of the definition (Ehrmann D, 2005). Rotterdam European Society have revised the diagnostic criteria for Human Reproduction/American Society of Reproductive Medicine (ASRM)-sponsored PCOS consensus workshop group in 2003, where the following criteria were established: oligo/amenorrhea, clinical and biochemical signs of hyperandrogenism, and sonographically confirmed PCOS (ultrasonography) (Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2004). A woman with PCOS must present with two as a minimum of three diagnostic criteria (AZZIZ, 2005). In practical work the Ultrasound procedure by far is the most frequent in finding polycystic ovaries (FRANKS, MCCARTHY and HARDY). Sometimes women with PCOS is recognized with sonographic findings but no evidence of irregular cycles and no clinical or biochemical signs of hyperandrogenism. However, other studies believe that hyperandrogenism should be an integral part of the definition (Azziz et al., 2006).
Medical History
Information about the women’s past and family medical history should be gathered by the doctor, including questions about menstrual cycles in detail, pregnancy history or infertility, weight changes, sleep patterns, fatigue, depression, medications that are taking, review of previous blood testing the patient have had and other medical history (Diamanti-Kandarakis and Farid).
Physical Exam
The exam will include measuring blood pressure, weight, and identifying the body mass index (BMI). They will examine the patient body for any signs and symptoms such as hair growth, skin discoloration, skin tags, acne and thinning hair. Sometimes women with metabolic syndrome signs may have high blood pressure. Also check if there is any diffuse or velvety thickening and hyperpigmentation of the skin, this is known as Acanthosis nigricans. It could be present at the nape of the neck, axillae, area beneath the breasts and exposed areas such as elbows and knuckles. Acanthosis nigricans is thought to be the result of insulin resistance in women with PCOS, and can be a cutaneous marker of malignancy.
Ultrasonography
Ovarian ultrasound can be performed to assess ovarian morphology. A pelvic ultrasonography should be preformed if the pelvic examination is inadequate, the patient has abdominal pain, testosterone levels are unusually high (eg, >200 ng/dL). Ultrasonography is needed to support the diagnostic criteria, whether the women has amenorrheic or not (assess the endometrial thickness and exclude anatomic causes of amenorrhea), and take images of the endometrial lining and look for multiple cysts (Bachanek et al.).