What is a polycystic ovarian syndrome or PCOS ?

The exact pathophysiology of PCOS is not clearly known. Numerous genetic & environmental factors act & contribute to its           pathophysiology.

Reasons :

Excessive production of Androgen especially from the ovaries & from adrenals in 50 % of women.

Causes :

• Hyperinsulinemia
• Increased Testosterone level
• Increased Androstenedione Level

Clinical Manifestation of increased Androgen:

• Hirsutism
• Acne
• Androgenic Alopecia
• Dislipidemia
• Oligomenorrhoea
• Amenorrhea
• Infertility
• Acanthosis Nigricans

Hirsutism

Excessive growth of dark & coarse hair in male-like patterns in females due to excess production or secretion of Androgen Hormone by the ovaries or Adrenal glands.

Androgenic Alopecia

The primary culprit/wrongdoer is the Dihydrotestosterone Hormone (DHT) that comes from testosterone. The DHT hormones attack the hair follicles causing hair loss & no growth.

Dislipidemia

Occurs due to abnormal levels of Lipids in the blood.

Oligomenorrhea

It is a condition during which females have infrequent menstrual periods. PCOS causes an imbalance in female hormonal levels along with the formation of fluid-filled cysts within the ovaries & secretion of a larger amount of male hormones called Androgen.

Amenorrhea

The absence of regular menstrual cycles is one of the symptoms of Amenorrhea. Primary Amenorrhea is when you get a delayed Menarche or you do not get your first menses within the normal age of 11 – 15 years. Secondary Amenorrhea is when a woman misses her menses for 3 months in a row or more. A woman can suffer from headache, vision changes, nausea, excessive facial hair, hair loss, changes in the breast, secretion of milky fluids of discharges from

Infertility

This is a condition when a woman is not able to conceive even after having continuous unprotected coitus for a year. This may happen due to anovulation or no folliculogenesis due to PCO.

Acanthosis Nigricans

Skin thickened & pigmentation commonly appears at the nape of the neck, groins, axilla, etc. This atypical skin cell growth is most commonly triggered by high levels of insulin in the blood.

• Disorders to be ruled out
• Idiopathic hirsutism
• Androgen secreting tumor of the ovary
• Late-onset of CAH / nonclassical CAH
• Rule out CAH(Congenital Adrenal Hyperplasia) by measuring 17 OH progesterone to differentiate from PCOS.

Long term complications of PCOS

• Presentation 
• Hirsutism
• Irregular cycles
• Infertility
• Complications
• Coronary Artery Disease (CAD)

Dyslipidemia – Metabolic syndrome

•  Increased triglycerides
• Increased FBS
• Decreased HDL
• Increased BP
• Increased Waist circumference

Endometrial Hyperplasia – Increased risk of Endometrial CA, Ovarian CA, Breast CA

• Due to obesity – Sleep Apnea, NASH, Depression
• Diabetic Medication (due to insulin resistance)

OHSS is a complication of ART techniques. All ovulation-inducing drugs directly or indirectly increase the FSH hormonal levels. Several numbers of follicles are stimulated & each follicle releases 150 – 200 PG of Estrogen follicles. Once the follicles ovulate, they release follicular fluid containing inflammatory mediators. Vascular endothelial growth factor (VEGF) is the utmost mediator of OHSS. The most important trigger for OHSS is HCG injection.

Complications in pregnancy due to PCOS

• Abortion or stillbirth due to Low progesterone levels
• Gestational diabetes
• Preeclampsia
• Pre-term Labor

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