Polycystic ovarian syndrome is the commonest endocrine abnormality affecting woman.
The features of PCO are irregular menstrual cycles, skin problems like acne, hirsutism and obesity. It is best described as a condition resulting from a hormonal imbalance.
The high levels of the hormone LH, stimulates the ovary to produce an excess of male hormone.
The increase in testosterone causes skin problems like an oily skin, acne, increase in facial and body hair and thinning of the scalp hair.
The increase in the hormone LH, also prevents the follicles (eggs) with the ovary from maturing, thus preventing ovulation. This results in an irregular menstrual cycle. Some woman can have a 35 to 40 day cycle, some can have a period every 2 to 3 months or 1 to 2 periods per year. This is called oligomenorrhea / amenorrhea.
The diagnosis of PCO can be confirmed by blood tests and ultrasound. The ovaries typically has a beaded and honeycomb like appearance on ultrasound.
Polycystic ovarian syndrome is genetic in origin and tends to run in families. It is also related to obesity. Weight gain can often exacerbate the symptoms of PCO. PCO is often a marker for diabetes. Woman with PCO have a strong family history diabetes and they are at risk of developing diabetes. They are insulin resistant – their fasting levels of insulin are high. Metformin/ Glucophage improve ovulation rates, assist in weight loss and may prevent the development of diabetes during pregnancy.
Woman with PCO present to the gynaecologist with abnormal periods, skin problems and infertility.
Diane 35 / Ginette is prescribed for cycle regulation and skin problems. Roacutane is prescribed for severe acne.
Women seeking fertility treatment, are prescribed ovulation inducing drugs.
Clomiphene Citrate (Clomid / Fertomid) is the commonest medication given to induce ovulation. Ultrasound monitoring is important to track the mature follicle and timing of ovulation. Some woman may be resistant to ovulation with Clomid. Letrozole (Femara) is prescribed for the above. Gonadotropin injections (Gonal f / Menopur) are given in special circumstances.
Laparoscopy ovarian drilling is recommended for woman that fails to ovulate on Clomid and Femara. This is a procedure where the ovaries are drilled with an electric current. Usually 6-10 puncture holes are made into each ovary. About 70% of woman will spontaneously ovulate following the procedure, thereby improving their chances of spontaneous pregnancy. However the benefit of the procedure may be for a few months only.