What Is Polycystic Ovarian Syndrome ( PCOS )?
Polycystic ovarian syndrome (PCOS) or Stein-Leventhal syndrome is a set of coherent anomalies, often (small) cysts are present in the ovaries. The deviations are probably caused by, or associated with, and hormonal abnormalities.
This develop in the ovaries (ovarian) multiple (poly) cysts. The eggs do not grow or irregularly, leaving no or irregular ovulation occurs and women irregularly or not menstruate. Because ovulation occurs irregularly or not at all these women are less fertile. Hormone treatment can remedy this.
It is estimated that about ten to fifteen percent of women PCOS. It is relatively more common among Indian women and Aboriginals. In Africa it is much rarer.
Pathogenesis
The pathophysiology of polycystic ovarian syndrome is complex. A specific cause can not be identified. Many changes in the metabolism play a role.
-Focus is on the relative increase in the production of luteinizing hormone by the pituitary gland, causing the production of androgens increases in the theca cells of the ovaries. Then be converted to androgens in the increased rate in androstenedione, which is then converted into testosterone. This process is enhanced by insulin.
-An enzyme defect in the steroid production by the ovaries.
-Insulin resistance, contributes to the metabolic and reproductive disorders
Polycystic Ovarian Syndrome Symptoms (PCOS Symptoms)
By an excess of testosterone may occur one or more of the following symptoms.
-Irregular menstruation (less than 9 times per year), or whole absence of menstruation
-Infertility / reduced fertility (due to anovulation)
-Acne, oily skin (seborrhea) and oily dandruff
-Hirsutism: increased body hair in a male pattern (upper lip, chin, around the nipples, the middle of the abdomen, lower back, inner thighs).
-Androgenetic alopecia: hair loss in male pattern (thinning on the crown, "coves")
-Cysts (vesicles) in the ovaries. These are immature follicles.
-Higher / elevated LDL-cholesterol and / or low HDL-cholesterol
-High blood pressure
-Places thickened and dark brown / black skin (acanthosis nigricans) in the neck, arms, underarms, breasts or thighs
-Called skin tags (skin tags), small warts or meat saplings in the armpits, around the neck and neck, or face
pelvic pain
-Anxiety or depression due to appearance or fertility problems
Other possible effects of polycystic ovarian syndrome: metabolic and cardiovascular abnormalities.
-Overweight and obesity, especially around the waist
-Type 2 diabetes or insulin resistance
-High blood pressure
-Cardiovascular disease
-Sleep Apnea
PCOS Diagnosis
Two of the three following symptoms must be present.
-Oligo- or anovulation (reduced or absent ovulation).
-Hyperandrogenism: excess body hair, acne, baldness, or a too high free testosterone levels in the blood. -The latter are laboratory tests available.
-The presence of multiple cysts, determined using ultrasound.
A number of issues should be excluded because they are symptoms that occur with polycystic ovarian syndrome (PCOS) can cause.
-Congenital adrenal hyperplasia (adrenal gland produces too much hormone)
-Cushing's syndrome
-Hyperprolactinemia or prolactinoma
-Primary hypothyroidism (underactive thyroid)
-Acromegaly (excessive growth hormone)
-Premature ovarian dysfunction
-Obesity (but does belong to the possible symptoms of PCOS)
-Masculinising tumor (in adrenal or ovarian)
-Drug-related symptoms (androgens, valproic acid, cyclosporine and other drugs)
Polycystic Ovarian Syndrome Treatment (PCOS Treatment)
Increased body hair and acne
A usual treatment is with an oral contraceptive which contains a combination of an estrogen and a progestogen. The choice of the pill is important; the progestogen that it contains, must not exhibit any androgenic effects is preferably used.
Flutamide is effective against excessive body hair but also potentially hefty side effects.
Reduced or absent menstruation
The cycle can be more regularly by the use of the pill. When you use the pill will not ovulating occur and you can not get pregnant. When you stop the pill can be again irregular.
Recently, it has been shown that lifestyle changes such as weight loss (about 5 percent), and healthy foods have a positive effect on the cycle and fertility. It is also true that a reduction of the insulin level also has a beneficial effect on the cycle and fertility. The insulin level can be reduced by the use of metformin, which due to its weight-reducing effect is also a good choice.
If fertility is not achieved with weight loss and metformin, one can consider hormone therapy. Ovulation can be relaunched by the drug clomiphene, optionally followed by treatment with follicle stimulating hormone. In practice, this is done by subcutaneous injections of Menopur *.
Insulin resistance, glucose intolerance and type 2 diabetes
Weight reduction is important in type 2 diabetes-related problems such as insulin resistance and glucose intolerance. Often drugs are used to enhance the beneficial effect of weight reduction. You then have the choice of metformin, tolbutamide, glibenclamide and the resources from the group of thiazolidinediones which may cause serious (cardiac) side effects (eg, pioglitazone (Actos) or rosiglitazone (Avandia)). Also, there is a natural remedy available to improve insulin sensitivity. This is the metabolite D-Chiro-inositol, which is also present in food, such as buckwheat, and carob. When using D-chiro inositol are no known side effects.