September is being observed as a PCOS awareness month to initiate a dialogue about this much misunderstood and misdiagnosed condition. As our knowledge of the role of hormones and the impact of hormonal imbalance continues to grow, we learn more about the ways to tackle this condition.
WHAT IS PCOS?
PCOS is an endocrine disorder characterised by 3 main features:
1) Irregular periods (which indicates that your ovaries are not regularly releasing eggs)
2) Excess facial or body hair (which indicates excess 'male' hormones in your body)
3) Enlarged ovaries with multiple, tiny fluid-filled sacs around the eggs.
NOTE: Despite the name 'polycystic ovaries', you DO NOT actually have cysts in your ovaries!
COMMON SIGNS AND SYMPTOMS OF PCOS
Irregular menstrual periods (which can include absent periods, frequent periods or unpredictable periods)
Excess hair growth
Acne
Oily skin
Weight gain
Infertility
WHAT ARE THE HEALTH RISKS FOR WOMEN WITH PCOS?
PCOS increases the risk of serious conditions like:
Diabetes
Heart Disease
Endometrial Cancer
WHAT INVESTIGATIONS WILL BE NEEDED?
Investigations are aimed at confirmation of the diagnosis of PCOS and also to rule out other conditions which can mimic the presenting features of PCOS like:
- Pregnancy
- Thyroid Diseases
- Hyperprolactinemia
- Premature Ovarian Failure, etc.
TREATMENT FOR PCOS
There is no cure for PCOS....But the silver lining on this dark cloud is that we can successfully tailor the treatment for each woman according to her target problem - Menstrual irregularity or excess hair growth or infertility.
NOTE: 'Lifestyle modification' is still the first line of management and includes intake of healthy, balanced diet and regular exercise to keep the Body Mass Index within the normal range.
With treatment, most of our women with PCOS are able to get pregnant.
Contact your Doctor to know more about the role of Insulin Sensitizers (Metformin), Myoinositol and Laparoscopic Ovarian Drilling in PCOS.
ACADEMIA
RECOMMENDATIONS FROM THE INTERNATIONAL EVIDENCE-BASED GUIDELINE FOR THE ASSESSMENT AND MANAGEMENT OF POLYCYSTIC OVARY SYNDROME
ASRM Pages. Fertility and Sterility 2018
DIAGNOSIS IN ADULTS :
Rotterdam PCOS Diagnostic Criteria (Any two of the following three)-
1) Oligo- or Anovulation
2) Clinical and/or Biochemical Hyperandrogenism
3) or Polycystic ovaries on ultrasound
after exclusion of related disorders.
Note: Where both Oligo- or anovulation and Hyperandrogenism are present, ultrasound is NOT necessary for diagnosis.
DIAGNOSIS IN ADOLESCENTS :
Criteria (Both required)-
1) Oligo- or Anovulation
2) Hyperandrogenism
Note: Ultrasound NOT recommended for diagnosis of PCOS in Adolescents.
INVESTIGATIONS
AMH - NOT recommended for Diagnosis of PCOS.
Insulin Resistance - Key Feature but NOT recommended at the current time.
MANAGEMENT:
Priority - Lifestyle intervention for management of excess weight.
Emotional wellbeing and quality of life.
For menstrual irregularity and Hyperandrogenism
First Line - Low dose Combined OCPs
For Metabolic Features
Metformin recommended alone or in addition.
For Infertility
First Line - Letrozole
(Clomiphene and Metformin - alone or in combination)
Second Line - Gonadotrophins
Third Line - IVF
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