Polycystic Ovary Syndrome (also known clinically as Stein-Leventhal syndrome) is an endocrine disorder that affects approximately one in ten women. It occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility.

The principal features are weight issues, lack of regular ovulation or excessive amounts. The symptoms and severity of the syndrome varies greatly between women. While the causes are unknown, insulin resistance, diabetes and obesity are all strongly correlated with PCOS.

Polycystic ovary syndrome is characterised by anovulation (irregular or absent menstrual periods) and hyperandrogenism (elevated serum testosterone and androstenedione). Patients with this syndrome may complain of abnormal bleeding, infertility, obesity, excess hair growth, hair loss and acne.

In addition to the clinical and hormonal changes associated with this condition, vaginal ultrasound shows enlarged ovaries with an increased number of small (6-10mm) follicles around the periphery (Polycystic Ovaries). Polycystic Ovary Syndrome (PCOS) is estimated to affect about  6-10 per cent of women.

The condition appears to have a genetic component and those affected often have both male and female relatives with adult-onset diabetes, obesity, elevated blood triglycerides (Blood Fat), high blood pressure and female relatives with infertility, hirsutism (those who suffer from it tend to produce elevated levels of male sex hormones called androgens from their ovaries and adrenal glands.  This results in an excessive growth of dark, coarse body and facial hair) and menstrual problems.

Risks

Women with PCOS are at risk for the following:
Increased risk of strokes and heart attacks
Insulin resistance/Type II diabetes
High blood pressure
Cardiovascular disease
Weight gain
Miscarriage
Increased risk of endometrial cancer (cancer of the lining of the womb), particularly if they have infrequent or absent periods.

Diagnosis

Getting a diagnosis for polycystic ovary syndrome can be part of the battle with this disorder as often the typical PCOS symptoms do not seem to be related to each other, at least initially. This is why there are a number of steps involved when you are looking for a PCOS diagnosis. In addition to a regular check-up and physical exam, it is imperative to get some blood tests and perform an ultrasound.

A couple of blood tests will assist in making the diagnosis - one to check the level of androgens, such as testosterone. Another test will measure the hormones involved in egg development.

Since polycystic ovarian syndrome is so heavily associated with insulin resistance, you can also expect to have your blood tested for fasting glucose and insulin levels. In some cases, though, blood tests may show that your glucose levels are normal, in which case you may be asked to do an oral glucose tolerance test (OGTT) to double check that everything is actually fine.

Finally, your cholesterol levels may also be assessed. Ultrasound is usually done as an internal scan, meaning a small ultrasound probe is placed just inside the vagina, giving the best views of the ovaries and pelvic organs.

 Treatment

The treatment of PCOS depends on the intensity of the disease.
The treatment is directed towards persistent complaints, irregular or heavy periods, infertility, Hirsutism, acne or obesity. The following treatments can help in curing PCOs to an extent.

Changes in lifestyle are imperative.   Weight loss is an important part of this process. Hence it is essential to exercise daily, eat healthy food, even five per cent of loss of weight is beneficial in the treatment.

Insulin sensitizers

Insulin resistance is one of the features of PCOs. It can be corrected by giving drugs which improve insulin action. Even the drugs which are used to treat diabetes can be used. These drugs are Metformin and Rosightazone.
ART (Assisted Reproductive Techniques)
 When all of the above treatments fail, ART-IVF may be required.

The author is a gynaecologist,  Pulse hospital, Ahmedabad and can be contacted at 09824026659 or email drbanker@pulse-hospital.com