Polycystic Ovary Syndrome (PCOS)

Overview

PCOS is a condition characterized by multiple abnormally developing follicles in the ovaries.
It is the most common endocrinopathy in females of reproductive age, affecting 6-13% of females.
The underlying mechanism is not well understood but involves hormonal imbalances.

Involves the hypothalamic-pituitary-ovarian axis.
Hypothalamus releases GnRH which stimulates the anterior pituitary to produce FSH and LH, leading to androgen production in ovaries.
In PCOS, rapid GnRH pulses increase LH more than FSH, causing excess androgen production.
Hyperandrogenism is a key feature, particularly increased testosterone.
Insulin resistance is present, contributing to the cycle of androgen production.
Genetic component suspected with a heritability of roughly 70%.

Hyperandrogenism-related:
- Hirsutism in 60% (excessive hair growth).
- Acne in around 20%.
Metabolic Issues:
- Insulin resistance leading to weight gain.
Reproductive Issues:
- Irregular periods, often less than 8 per year.
- Infertility, with PCOS being the most common cause in young females.
- Increased risks during pregnancy such as gestational diabetes.

Rotterdam Criteria:
- Two out of three criteria needed in adults (all three in teenagers):
  1. Clinical or biochemical hyperandrogenism.
  2. Oligo/anovulation.
  3. Ultrasound evidence of polycystic ovaries.
Additional tests to rule out other conditions:
- Blood tests for hyperprolactinemia.
- 17-Hydroxyprogesterone for adrenal hyperplasia.
- Thyroid function tests for hypothyroidism.
- Prolactin levels.

Lifestyle Changes:
- Weight loss (5-7% body weight) can restore ovulation in 80% of females and improve symptoms.
Medication:
- Oral contraceptive pills for those not wanting to conceive.
- Metformin for insulin resistance.
- Aromatase inhibitors like letrozole increase live birth rates.
- Anti-androgen therapies (finasteride, spironolactone) for symptom control.
Other Treatments:
- Antibiotics and retinoids for acne.