5th year medical student
UTG Medical Students’ Association
Polycystic ovary syndrome (PCOS) is the most common chronic reproductive and metabolic endocrine disorder affecting women of childbearing age, its prevalence is estimated to be 4%–21% worldwide.
With “Poly” meaning many, and “cystic” meaning cysts related to; polycystic ovary syndrome is a mixed disorder characterized by a triad of too much male sex hormones, menstrual irregularities and many cysts in the ovaries. Therefore, patients can present with different manifestations of these three depending on the disease presentation, patient’s age, and lifestyle. However, most patients seek medical care because of the clinical symptoms of too much male sex hormone, menstrual irregularities and infertility.
Signs of PCOS
Clinical signs of an excessive amount of male sex hormones that are frequently seen in PCOS are hair growth on the face, abnormal loss of hair, and acne. A recent study showed that more than 80% of females with symptoms of beyond-normal male sex hormones are diagnosed with PCOS. Additionally, 70–80% of females with PCOS complain of a male-like pattern of facial hair growth on the lower face, chin, and neck.
Patients with PCOS may complain of scanty periods, not seeing their periods or dysfunctional uterine bleeding. In addition to infertility, PCOS can lead to serious complications such as metabolic syndrome, diabetes mellitus, abnormal metabolism of fats, cancers in the womb and diseases of the heart and blood vessels. Due to these complications, PCOS is considered a metabolic reproductive syndrome. Thus, women with PCOS should be diagnosed early, treated correctly and followed up carefully to avoid these detrimental effects.
How does PCOS result in infertility?
Polycystic ovary syndrome accounts for 80% of anovulatory (not releasing eggs) infertility. Generally, most patients with PCOS-induced anovulation have irregularities in their menstrual cycle, commonly amenorrhea or oligomenorrhea, combined with hyperandrogenism. PCOS may also cause weight gain which can lead to obesity.
Obesity accounts for 90% of infertility cases of PCOS. It is an independent factor of infertility and may cause many obstetric complications. Adiposity (body mass index (BMI) > 30 kg/m2) is correlated with anovulation, causing a higher risk for infertility due to an increase in the androgen (male sex hormone) concentration. Weight reduction in obese females with PCOS leads to improving the menstrual cycle and fertility due to the reduction in circulating insulin and androgen levels.
Management of PCOS- induced infertility
Infertility is the main reason for most obstetrics and gynaecology clinic visits by females complaining of PCOS. Fortunately, with the advancing scientific evidence-based therapeutic approach, there are many successful non-pharmacological and pharmacological treatments for PCOS-induced infertility. Since the main problem in PCOS is the fact that the ovaries are not releasing eggs, all treatments focus on stimulating or removing barriers that are preventing ovulation. These factors may range from lifestyle changes, diet modifications and medical, and sometimes surgical treatment. Sometimes treatment may employ a combination of two or more of these factors to increase the chances of ovulation and ultimately infertility.
Lifestyle modifications
Weight loss is considered the first line of treatment for obese females with PCOS seeking pregnancy. Weight loss through lifestyle interventions is considered the first-line treatment for all overweight or obese females (BMI >25 kg/m2) with PCOS. Several studies have shown that weight reduction of at least 5–10% of the total body weight can improve metabolic, psychological as well as reproductive disturbances associated with PCOS. These results have been associated with decreased insulin insensitivity, reduction of androgen levels, and restoration of ovulation.
Lifestyle modifications should involve eating a healthy hypocaloric diet and engaging in regular physical exercise for at least 3–5 days/week. Patients should be encouraged to decrease the consumption of saturated fats and refined carbohydrates while increasing protein-rich foods to promote satiety and improve insulin sensitivity
Medical treatment
Medical treatment may be in the form of hormones, drugs that stimulate ovulation, and drugs that may counter the effects of the excess male sex hormone in the body.
Surgical treatment on the other hand may be the last approach and can only be done based on absolute necessity but hopefully, lifestyle changes, dietary modification and medical treatment may work and surgical treatment will not be necessary in these cases.
Conclusion
In conclusion, many successful non-pharmacological (use of medications) and pharmacological treatments have been developed to treat this problem. Although ovulation induction is still the main intent of these treatment strategies, patients’ adherence to lifestyle interventions plays a major role in recovering their reproductive and metabolic health. Medications are used next in different orders and finally, bariatric surgery could be used to reduce body weight for obese females with PCOS when other solutions did not work.
