Introduction
Polycystic ovarian syndrome is a common, enigmatic, complex infirmity that subjects patients to ovarian wedge resection. It is common in women of reproductive age, and chronic anovulation results in irregular menstruation, infertility, hirsutism, and obesity. A patient may have PCOS if they have polycystic ovaries, hyperandrogenism, and oligomenorrhea. Illness was first described by the American gynecologists Michael Leventhal and Irving Stein in 1935 (Cavalcante et al., 2019). The illness includes ovarian hyperthecosis, Stein-Leventhal syndrome, sclerocystic ovary syndrome, and functional ovarian hyperandrogenism.
Prevalence
According to Negris et al. (2020), PCOS affects 6% to 12% of United States women. Other studies have shown that prevalence in highly affected populations may increase to 21 percent. The prevalence of the illness varies in different ethnic and racial groups. A study by Wolf et al. (2018) indicated that PCOS is more common among Native Americans and Hispanics than African Americans and white women. The occurrence of the ailment appears to increase over time and is associated with changes in lifestyle and diet. PCOS has been more common in women with a history of the illness and those with obesity. It is additionally higher in women with other illnesses such as mental health disorders, heart diseases, and diabetes.
Pathophysiology
The pathophysiology of PCOS will discuss four interrelated topics that include its pathogenesis, etiology, treatment implications, and clinical manifestation.
Pathogenesis of PCOS
Polycystic ovaries form after ovaries are stimulated to produce higher levels of androgens, especially testosterone. This situation arises once the anterior pituitary releases excess luteinizing hormone and hyperinsulinemia in individuals with reduced sex-hormone binding globulin, causing an elevation in free androgens. This syndrome gained its name due to common signs seen during ultrasound examinations presenting mature follicles. The examination indicates that follicles have developed from the body of stage. On the ultrasound, the follicles appear as a string of pearls oriented along the periphery of the ovary.
Pathogenesis
PCOS patients release more gonadotropin hormone, resulting in Higher LH/ FSH ratios in women. Insulin resistance in the patients causes elevated abnormalities in the hypothalamic-pituitary-ovarian axis, leading to polycystic ovaries. The pulse frequency of the Gonadotropin hormone is increased by hyperinsulinemia. It additionally increases androgen formation, and LH’s dominance over FSH decreases the binding of SHBH and follicular maturation.
PCOS is characterized by the positive feedback of hyperandrogenism and insulin resistance, and in most cases, one is unable to determine which of the two the causative agent is. The fatty tissues contain an enzyme named aromatase that converts testosterone to estrogen and androstenedione to estrone. In obese persons, adipose tissue is in excess, resulting in more androgens responsible for virilization and hirsutism and more estrogens that prevent FSH through negative feedback. Chronic inflammation due to the illness may induce metabolic, endocrinal, and conformational changes that predispose a patient. Additionally, more androgen production results in decreased serum levels, which is the binding protein-1 (IGFBP-1) and increases free IGF-1 (Walters et al., 2018). PCOS is additionally related to mental retardation fragile x of sub-genotype 1 (FMR1).
Etiology
The exact etiology and underlying causes of polycystic ovarian syndrome are unknown. Insulin resistance is a major underlying cause of the disorder. The pancreas produces the hormone insulin that helps the cells use sugars, the basic energy supply. Insulin resistance results in blood sugar increasing more than normal, and the body react by generating more insulin to regulate these sugars. High levels of insulin results in the body releasing more male hormones called androgen, which can cause trouble with ovulation in the releasing of eggs by the ovary. A common sign is skin darkening, especially on the armpits, neck, under breasts, and groin. Another underlying cause is low-grade inflammation, where the white blood cells make a chemical that responds to injury and infections. This condition may result in blood vessel problems and heart diseases.
Hormonal imbalance is a common occurrence in women suffering from PCOS. The patient has raised testosterone, a higher prolactin hormone that stimulates milk production during pregnancy in the breast glands, and elevated luteinizing hormone that stimulates ovulation but may cause abnormalities when it is more than usual. Consequently, sex hormone-binding globulin levels are lower, a protein that binds testosterone to reduce its effects. Heredity may have additional results on the condition in patients. A family genetic history of the illness may be influential in acquiring this ailment.
Clinical Manifestations
PCOS clinical manifestation varies in different individuals and may range from mild to severe. Irregular menstrual flow is the major manifestation in patients. The individuals may experience prolonged and infrequent periods or may have no flow at all. These periods may affect their ability to give birth and cause symptoms such as bloating and abdominal pains. Another clinical manifestation is the production of excess androgen. The levels are higher than normal, causing alopecia, hirsutism, excess facial hair, and acne. Another characteristic is the presence of cysts in the ovaries. These cysts are small sacs filled with fluid that can cause discomfort and abdominal pains. The cysts may rupture, causing more complications for the patient. Females with PCOS are at higher risks of other ailments such as metabolic disorders and type 2 diabetes. Other risks include sleep apnea, anxiety, depression, and heart disease.
Treatment Implications
PCOS ailment does not have a specific cure, but treatment options available aim to reduce risks and alleviate symptoms related to the health issue. Oral contraceptives can be used as a medication that can help reduce the production of androgens and regulate the menstrual cycle by using birth control pills, which may be a combination of estrogen-progestin. Spironolactone is a form of anti-androgen that helps improve hirsutism related to excessive body and facial hair and decreases androgen levels (Ashraf et al., 2021). The patients may opt for cosmetic treatments or laser hair removal. Lifestyle changes are a significant practice in the treatment of PCOS. Weight loss can help improve the symptoms by improving fertility and regulating menstrual periods. Obesity is a major risk factor; hence, losing weight improves the condition. Frequent exercise and eating a balanced diet are essential to lower insulin levels in the body, improve insulin resistance and promote weight loss.
Fertility treatments are available for women trying to get pregnant, such as gonadotropin and clomiphene, which are recommended to stimulate ovulation. Patients who do not respond to fertility treatments may be recommended to use in vitro fertilization. Psychological support is significant for females experiencing PCOS..In addition to treatments, PCOS patients may be required to manage other health conditions associated with the illness, such as diabetes, insulin resistance, and heart disease. These conditions include lifestyle changes, follow-up care, regular monitoring, and specific medication.
Diagnosis
No single test is available to help with the diagnosis of PCOS. Healthcare professionals start by discussing symptoms, other medical conditions, and medications. The provider may make inquiries about weight changes and menstruation flow. Physical examinations may include signs of insulin resistance, excess hair growth on the body and face, and acne. The provider may then recommend the patient have a pelvic examination to assess the reproductive organs for growths, masses, and other changes. Blood tests can help measure levels of hormones and may exclude possible causes of excess chain that mimic PCOS. Blood tests such as triglyceride levels and fasting cholesterol may be involved, and tests for glucose tolerance can measure the patient’s response to glucose. An ultrasound may be recommended to check the appearance of ovaries and uterine wall thickening.
References
Ashraf, S., Rasool, S. U. A., Nabi, M., Ganie, M. A., Jabeen, F., Rashid, F., & Amin, S. (2021). CYP17 gene polymorphic sequence variation is associated with hyperandrogenism in Kashmiri women with polycystic ovarian syndrome. Gynecological Endocrinology, 37(3), 230-234. Web.
Cavalcante, M. B., Sarno, M., Cavalcante, C. T. D. M. B., Júnior, E. A., & Barini, R. (2019). Coagulation biomarkers in women with recurrent miscarriage and polycystic ovarian syndrome: Systematic review and meta-analysis. Geburtshilfe und Frauenheilkunde, 79(07), 697-704. Web.
Negris, O., Brown, D., Galic, I., Zhaunova, L., Klepchukova, A., & Jain, T. (2020). SUN-LB3 Relationship between BMI and PCOS symptoms Among Flo App users in the United States. Journal of the Endocrine Society, 4(1). Web.
Walters, K. A., Gilchrist, R. B., Ledger, W. L., Teede, H. J., Handelsman, D. J., & Campbell, R. E. (2018). New perspectives on the pathogenesis of PCOS: neuroendocrine origins. Trends in Endocrinology & Metabolism, 29(12), 841-852. Web.
Wolf, W. M., Wattick, R. A., Kinkade, O. N., & Olfert, M. D. (2018). Geographical prevalence of polycystic ovary syndrome as determined by region and race/ethnicity. International journal of environmental research and public health, 15(11), 2589. Web.