PCOS is sometimes associated with fertility. In PCOS LH goes higher than FSH. Due to the low levels of FSH, many follicles will develop however it will not mature. These follicles which are present in ovaries form cysts once they become ataractic. Hence the ovaries seem to be polycystic. Follicles do not mature and that is the reason no eggs are released and subsequently, there is no ovulation. Infertility is primarily caused by anovulation or lack of ovulation. Ovulation drugs (Clomid & metformin) by gonadotropins help in ovulation or correcting the resistance to insulin.
Some common symptoms of PCOS include an excessive hair growth in the face and body along with weight gain and, irregular and infrequent periods or absent periods. Ovulation is infrequent or mostly absent. The symptoms can vary from one woman to another and may also include obesity, high levels of cholesterol or even acne. There have been some symptoms of skin tags as well as extreme tiredness, or lack of mental alertness combined with depression, anxiety and decreased sex drive. Excess male hormones and infertility are also observed in some cases.
Polycystic ovarian syndrome (PCOS) accounts for 90% of women with infrequent periods 30% of women with absent periods and over 70% of women with anovulation.
PCOS can be inspected with laparoscopy which allows direct inspection of the ovaries. However polycystic ovaries may appear normal at laparoscopy. Ultrasound of the vagina may show the PCOS. To know the total number of visible cysts, a pelvic scan of ovaries is recommended. However it is also to be noted that in case there is no visible cyst, it is not to be concluded that one does not have PCOS.
It is advisable to check the blood hormone levels of LH, FSH, androgens, and SHBG. The best time for these tests is the first four days of the cycle. However in situations where the woman has no period, then the test can be performed anytime and repeated if the tests do not provide a clear picture. It is seen that FSH levels are low or normal and LH levels are often raised. However, even if the level is normal, it cannot be assumed that there is no (PCOS). There is a possibility that the levels of androgens and testosterone may be raised.
To treat PCOS, removal of ovarian cysts is not an effective option. Cysts which form on the ovaries are due to the production of excess insulin leading to hormone imbalance. Hence removing the cyst only removes one symptom and not the entire problem.
Women who have Women with PCOS a much higher chance of contracting type 2 diabetes as well as cancer and cardiovascular disease (CVD). Getting your symptoms under control at an earlier age can help to reduce the above complications.
Treatment is usually ineffective pharmaceutically and is usually more effective if there is a strategy to change the lifestyle. In case the woman is overweight she needs to lose weight. This will help in getting the menstruation back and ovulation in patients having a polycystic ovarian syndrome. Including some changes in like exercise and weight control also helps in reducing chances of type 2 diabetes in later life.
Since there is no definite treatment for PCOS, it needs to be controlled to prevent problems. The treatment method is based on one’s symptoms, if one wishes to get pregnant and lowering one’s chances of getting heart disease and diabetes. Most women will need a combination of these treatments to meet these goals.
Usually induction of evolution with clomiphene tablets is the first choice and is an effective treatment of PCOS. Data shows that around 70% of women have experienced restoration of ovulation and around 30% of women will be able to get pregnant within three months of treatment. Post surgery it is seen that in close to 70-90% of women ovulation will occur spontaneously. Chances of pregnancy is in the range of 40-60% post one year.
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