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Is Polycystic Ovarian Syndrome (PCOS) Treatable?

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Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder that impairs the normal functioning of the ovaries. PCOS is highly prevalent amongst women of childbearing ages and affects approximately 12 percent of the US population(1). Due to its name, the syndrome is often believed to be associated with ovarian cysts but that is not the case. PCOS often acts as a gateway for the development of other medical conditions such as diabetes, hypertension, and depression.

What is PCOS?

Polycystic ovarian syndrome refers to a group of symptoms that are associated with dysfunctioning of ovaries, the female reproductive organ. Women with PCOS suffer from hormonal imbalance where they produce a high amount of androgens, the male reproductive hormone. This imbalance affects the ovaries which usually produce estrogen and progesterone, two hormones crucial for the maintenance and regulation of the menstrual cycle. Consequently, the menstrual cycle gets disturbed and this results in missed, frequent, or prolonged periods.

Polycystic Ovarian Syndrome is a multifactorial condition(2). Although the exact cause is not known, it is believed that PCOS runs in families meaning that if your mother has it, you may also suffer from it. Insulin resistance also plays an important role in the development of PCOS. In fact, almost 70 percent of women with PCOS suffer from insulin resistance, a condition where the cells do not respond to insulin properly (3). There are several risk factors that can cause insulin resistance, and obesity is the most important one amongst them. Insulin resistance, especially with obesity can result in the development of Diabetes Mellitus, which is a disorder commonly associated with PCOS.

PCOS has three marked features, and the presence of two of these features is more than enough for the diagnosis to be made. These diagnostic features are (4):
  • Ovarian cysts
  • Menstrual cycle irregularities
  • Overproduction of male hormones

Apart from these, PCOS manifests as weight gain, male-pattern baldness, acne, and infertility. However, infertility in this scenario can be treated, making conception possible. Some of the symptoms of PCOS include thinning of hair and excessive facial and body hair, similar to men. Hormonal imbalance can also result in darkening of the skin and even, headaches. Treatment of the syndrome can reverse hair loss, darkening of the skin, and other symptoms.

Is Polycystic Ovarian Syndrome (PCOS) Treatable?

Polycystic Ovarian Syndrome treatment depends on alleviating unpleasant symptoms like acne, hirsutism, and infertility. The treatment plan is personalized to the patient and usually begins with lifestyle modifications and changes.

Lifestyle Changes
Losing weight and living an active and healthy life can reduce the occurrence of the symptoms significantly. In fact, losing a mere 5 percent of your body weight can improve your symptoms by regulating your menstrual cycle and reducing insulin resistance. Moreover, losing weight also helps increase the efficiency of your medications for the treatment of PCOS. Working out, even moderately, helps with weight loss and also helps reduce the risk of diabetes and hypertension development.

In general, weight loss is an important requirement for the treatment of PCOS. Women with PCOS may lose excess weight through dietary modifications, working out, or through medications like Metformin. A combination of healthy eating and physical workouts can treat almost all of your symptoms and reduce the risk of any complications significantly.

Medications
Medical therapy should be considered for the treatment of Polycystic Ovarian Syndrome to help with the regulation of the menstrual cycle, ovulation and to induce conception. Some of the commonly prescribed medications include:
  • Birth Control: Contraceptives help restore hormonal balance by reducing the male hormones which can help with menstrual irregularities and ovulation problems. These pills may also be useful in treating acne and excess body hair that may be present. They are also important for reducing the risk of endometrial cancer, which is a serious consequence of long-term hormonal imbalance.
  • Metformin: This Anti-diabetic medication is often prescribed to women with PCOS to help lower their insulin levels. It also helps with weight loss and can slow down the progression of Diabetes Mellitus in patients.
  • Clomiphene: This medication is an anti-estrogen pill that is prescribed to induce ovulation and treat infertility in women with PCOS. If conception does not occur with clomiphene, Metformin may also be prescribed to increase the chances of pregnancy.
  • Hair Removal Treatment: Excessive hair growth can be a physical and psychological burden which is why medications to stop it or slow its progression are often given to women with PCOS.

Laparoscopic Ovarian Drilling (LOD)
When lifestyle changes and medical therapy does not bring about any change in symptoms, surgical options like this may be considered to treat PCOS. Laparoscopic Ovarian Drilling consists of internal heating or lasering of the ovaries to help reduce the production of androgens, the male hormone. This treatment modality is left as a last resort and other options should be exhausted before considering LOD.

It is important to note that PCOS is a treatable, not curable condition. The symptoms may be reduced but the condition will still persist and non-adherence to treatment can result in recurrence of the symptoms.

What is an Ovarian Cyst?

Ovarian cysts are fluid-filled sacs on the ovaries that can produce serious consequences if they burst. Ovarian cysts are of three main types with functional ovarian cysts being the most common type:
  • Functional Ovarian Cyst: Often harmless, these cysts form as a result of the menstrual cycle and resolve shortly.
  • Pathological Ovarian Cyst: Unlike functional cysts, these are less common and are formed as a result of abnormal cell growth in the ovaries.
  • Benign & Malignant Ovarian Cyst: Ovarian cysts are also classified as benign and malignant if they are non-cancerous or cancerous, respectively.
 

How is an Ovarian Cyst Diagnosed?

Ovarian cysts are usually asymptomatic but some of the symptoms they do produce include:
  • Pelvic pain
  • Bloated tummy
  • Painful sexual intercourse
  • Painful bowel movements
  • Nausea and Vomiting

Presence of these symptoms warrants a trip to the doctors’ office where the diagnosis of ovarian cysts can be made. To view the ovaries and confirm the presence of the cysts, an ultrasound will be performed. A blood test to check for hormonal imbalance and CA-125  may also be performed to rule out conditions like endometriosis and ovarian cancer, respectively. However, these are not routinely done.

Treatment of Ovarian Cysts

Treatment of ovarian cysts does not start immediately after the diagnosis has been made. In fact, your doctor may recommend waiting for a while before initiating treatment as most ovarian cysts are of the functional type and will resolve on their own. However, if the cysts are becoming larger or are not disappearing on their own, then treatment may be initiated. The treatment plan for ovarian cysts depends on the following criteria (5):
  • Has the patient reached menopause?
  • Presence or absence of symptoms
  • Size and appearance of the cyst

After careful assessment of the criteria, the following treatment options may be considered:
  • Birth Control: These oral contraceptives stop ovulation and hence prevent the progression and development of new ovarian cysts.
  • Surgical removal of the cysts, along with hysterectomy if the cysts are large and of cancerous type
 

Difference between Ovarian Cysts and PCOS

PCOS is a metabolic disorder associated with hormonal imbalance in which ovarian cysts may or may not be present. Polycystic ovarian syndrome includes enlargement of ovaries with the presence of large, fluid-filled follicles or tiny cysts. The hormonal imbalance also interferes with ovulation, resulting in infertility.

Ovarian cysts, on the other hand, are fluid-filled sacs on the ovary that do not alter the ovulation process. Moreover, ovarian cysts are usually painful and more prone to rupture.

Conclusion

The general takeaway here is that PCOS and Ovarian cysts are two different entities that are often confused with each other. However, it is important to realize the differences between them and you should visit your gynecologist if you are experiencing any of the symptoms mentioned above. It may be a gynecological or metabolic disorder, or it may be nothing, but visiting your doctor will give you the peace of mind you need.

Polycystic Ovary Syndrome Clinical Trials

A few of the more than 100 current clinical studies involving Polycystic Ovarian Syndrome are:
  • A study to identify the risk of developing metabolic disease
  • A clinical trial seeking to determine the genetic basis of polycystic ovarian syndrome
  • Research to see if following a particular diet can help to regularize menstrual cycles
  • Examining whether Time-Restricted Feeding is of value in regulating insulin resistance in obese women with PCOS
  • Comparing the effectiveness of homeopathic treatment to yoga in the treatment of menstrual disorders
  • A clinical trial to investigate the effect of aerobic exercise on menstrual regularity and quality of life in PCOS women
   
References
  1. PCOS (Polycystic Ovary Syndrome) and Diabetes. (2020, March 24). Centers for Disease Control and Prevention. www.cdc.gov/diabetes/basics/pcos.html
  2. PCOS (Polycystic Ovary Syndrome) and Diabetes. (2020, March 24). Centers for Disease Control and Prevention. www.cdc.gov/diabetes/basics/pcos.html
  3. March, W. A., Moore, V. M., Willson, K. J., Phillips, D. I., Norman, R. J., & Davies, M. J. (2010). The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human reproduction (Oxford, England), 25(2), 544–551. https://doi.org/10.1093/humrep/dep399
  4. Belenkaia, L. V., Lazareva, L. M., Walker, W., Lizneva, D. V., & Suturina, L. V. (2019). Criteria, phenotypes and prevalence of polycystic ovary syndrome. Minerva ginecologica, 71(3), 211–223. doi.org/10.23736/S0026-4784.19.04404-6
  5. Farghaly S. A. (2014). Current diagnosis and management of ovarian cysts. Clinical and experimental obstetrics & gynecology, 41(6), 609–612.

     

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This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. CenTrial Data Ltd. does not take responsibility for possible health consequences of any person or persons reading or following the information in this educational content. Treatments and clinical trials mentioned may not be appropriate or available for all trial participants. Outcomes from treatments and clinical trials may vary from person to person. Consult with your doctor as to whether a clinical trial is a suitable option for your condition.