What is PCOS ?

Polycystic ovarian syndrome(PCOS)affects up to 10%
of women of reproductive age. It is a heterogeneous disorder, often associated with obesity, for which the primary cause remains uncertain. Genetic factors probably play a role, since PCOS often affects several family members.

The severity and clinical features of PCOS vary between individual marked by  patients but a diagnosis is usually made during the investigation of hirsutism or amenorrhoea/oligomenorrhoea.
Infertility may also be present
There is no universally accepted definition, but it has been recommended that a diagnosis of PCOs
requires the presence of two of the following three

menstrual irregularity
clinical or biochemical androgen excess
multiple cysts in the ovaries(most readily
detected by transvaginal ultrasound

Women with PCOS are at increased risk of glucose intolerance and some authorities recommend screening for type 2 diabetes and other cardiovascular risk factors associated with the metabolic syndrome.

This should be directed at the presenting complaint, but all PCOS patients who are overweight should be encouraged to lose weight, as this can improve several symptoms, including menstrual irregularity, and reduces the risk of type 2 diabetes.

Menstrual irregularity and infertility
Most women with PCOS have oligomenorrhoea, with irregular, heavy menstrual periods.this may not require treatment unless fertility is desired.metformin by reducing insulin resistance, may restore regular ovulatory cycles in overweight women, although it is less effective than clomifene at restoring fertility as measured by a successful pregnancy. Thiazolidinediones also enhance insulin sensitivity and restore menstrual regularity in PCOS, but are contraindicated in women planning a pregnancy.
In women who have very few periods each year or are amenorrhoeic, the high Oestrogen concentrations associated with PCOS can cause endometrial hyperplasia. Progestogens can be administered on a cyclical basis to induce regular shedding of the endometrium and a withdrawal bleed, or a progestogen-impregnated intrauterine coil can be fitted.

For hirsutism, most patients will have used cosmetic measures, such as shaving, bleaching, and Waxing, before consulting a doctor. Electrolysis and laser treatment are effective for small areas like the upper lip  and chest hair but are expensive
Eflornithine cream inhibits ornithine decarboxylase in hair follicles and may reduce hair growth when applied daily to affected areas of the face.

If conservative measures are unsuccessful,anti-androgen therapy is available. The life cycle of a hair follicle is at least 3 months and no improvement is likely before this time when follicles have shed their hair and replacement hair growth has been suppressed.
Metformin and thiazolidinediones are less effective at treating hirsutism than at restoring menstrual regularly. Unless weight is lost, hirsutism will return if therapy is discontinued. The patient should know that prolonged exposure to some agents may not be desirable and they should be stopped before pregnancy.

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