Polycystic Ovarian Syndrome (PCOS) is a prevalent endocrine disorder, affecting approximately 6-10% of women of reproductive age worldwide. The precise cause of PCOS remains unknown, but it is considered to be multifactorial, with both genetic and environmental influences playing significant roles. There is evidence to suggest that insulin resistance, low-grade inflammation, and hormonal imbalances are key contributors to its development. It is believed that insulin resistance, which is associated with obesity, diabetes, and metabolic syndrome, may drive the ovaries to produce excessive amounts of androgens. This excessive androgen production subsequently disrupts the normal development of follicles in the ovaries, leading to menstrual irregularities and the hallmark polycystic appearance of the ovaries on ultrasound. 

The main symptoms of PCOS may vary widely from person to person and may include:

1-Irregular Periods: This is the most common symptom. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year), or their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods.

2-Heavy Bleeding: The periods you do get can be heavier than usual.

3-Excess Androgen: Elevated levels of male hormones may result in physical signs, such as excess facial and body hair (hirsutism), severe acne, or male-pattern baldness.

4-Polycystic Ovaries: Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.

5-Weight Gain: Many women with PCOS experience weight gain or difficulty losing weight.

6-Skin Changes: Darkening of skin under breasts, in the groin, and along neck creases. Skin tags may occur as well, particularly in the armpit area.

7-Fertility Problems: PCOS is one of the leading causes of infertility in women.

8-Hair Loss: Thinning hair or male-pattern baldness can occur.

9-Fatigue: Many people with PCOS report increased fatigue or low energy.

10-Type 2 Diabetes: PCOS increases the risk of type 2 diabetes and insulin resistance.

11-Mood Disorders: Both depression and anxiety are more common in women with PCOS.

The Rotterdam criteria is a set of standards that physicians use to diagnose polycystic ovary syndrome (PCOS). According to these criteria, two out of the following three characteristics must be present for a diagnosis:

a) Oligo- and/or anovulation: This is when a woman has irregular or absent menstrual periods. Oligomenorrhea is defined as having fewer than 8 menstrual cycles per year or menstrual cycles longer than 35 days. Anovulation is the absence of ovulation.

      b) Hyperandrogenism:  can be clinical (observed) or biochemical (detected through blood tests). Clinical hyperandrogenism may include hirsutism (excessive hair growth in a male pattern), severe acne, or alopecia (thinning hair or balding). Biochemical hyperandrogenism involves higher than normal levels of androgens (male hormones) in the blood.

c) Polycystic ovaries on ultrasound: On an ultrasound, the ovaries appear enlarged and contain many small follicles clustered around the edge of the ovaries. It's important to note that it's possible to have polycystic ovaries without having PCOS, and conversely, it's possible to have PCOS without polycystic ovaries appearing on an ultrasound.

The most common treatments for PCOS:

A) Lifestyle changes:

1-Weight loss: Losing even a small amount of weight can help improve insulin sensitivity and reduce androgen levels. A healthy diet and regular exercise are the best ways to lose weight.

2-Diet: Eating a healthy diet can help improve your overall health and reduce your risk of developing other health problems, such as heart disease and diabetes. A healthy diet for PCOS should be low in processed foods, sugary drinks, and unhealthy fats. It should be high in fruits, vegetables, and whole grains.

3-Exercise: Regular exercise can help you lose weight, improve your insulin sensitivity, and reduce androgen levels. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.

B) Hormonal therapy:

1-Birth control pills: Birth control pills can help regulate your periods, reduce androgen levels, and improve acne. They can also help protect against endometrial cancer.

2-Metformin: Metformin is a medication that helps your body use insulin more efficiently. It can help improve insulin sensitivity, reduce androgen levels, and help you lose weight.

3-Other medications: There are other medications that can be used to treat PCOS, such as clomiphene and letrozole. These medications can help induce ovulation and improve fertility.

C) Surgery:

1-Laparoscopic ovarian drilling (LOD): LOD is a surgical procedure that can help restore ovulation in some women with PCOS. During LOD, small holes are made in the ovaries using a laparoscope, a thin tube with a camera attached. The holes are then cauterized, which damages the tissue that produces androgens.

August 2023.