Introduction to PCOS

Broadly speaking, PCOS is a common hormonal disorder in women of reproductive age. While its effects and external manifestations may vary, PCOS causes an imbalance in reproductive hormone levels and affects women’s ovaries. Menstrual cycle involves ovulation - ovaries releasing an egg once a month after a follicle in either ovary matures. However, a PCOS patient experiences the growth of multiple follicles in the ovaries which tend to remain immature. This hinders the release of an egg, hence causing irregular ovulation. Follicles in the ovaries are capable of producing male hormones (androgens) that impedes the development and maturation of ovarian follicles, leading to anovulation. Because ovulation is unable to occur, the patient’s levels of reproductive hormones will undergo additional alteration as now, even the menstrual cycle will be implicated. Eventually, this results in a higher level of male hormones (androgens) and a lower level of female hormones (estrogen and progesterone).

Effects of excessive male hormones on females

Apart from affecting the menstrual cycle and causing irregular or prolonged periods, excessive male hormones could also result in excessive hair growth (hirsutism) and acne. Normally, androgens stimulate our sebaceous glands to produce more sebum, an oily secretion that lubricates the skin. With a surfeit of androgens, over stimulation of sebaceous glands occurs and obstructs the glands with dirt, dead skin cells and bacteria. This creates a breeding ground for pimples.

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How does PCOS disrupts Hypothalamic-Pituitary-Ovarian Axis?

Simply put, the Hypothalamic-Pituitary-Ovarian axis is a mechanism that regulates the complex interaction between the glands and organs of the endocrine system, in order to produce a finely-balanced level of hormones that manage ovary-stimulation. These hormones are collectively known as gonadotropins. PCOS may disrupt the equilibrium of gonadotropins. For example, it could cause an increase in Gonadotropin-releasing hormone levels, resulting in an increased secretion of luteinising hormone, ultimately causing the ovaries to produce more androgens.

What are other implications of PCOS?

Apart from adversely impacting the skin, PCOS could also pose other potential health risks such as infertility, endometrial cancer, depression and anxiety. Moreover, PCOS patients who have pre-existing medical conditions such as insulin resistance and/or obesity are at higher risk of getting diseases such as hypertension, the metabolic syndrome and diabetes mellitus.

What are the diagnosis and treatment of PCOS?

The typical PCOS diagnosis involves a consideration of the patient’s medical history, a physical examination and some laboratory tests. In investigating the patient’s medical history, key considerations include the regularity of the patient’s menstrual periods, weight changes, and presence of PCOS in any member of the patient’s family as well as hereditary medical conditions (e.g diabetes mellitus). During the examination, the doctor usually looks out for excessive hair growth and acne, then conduct a blood tests to measure the level of hormones, cholesterol, triglycerides and glucose tolerance. Other assessments include a pelvic ultrasound to look out for follicles in the ovaries and check the thickness of the uterus lining.

There is no definitive cure for PCOS – it’s a disorder that can only be managed, not treated. This is done by applying individualised, targeted treatment to control and alleviate the symptoms and potential health risks that the patient may experience. For instance, in order to target the problem of excessive hair growth and acne, birth control pills could be used interchangeably with spironolactone. The two forms of medication achieve similar effects through different means: while birth control pills decrease androgen levels, spironolactone minimises the effect that androgens have on the body. By decreasing either the amount or effect of androgens on the body, the two medications are effective in minimising acne and excessive hair-growth.

Apart from medication, laser treatments may also be considered to reduce excessive hair growth. That being said, however, they come with respective pros and cons, and it is crucial to make an informed decision with your doctor.

Finally, a multi-faceted approach is crucial in order to tackle the cardiovascular and metabolic health risks posed by insulin resistance and obesity. Apart from taking diabetic medication (e.g. metformin) to regulate blood sugar levels, it is equally important to implement lifestyle changes such as regular exercise and a low-calorie diet. Even a slight decrease in weight can prove useful in the reduction of effects PCOS has on the body.

In addition, regular check-ups for blood pressure, blood cholesterol and triglyceride levels are also essential to identify any health problems, so that they may be treated and managed in time.