Pcos

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting women of reproductive age. Characterized by a combination of symptoms and signs, its etiology is multifactorial, involving genetic, environmental, and lifestyle factors. PCOS is associated with anovulation, hyperandrogenism, and polycystic ovaries, with its clinical manifestations ranging from menstrual irregularities and infertility to acne, hirsutism, and obesity. The syndrome is also linked to serious long-term health risks, including type 2 diabetes mellitus, cardiovascular disease, and endometrial cancer.

Etiology and Pathophysiology

The exact cause of PCOS remains unclear, but it is believed to involve a combination of genetic and environmental factors. Insulin resistance is a key pathophysiological feature, contributing to hyperandrogenism and anovulation. High levels of insulin stimulate the ovaries to produce excessive amounts of androgens (male hormones), which can prevent the ovaries from releasing an egg each month, leading to anovulation.

Clinical Features

Women with PCOS may present with a wide range of symptoms, including:

• Menstrual disorders such as amenorrhea (absence of menstrual periods), oligomenorrhea (infrequent menstrual periods), or menorrhagia (heavy menstrual periods)
• Signs of hyperandrogenism, including acne, hirsutism, and androgenic alopecia
• Obesity or difficulty losing weight
• Infertility due to irregular ovulation or anovulation
• Polycystic ovaries visible on ultrasound

Diagnosis

The diagnosis of PCOS is primarily clinical, based on the presence of two out of three of the following criteria (Rotterdam criteria): 1. Oligo- or anovulation 2. Clinical and/or biochemical signs of hyperandrogenism 3. Polycystic ovaries on ultrasound

Exclusion of other etiologies for hyperandrogenism and ovulatory dysfunction is also necessary.

Management

Management of PCOS focuses on symptom relief and prevention of long-term complications. Treatment options include:

• Lifestyle modifications such as weight loss and exercise, which can improve insulin resistance and reduce symptoms
• Hormonal contraceptives to regulate menstrual cycles, reduce androgen levels, and clear acne
• Anti-androgens such as spironolactone to reduce hirsutism and acne
• Metformin to improve insulin sensitivity and potentially aid in weight loss
• Clomiphene citrate or letrozole for ovulation induction in women desiring pregnancy

Prognosis

While PCOS is a chronic condition, symptoms can be managed effectively with lifestyle changes and treatment. Early diagnosis and intervention can reduce the risk of long-term complications.

Epidemiology

PCOS affects approximately 6-12% of women worldwide, making it the most common endocrine disorder among women of reproductive age.

See Also

• Endocrine system
• Insulin resistance
• Menstrual cycle
• Infertility