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Best Known PCOS Diagnosis and Treatment Options

Updated on June 23, 2020
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A certified medical doctor and a medical writer in the UK. Love to read,write,cook and travel.

Are you worried due to hormonal imbalance, male pattern hair growth, acne, unusual stomach discomfort, irregular menstruation, and difficulty to conceive? This article might help you.

Although numerous medical causes mimic such symptoms, these specific features may want to bring your attention to the PCOS (polycystic ovarian syndrome).

Its name suggests as if it is a dangerous, lethal, and cancer sort of disease. However, it is not that horrifying. It is just a hormonal disturbance, bringing those symptoms that are treatable. It has become easy to treat this condition with advanced diagnostic tools and medical treatments.

wikimedia commons
wikimedia commons

Polycystic Ovary Syndrome(PCOS)

Polycystic ovary syndrome is the most common hormonal disorder of females in their childbearing age that involves hormones as well as ovaries. In it, female suffers high levels of androgen hormones, irregular menstruation, and small cysts in one or both ovaries.
It could be possible that either ovarian changes or hormonal changes take place.

PCOS affects 1 in 10 women in their reproductive age.

This condition affects women when they are at the peak of their reproductive age, and most of the time, they are unaware until they face difficulty to conceive as PCOS causes infertility.

Females suffer PCOS in their 20s and 30s.

Two Major Root Causes

  • Obesity
  • Family history


Weight gain
Weight gain | Source

Mechanism Behind PCOS

For normal functioning, ovaries require insulin. The main problem begins when obesity causes insulin resistance, due to which ovarian tissues, instead of making estrogen produce androgens. As a result, high levels of androgen develop follicular arrest resulting in anovulation(no ovulation), menstrual abnormalities, infertility, and small single or multiple cysts in ovaries.

Research shows that high levels of GnRH hormones(gonadotropin-releasing hormone) from the brain stimulate ovaries to release more androgen, which adds up with androgen production due to insulin resistance.

PCOS Main Symptoms

Hormonal Symtoms
Ovarian Symtoms
Hirsutism(male-pattern excess body hairs)
Pelvic pain
Hair thinning/Hair fall
Infertility
Acne
Irregular menstrual cycles
Skin tags
Ovarian cysts

PCOS increases the risk of heart disease, breast, and uterus cancers.

Diagnostic Criteria

There is a criteria to diagnose PCOS, and we need two out of three signs in a patient to meet a definite diagnosis.

Rotterdam Criteria to Diagnose PCOS
Menstrual irregularities
Ovarian cysts (on ultrasound)
High levels of androgen

Diagnosis criteria: 2 out of 3 signs

Along with the diagnostic criteria, patients' blood tests, ultrasound, physical examination, and medical history are also necessary to figure out the causes of weight gain; hair growth pattern and to rule out other irregular menstruation reasons.

Blood Test for PCOS
Sonogram
 
Pelvic ultrasound
Free androgen index (FAI)
 
Testesterone(total+free)
 
FSH(Follicle stumilating hormone)
 
LH (Lutenizing hormone)
 
GnRH(Gonadotropin-releasing hormone)
 
Estrogen
 
OGTT(Oral glucose tolerance test)
 
Lipid profile
 

Ultrasound diagnoses more than 70% of PCOS cases.

Ultrasoun showing cysts
Ultrasoun showing cysts | Source

Clincal Signs Indicating PCOS

  • ↑ LH (Luteinizing hormone)
  • ↑GnRH (Gonadotropin-releasing hormones)
  • ↑ Prolactin(25%cases)
  • ↔Fsh (Follicular stimulating hormone)
  • Ultrasound showing polycystic morphology(at least 25 follicles in the ovary)


Later Consequences of Untreated PCOS

Studies show that about 50% of patients develop a prediabetic or diabetic state after they are diagnosed with PCOS. Also, there is a high chance of heart diseases, high cholesterol, hypertension, uterine and breast cancers.


Moreover, Pregnant ladies with PCOS possess a high risk of miscarriage, gestational diabetes(diabetes during pregnancy), and premature baby birth. It is recommended that if they reduce their weight before planning a pregnancy, it would be beneficial to both mother and baby.

Modes of PCOS Treatment

As the exact reason causing PCOS is unknown, therefore treatment focuses on treating the symptoms. The main target of treatment includes treating anovulation, inhibiting androgen production, and reducing insulin resistance.

Main Goals of Treatment
Resume Ovulation
Inhibit excess androgen
Reduce insulin resistance

Non-Medical Treatment

Weight Reduction

The best treatment is weight reduction. It would reduce insulin resistance that lowers androgen production, reviving ovulation process, and fertility. Also, acne, excess body hairs, and hair fall symptoms would improve.


A 5% reduction in the overall weight can significantly improve PCOS symptoms.

Source

Cosmetic Hair Removal Procedures

Wax, creams, shaving, threading, electrolysis, and laser treatments are well known and effective ways to remove hair growth due to androgens.

Plucking hairs and waxing skin are a cheap and quick way to achieve hair-free and smooth skin. But, it causes ingrown hair, redness, acne, rash, and inflammation.

Laser hair removal and electrolysis are a painless and advanced technique, but it is expensive. Also, don't expect overnight results from these procedures as hair growth regress after a few sittings.

Hair removal by wax, cream, and epilator would regrow hairs after some time. Similarly, although cosmetic treatment removes unwanted hairs permanently, the underlying disease is still present. Having said that, Medicine takes time to resolve hirsutism, but it clears the root cause of disease, provoking the symptoms.

Source

Medical Approaches

Clomiphene Citrate (Clomid)

This medicine is the ultimate hope for patients wishing for pregnancy, as it is the first-line treatment for PCOS patients facing infertility. It boosts ovulation in each monthly cycle. Initial treatment follows for a few days. Dosage can be increased if ovulation doesn't occur or if ovulation occurs, but fails to conceive. It is not recommended after three courses of therapy. However, you can consider further treatments after some gap. Its side effects include ovaries enlargements, multiple pregnancies, bloating, and discomfort.



Clomiphene has a 30% successful pregnancy rate.

Anti-diabetic Medications

Metformin normalizes blood glucose levels and reduces insulin resistance by stimulating cells to take glucose by increasing their insulin sensitivity.

Metformin+ clomiphene combination ensures better ovulation and fertility outcomes. Studies have proved that metformin with the clomiphene brightens more chances of pregnancy and live births than metformin alone.

Side effects of metformin are stomach pain, diarrhea, nausea, and vomiting.

Pioglitazone is another blood-glucose-lowering drug, also useful for PCOS. Although it lowers fasting blood glucose levels in the body, metformin also helps in reducing weight.

Source

Gonadotropins Injections

Pituitary glands in the brain release gonadotropin hormones. They act upon reproductive organs such as testes and ovary to produce sperms and eggs. There are two main gonadotropins; LH(luteinizing hormone) and FSH(follicular stimulating hormone).

Studies show low concentrated FSH injection is more effective in promoting pregnancy than clomiphene. But doctors consider clomiphene as the first therapy because it is less expensive, and patients take it orally.

Studies reveal that if we increase Fsh hormones in PCOS females, it will resume follicular development and ovulation in them.

Multiple pregnancy is the side effect of Gonadotropins injection.

Letrozole

This medicine is used against hormone-sensitive breast cancer. Besides, it induces ovulation in the PCOS. However, it doesn't prove to increase the pregnancy rate. It is not as effective as clomiphene in inducing ovulation and pregnancy, but it can be used in those who failed to respond clomiphene or can't use other treatments due to side effects.

Androgen Antagonist Drugs

Spironolactone, flutamide, and finasteride are three classes of drugs against androgen. Spironolactone is more used as it is cheap and safe as compared with others. It lower androgen levels, improving hair fall, extra body hairs, acne, and blood lipid levels

Oral Contraceptive Drugs (OCPs).

Combined OCPs(estrogen+progesterone) are another way to treat PCOS. They are ideal for treatment if the patient doesn't want to get pregnant. They revive ovulation, regulate menstruation, improves acne, and regress hirsutism(excess hairs) within six months of its use. Research proves that Hirsutism improves significantly if oral contraceptives are used with ani androgen drugs(spironolactone).

Oral Contraceptive Pills
Oral Contraceptive Pills | Source

Anti-Acne Medications

Over the counter, topical creams and ointments such as Clindamycin gel, Benzoyl peroxide, Retinol(vitamin A) gel/cream can be used to calm mild and moderate acne. Side effects of topical creams for acne are dry, flaky, and itchy skin.

Consult GP if you suffer nodular or cystic acne, as it requires Retinoic acid(vitamin A) and antibiotics to treat severe acne.

Anti-acne gel for acne
Anti-acne gel for acne | Source

Laproscopic Procedure

It is a minor surgical procedure in which the doctor operates by drilling ovaries to destroy those ovarian tissues producing androgen hormone. Studies show that it also favors FSH production, promoting ovulation.

Nutshell

It has become much easier to treat PCOS like never before. Clomiphene appears best for PCOS with infertility, and oral contraceptives if there is no desire for pregnancy. Spironolactone works miracles if male-pattern body hairs and acne are the predominant issues. Due to the advancements in healthcare sciences and clinical practice, best of best alternative treatment options for PCOS are available. Now a woman, with PCOs, can think of giving birth and getting rid of unwanted symptoms of hormonal imbalance.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

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