Polycystic Ovary Syndrome: Causes, Effects, and Treatment Options

Q: Polycystic Ovary Syndrome: Causes, Effects, and Treatment Options

Hello, the questioner： Polycystic Ovary Syndrome (PCOS) is characterized by abnormal hormone secretion, leading to inadequate ovulation, where follicles that should develop into eggs fail to grow properly. <br>The exact cause is unknown, but it is believed that genetics may play

Polycystic Ovary Syndrome and Hormones

Hello, Doctor: After my surgery for uterine polyps last year, my menstrual cycle has been very irregular.
Last week, I went to the hospital for an ultrasound and found that the polyps have recurred.
The doctor ordered blood tests (LH: 6.2; FSH: 4.7) and mentioned that I have polycystic ovary syndrome (PCOS).
Could this affect my future fertility? What causes PCOS? Is it curable? Additionally, my estradiol (E2) level spiked to 244...
what could be the reason for that?

Xiao Wen, 20~29 year old female. Ask Date: 2017/01/14

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the questioner: Polycystic Ovary Syndrome (PCOS) is characterized by abnormal hormone secretion, leading to inadequate ovulation, where follicles that should develop into eggs fail to grow properly.
The exact cause is unknown, but it is believed that genetics may play a role in some cases.
However, "polycystic ovaries" do not equate to "polycystic ovary syndrome." If an ultrasound examination reveals many small follicles (like a pearl necklace, with at least 10 on each ovary) but menstruation is normal and there are no symptoms, it is clinically referred to as "polycystic ovaries," which is considered a normal phenomenon.
Clinical observations show that 30% of normal women have polycystic ovaries on ultrasound.
The diagnostic criteria for Polycystic Ovary Syndrome include three main features: 1.
Chronic anovulation.
2.
Elevated androgen levels.
3.
Ultrasound findings of polycystic ovaries.
If two of these criteria are met, a diagnosis of Polycystic Ovary Syndrome can be made.

The treatment for Polycystic Ovary Syndrome is summarized as follows: For patients who do not wish to become pregnant, treatment may include regular administration of progesterone (every 45-60 days) to induce menstruation and reduce the risk of endometrial cancer.
Alternatively, oral contraceptives can be used, which suppress gonadotropin secretion, inhibit ovarian androgen production, and maintain regular menstrual cycles.
For those with significant masculinization, stronger anti-androgen contraceptives may be prescribed.
The occurrence of Polycystic Ovary Syndrome is primarily due to the body's poor utilization of insulin.
Therefore, medications used to treat type 2 diabetes, such as metformin, can be effective for managing PCOS.
Inositol is currently classified as a dietary supplement and is not a standard treatment.
For patients with Polycystic Ovary Syndrome who wish to conceive, the primary issue is anovulation.
The most commonly used medication is the oral ovulation inducer Clomiphene Citrate.
For those who do not respond to oral ovulation medications, injectable ovulation drugs such as HMG, FSH, and r-FSH may be considered.
In addition to medication, changes in dietary habits, regular exercise, and maintaining a normal weight are more effective than medication alone in controlling hyperinsulinemia and reducing insulin resistance, thereby improving the clinical manifestations of Polycystic Ovary Syndrome and promoting ovulation.
For obese patients with Polycystic Ovary Syndrome, weight loss is the first-line treatment, often restoring normal hormonal balance, resuming ovulation, and reducing the risk of miscarriage.
Additionally, exercise can help control weight and improve insulin sensitivity.

Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2017/01/14

More Info

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that affects many women of reproductive age. It is characterized by a combination of symptoms and hormonal imbalances, primarily involving irregular menstrual cycles, excess androgen levels, and polycystic ovaries. Understanding the causes, effects, and treatment options for PCOS is crucial for managing the condition and improving overall health.

Causes of PCOS
The exact cause of PCOS remains unclear, but several factors are believed to contribute to its development:
1. Hormonal Imbalances: Women with PCOS often have elevated levels of androgens (male hormones), which can lead to symptoms such as acne, hirsutism (excess hair growth), and irregular menstrual cycles. The imbalance in hormones can disrupt the normal ovulation process.

2. Insulin Resistance: Many women with PCOS exhibit insulin resistance, where the body's cells do not respond effectively to insulin. This can lead to higher insulin levels, which may stimulate the ovaries to produce more androgens, exacerbating the symptoms of PCOS.

3. Genetics: There is a hereditary component to PCOS, as it often runs in families. If a close relative has PCOS, the likelihood of developing the condition increases.

4. Inflammation: Some studies suggest that low-grade inflammation may play a role in the development of PCOS, contributing to insulin resistance and hormonal imbalances.

Symptoms of PCOS
The symptoms of PCOS can vary widely among individuals but commonly include:
- Irregular or absent menstrual periods
- Excessive hair growth on the face and body (hirsutism)
- Acne and oily skin
- Thinning hair or male-pattern baldness
- Weight gain or difficulty losing weight
- Dark patches of skin, particularly in skin folds

Effects on Fertility
PCOS can significantly impact fertility due to irregular ovulation or anovulation (lack of ovulation). Women with PCOS may find it more challenging to conceive, but many can achieve pregnancy with appropriate treatment. The hormonal imbalances associated with PCOS can also lead to complications during pregnancy, such as gestational diabetes and preeclampsia.

Treatment Options
While there is currently no cure for PCOS, various treatment options can help manage symptoms and improve fertility:
1. Lifestyle Changes: Weight management through a balanced diet and regular exercise can help improve insulin sensitivity and regulate menstrual cycles. Even a modest weight loss of 5-10% can have a significant impact on symptoms.

2. Medications:
- Hormonal Birth Control: Oral contraceptives can help regulate menstrual cycles, reduce androgen levels, and alleviate symptoms such as acne and hirsutism.

- Metformin: This medication, commonly used to treat type 2 diabetes, can improve insulin sensitivity and help regulate menstrual cycles in women with PCOS.

- Ovulation Induction Agents: For women trying to conceive, medications like Clomiphene Citrate or Letrozole can stimulate ovulation.

3. Cosmetic Treatments: For managing hirsutism, options include laser hair removal, electrolysis, and topical treatments.

4. Surgery: In some cases, laparoscopic ovarian drilling may be performed to induce ovulation by reducing androgen production from the ovaries.

Understanding Elevated Estradiol Levels
Regarding your elevated estradiol (E2) levels, this hormone is primarily produced by the ovaries and plays a crucial role in regulating the menstrual cycle and reproductive system. Elevated estradiol can occur in PCOS due to the presence of multiple follicles that do not ovulate, leading to increased estrogen production. It is essential to discuss these findings with your healthcare provider to understand their implications and determine the best course of action.

Conclusion
In summary, PCOS is a multifaceted condition that can affect various aspects of a woman's health, including menstrual regularity and fertility. While it cannot be cured, effective management through lifestyle changes, medications, and regular monitoring can significantly improve symptoms and enhance the chances of conception. If you have concerns about your condition or treatment options, it is essential to maintain open communication with your healthcare provider for personalized care.

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