PCOS is recognized as a common endocrine disorder affecting women of reproductive age, with significant advancements in its diagnosis, treatment and management aimed at improving quality of life and long-term health outcomes.
PCOS is a hormonal disorder characterized by a combination of symptoms including irregular periods, elevated androgen levels and the presence of multiple small ovarian cysts. In comparison to normal ovaries, ovaries affected by PCOS typically exhibit a higher number of small follicles, irregular follicle development and associated hormonal imbalances. Proper diagnosis and management often involve a combination of clinical evaluation, ultrasound imaging and hormonal assessments.
Normal Ovary vs PCOS Ovary
Normal Ovary
- Appearance: Smooth surface; follicles at different stages of development.
- Follicles: A few follicles; one matures and ovulates each cycle.
- Size and Shape: Typically 3-5 cm; regular in shape.
- Hormones: Balanced levels; regular estrogen and progesterone production.
- Menstrual Cycles: Regular, about 28 days; ovulation occurs mid-cycle.
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PCOS Ovary
- Appearance: Thicker, sometimes irregular surface; "string of pearls" pattern on ultrasound.
- Follicles: Multiple small follicles (usually >12) around the edge; do not mature properly.
- Size and Shape: Can be slightly enlarged; thicker outer layer.
- Hormones: Elevated androgens; often insulin resistance.
- Menstrual Cycles: Irregular or absent periods; disrupted ovulation.
Symptoms:
- Irregular menstrual cycles: Infrequent, irregular, or prolonged menstrual periods.
- Excess androgen: Elevated levels of male hormones causing hirsutism (excess facial and body hair), severe acne and male-pattern baldness.
- Polycystic ovaries: Enlarged ovaries containing numerous small cysts.
- Weight gain: Especially around the abdomen.
- Darkening of the skin: Especially in body creases like those on the neck, groin and under the breasts (acanthosis nigricans).
- Thinning hair: On the scalp.
- Infertility: Difficulty in conceiving due to irregular ovulation.
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Causes:
- Hormonal imbalance: Excess insulin and androgens disrupt normal ovarian function.
- Genetics: Family history of PCOD or PCOS can increase risk.
- Low-grade inflammation: May contribute to the condition by stimulating polycystic ovaries to produce androgens.
- Lifestyle factors: Poor diet, lack of physical activity and obesity can exacerbate symptoms.
Diagnosis:
- Medical history and physical examination: Assessing symptoms and family history.
- Pelvic exam: Checking for enlarged ovaries or clitoral enlargement.
- Blood tests: Measuring hormone levels (androgens, insulin, thyroid hormones and others).
- Ultrasound: Imaging to detect cysts on the ovaries and assess their size and number.
Treatment:
- Lifestyle changes: Weight loss through a healthy diet and regular exercise can improve symptoms.
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Medications:
- Hormonal contraceptives: To regulate menstrual cycles and reduce androgen levels.
- Anti-androgens: To reduce hair loss, acne and excess hair growth.
- Metformin: To manage insulin resistance.
- Fertility treatments: Such as clomiphene citrate, letrozole, or assisted reproductive technologies for those trying to conceive.
- Cosmetic treatments: For hair removal and acne management.
Recovery and Management:
- Regular follow-ups: Ongoing monitoring with a healthcare provider to adjust treatments as necessary.
- Healthy lifestyle: Maintaining a balanced diet, regular physical activity and healthy weight.
- Support: Joining support groups or seeking counseling can help cope with emotional and psychological aspects.
- Medication adherence: Consistent use of prescribed medications to manage symptoms effectively.
- Education: Understanding the condition and its impact can empower individuals to take an active role in managing their health.
Prognosis
PCOD is a chronic condition but can be effectively managed with lifestyle changes and medical treatment. Early intervention and consistent management can improve symptoms, reduce complications and enhance quality of life.
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