Polycystic ovary

POLYCYSTIC ovary syndrome a.k.a PCOS is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone levels.

The ovaries in this case may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

Stats show that PCOS affects 6.6 per cent or 4-5 million women in the world, making it the most common endocrine abnormality in women of reproductive age (The Journal of Clinical Endocrinology & Metabolism). This condition has a variety of symptoms and contributing factors, but the key features include menstrual cycle disturbance, hyperandrogenism and obesity, which are all things to look out for with a potential PCOS diagnosis.

The health consequences of PCOS are far-ranging and include:

 Infertility,

 Hypertension,

 Hyperlipidemia,

 Type 2 diabetes,

 Coronary artery disease and

 Cerebral vascular disease.

Up to 70 per cent of all PCOS patients are clinically obese, and women with PCOS are more frequently glucose intolerant or diabetic than their non-PCOS counterparts (The Journal of Clinical Endocrinology & Metabolism). They are also at greater risk for:

 Endometrial hyperplasia and

 Carcinoma

 As well as breast and ovarian cancers. Though there are many extra–ovarian characteristics of PCOS, ovarian dysfunction is a central component, which is why accurately diagnosing PCOS should include a pelvic ultrasound for ovarian assessment. Causes:

The exact cause of PCOS isn’t known. Factors that might play a role include:

 Excess insulin – insulin is the hormone produced in the pancreas that allows cells to use sugar, your body’s primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your blood might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation

 Low-grade inflammation - this term is used to describe white blood cells production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.

 Heredity - research suggests that certain genes might be linked to PCOS.

 Excess androgen – the ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne. Signs and symptoms of PCOS vary:

A diagnosis of PCOS is made when people experience at least two of these signs:

 Irregular periods- infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS.

 Excess androgen - elevated levels of male hormones may result in physical signs, such as excess facial and body hair and occasionally severe acne and male pattern baldness.

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

The PCOS complication includes:

 Infertility

 Gestational diabetes or pregnancy – induced high blood pressure

 Miscarriage or premature birth

 Nonalcoholic steatohepatitis - a severe liver inflammation caused by fat accumulation in the liver

 Metabolic syndrome

 Type 2 diabetes or prediabetes

 Sleep apnea

 Depression, anxiety and eating disorders

 Abnormal uterine bleeding

 Cancer of the uterine lining

Obesity is associated with PCOS and can worsen complications of the disorder.

The gold standard of ovarian imaging Polycystic ovaries are commonly seen during routine ultrasounds. The Lancet Journal reports that 23 per cent of women of reproductive age are likely to have polycystic ovaries. Only 5–10 per cent of these women, however, will have classic symptoms of PCOS such as

 Infertility;

 Amenorrhea; and

 Signs of hirsutism or obesity.

Those with polycystic ovaries should not be considered to have PCOS until additional workup is performed.

Ultrasound is used to identify and document the presence of polycystic ovaries. However, the presence of polycystic ovaries alone is insufficient for diagnosis. The expected appearance in ultrasound:

 Polycystic ovaries are enlarged and rounder than normal;

 It has numerous small cysts, less than 5mm, that line up on the periphery, in a “string-of-pearls” appearance; and

 Ultrasonography criteria for PCOS include 10 or more cysts that are 2-8mm in diametre and are peripherally arranged around an echo dense stroma as seen in the figure below.

Pelvic imaging cannot definitively diagnose PCOS, but it does provide invaluable information during the diagnostic process.

When imaging to assess for polycystic ovaries, Transvaginal ultrasound is considered the gold standard due to the optimal visualisation it provides of the internal structure of the ovary, particularly in obese patients. Compared with Transabdominal ultrasound, it is more effective for detecting the appearance of polycystic ovaries in women with PCOS.

With the addition of 3D ultrasound to the Transvaginal routine, it is even easier to assess and image the detail needed for accurate diagnosis of PCOS. The technology makes it easy to compare ovarian sizes, and a high resolution cine sweep makes it possible to record the ovary in real time.

Ovarian imaging, done with the right tools, is crucial in the evaluation of patients with suspected PCOS. The imaging report should specifically include ovarian volumes, follicle counts and any other relevant information, such as the presence of a dominant follicle or corpus luteum.

Although it is common to find polycystic ovaries during routine ultrasounds, it is important to be aware of the requirements for making a PCOS diagnosis, especially if patients are being assessed for other syndromes that may

Diagram: https://www. brainkart.com signal the presence of this condition.

Physicians who have the most current knowledge of clinical definitions and imaging capabilities will be able to confidently diagnose PCOS and take the appropriate next steps with their patients.

How can we help decrease the effects of PCOS

 Maintain a healthy weight- weight loss can reduce insulin and androgen levels and may restore ovulation. Ask your doctor about a weight-control program and meet regularly with a dietitian for help in reaching weight-loss goals.

 Limit carbohydrates - low fat, high carbohydrate diets might increase insulin levels. Ask your doctor about a low- carbohydrate diet if you have PCOS

 Be active - exercise helps lower blood sugar levels. If you have PCOS increasing your daily activity and participating in a regular exercise program may treat or even prevent insulin resistance and help you keep your weight under control and avoid developing diabetes.

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The Uterus - Female Reproductive System.