Polycystic ovarian syndrome: Enigma and ignorance

Summary

In polycystic ovary syndrome or PCOS, the name associated with the presence of multiple small cysts in the ovary, is related to anovulation, infertility and features due to higher than usual levels of male hormones. Alternative names used for this condition also include polycystic ovaries, polycystic ovary disease, Stein-Leventhal syndrome and polyfollicular ovarian disease. The signs and symptoms of PCOS manifest early after the first menstrual period during puberty. Excess androgen. Elevated levels of the male hormone can cause physical signs, such as excess facial and body hair (hirsutism), and sometimes severe acne and male pattern baldness. Unfortunately, frequently due to medical incompetence, the diagnosis is delayed till later life, compromising women's life quality. 

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a disease in which women has high levels of androgens (male) hormones. Many problems can occur as a result of this increase in hormones, including menstrual irregularities, infertility, skin problems such as acne and hair growth, and resulting psychological effects on sufferers. 

PCOS is linked to changes in hormone levels that make it difficult for the ovaries to release mature eggs. This also leads to the observation of ovarian follicles when an ultrasound scan is carried out. The reasons for the changes are not clear, as is the case with most disorders in medicine. The hormones affected in PCOS are estrogen and progesterone, the female hormones that help a woman's ovaries release eggs, and androgens, a male hormone found in small amounts in normal women. Normally, one or more eggs are released during a woman's menstrual cycle, a process that is known as ovulation. In most cases, the release of the eggs occurs approximately two weeks before the start of menstruation.

Most of the time, PCOS is diagnosed late in young women. Diagnosis is often not entertained in affected adolescent girls. Originally symptoms often begin when a girl's periods start. Affected girls often have a mother or sister with similar symptoms. Sadly, medics are not trained to consider the initial symptoms seriously, which include changes in the menstrual cycle, such as a missed menstrual period after having one or more normal menstrual periods during puberty (secondary amenorrhea ), irregular menstrual periods, range of period heaviness from very light to very heavy, extra body hair that grows on the chest and abdomen and around nipples and face, acne on the face, chest or back, skin changes such as thick or dark marks and skin folds around the armpits, groin, neck, and breasts. Gynaecologists and general practitioners are too arrogant to consider skin and hair changes to be a part of their consideration. This causes a diagnostic delay.

The consequence of a diagnostic delay

The textbooks written on PCOS describe as typical cases that are entirely a result of the professional incompetence of gynaecologists in making the diagnosis early. Development of male characteristics is not typical and not necessarily an outcome in PCOS, unless someone missed the diagnosis earlier on. When their own diagnostic incompetence afflicts sufferers, the 'experts' end up describing the following changes as typical sequelae: thinning of head hair in the temple area called male pattern baldness, clitoral enlargement, deepening of the voice, and decreased breast size. This should never happen in a health system that works well and pays attention to detail. Serious conditions associated with diagnostic delay lead to chronic conditions like insulin resistance and diabetes, arterial hypertension, high cholesterol, weight gain and obesity, and metabolic syndrome.

The healthcare provider, on suspicion of the diagnosis, may check weight, body mass index (BMI) and other bodily measurements. Blood tests may be done to check hormone levels, including estrogen, follicle-stimulating hormone, luteinizing hormone, male hormones (testosterone, DHEA), prolactin and thyroid functions. Other blood tests may include fasting glucose (blood sugar), tests for impaired glucose tolerance and insulin resistance, lipid levels amongst others. A pelvic ultrasound of the pelvis would need to look at the ovaries. If there is any doubt that a period delay may be due to pregnancy, a urine HCG test may be undertaken.

Treatment and prognosis

Weight gain and obesity is common in people with polycystic ovary syndrome. Losing weight, even in small amounts, can help treat hormonal changes, diabetes, high blood pressure, high cholesterol, etc. Birth control pills can make menstrual periods regular and, depending on the hormones in the pills, can also help reduce abnormal hair growth and acne. A diabetes medicine called Glucophage (metformin) may also be prescribed to make periods regular, prevent diabetes, and help lose weight. Effective hair removal methods include electrolysis and laser hair removal, and often these are repeatedly needed.

Other hormonal medications that may be prescribed include luteinizing hormone-releasing hormone analogs, clomiphene citrate and other medication that can cause ovaries to release eggs. Treatment to improve your chance of becoming pregnant should be given under supervision to detect multiple pregnancies early. With treatment, women with PCOS become pregnant close monitoring is needed as there is higher risk of spontaneous pregnancy loss, gestational diabetes and other complications.

Women with PCOS are more likely to develop endometrial cancer, diabetes, and obesity-related to complications

Conclusion

The wide variability of symptoms and signs associated with a universal disregard for concerns when they are first raised makes PCOS in women an enigmatic condition that exposes medical ignorance about its early diagnosis. The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss can reduce the risk of long-term complications, such as diabetes and heart disease.

Author: Professor Khalid Khan