Polycystic ovary syndrome

Diagnosis

PCOS has no specific diagnostic test and women are diagnosed after an examination, in which the doctors ask about the symptoms and medical history, including the family’s medical history. The doctor will likely take patient’s weight and blood pressure as part of the examination as well as a physical exam particularly for hirsutism, thinning hair, insulin resistance and acne is also performed.

The doctor may also order the following:

• Pelvic examination: Find problems with ovaries or other reproductive system organs by the doctor inserting gloved fingers into the vagina and feeling for any growths or changes in the uterus or ovaries.
• Ultrasound: This uses a device called a transducer to produce the sound waves to determine abnormalities in the uterus and ovaries. The condition of the ovaries and the thickness of uterus lining is examined through the ultrasound.
• Laboratory tests: This test aims to evaluate hormone and glucose levels. Levels of triglycerides, insulin and cholesterol is also measured to assess the risk for diseases like diabetes and heart disease. This testing can rule out other reasons of irregular menstruation or androgen excess that resemble PCOS.

Women may be required to closely monitor their health for any complications related to the diagnosis of PCOS. Several tests may be necessary:

• Monitor blood pressure, glucose tolerance, and cholesterol and triglyceride levels
• Assessment for depression and anxiety symptoms
• Assessment for obstructive sleep apnea

Treatment

The treatment plan for PCOS depends on the signs and symptoms experienced by the patient. Since PCOS has no definite cause, the treatment will focus on the management of the symptoms such as thinning of hair, excess hair growth, acne, infertility, and obesity as well the medical history. Generally, the treatment comprises of medications, lifestyle changes or both.

• Lifestyle changes: Research shows that symptoms of PCOS including problems with menstrual cycle may be addressed with just a 5 to 10 percent weight loss. A woman’s ideal weight-loss strategy is best discussed with the doctor and a qualified dietician. The doctor could advise losing weight by following a healthy diet and exercising. Losing weight can aid with infertility, boost the effectiveness of PCOS drugs, improves ovulation, and lowers risk for diabetes and heart disease.
• Medications: To improve the menstrual cycle and other symptoms of women with PCOS, doctors may prescribe:
• Combination birth control pills: Normalizing the hormones can reduce the chance of endometrial cancer and get rid of acne, excess hair growth, and irregular bleeding. Combination pills contain estrogen and progestin which reduce androgen production and control estrogen.
• Progestin therapy: This is recommended for women who are not allowed to take estrogen due to medical conditions. Progestin may come in a pill, patch, or vaginal ring. The choice will depend on whether the patient is considering pregnancy or not. Progestin-only mini-pill or progestin-containing intrauterine device is a preferable option for those who want to prevent pregnancy. The use of progestins for a specified period can regulate ovulation, relieve PCOS symptoms, regain hormonal balance and reduce risk for endometrial cancer.

Women with PCOS who wish to get pregnant may be prescribed by their doctor with medications, such as:

• Clomiphene: This medication is proven to cause ovulation or treat infertility in women with PCOS. It is an anti-estrogen medication taken orally, which increases the chances of twins and multiple births.
• Gonadotropins: This medication aims to induce ovulation. This medicine is administered by injection.
• Letrozole: Fights a few forms of breast cancer by stimulating the ovaries. It functions by reducing the amount of estrogen the body produces, which slows or halts the growth and spread of breast cancer cells.
• Metformin: This drug works by helping the body effectively process insulin and is recommended to treat type 2 diabetes by enhancing insulin resistance and reduces insulin levels. Metformin can help lose weight, stimulate ovulation, and delay the onset of type 2 diabetes for those who have prediabetes.

If the initial medication fails to resolve the symptoms of PCOS and improve chances of pregnancy, the doctor may recommend in vitro fertilization.

To minimize thinning of hair and hormonal acne, the doctor may prescribe:

• Birth control pills: PCOS symptoms such as hirsutism and acne are managed through birth control pills as it limits the production of androgen.
• Acne treatments: Several creams and pills may be recommended to treat the acne caused by hormonal imbalance depending on the skin condition of the patient.
• Spironolactone (Aldactone): This antiandrogen medication is recommended to those who are not pregnant and have no plans for pregnancy as the use of this drug can lead to birth abnormalities. Spironolactone is an androgen blocker that reduces the effects of androgen hormones and help treat some symptoms of PCOS such as acne and hirsutism.
• Eflornithine (Vaniqa): This is a cream-based prescription drug that slows the growth of hair in unwanted areas such as face.
• Hair removal: Noninvasive procedures such as electrolysis is a known permanent solution to inhibit new hair growth for all skin and hair types by preventing hair growth by damaging the hair follicles using shortwave radio frequencies.

Laser is another hair removal solution which is ideal for women with pigmented hair. The laser is attracted to hair’s melanin pigment. It works by targeting the hair follicles with concentrated light.

Results are not achieved instantly and require multiple appointments. Temporary solution for hair removal such as shaving, plucking, and waxing are also recommended for unwanted hair growth.