Polycystic ovarian syndrome (PCOS) is the most common hormonal disorder in reproductive-age women around the world. The prevalence ranges from 5% to 15%. The diagnosis is by exclusion and should have two of the following three criteria: Chronic anovulation characterised by irregular cycles, Clinical or biochemical features of increased androgen levels characterised by acne, hirsutism, alopecia, hyperpigmentation or by laboratory tests and polycystic ovarian morphology diagnosed by sonography.
levels characterized common in South Asians. It has a genetic predisposition with 70% heritable in twins and common in first-degree relatives with PCOS. Environmental factors like obesity, insulin resistance, and fetal androgen excess have all been associated with PCOS. Due to these predisposing conditions, there is androgen excess in the body, causing anovulation and in turn leading to PCOS.
Clinically, they present with menstrual irregularities and features of hyperandrogenism such as hirsutism, alopecia, acne, obesity and infertility due to anovulation. Few women are asymptomatic and are diagnosed with laboratory or sonographic findings. PCOS is also associated with conditions such as metabolic syndrome, impaired glucose tolerance, type 2diabetes mellitus (DM-2), cardiovascular risk, depression, obstructive sleep apnea, endometrial cancer, non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH).
Evaluation is done by taking a detailed reproductive history. The history of medical conditions and a general physical examination are done. Commonly, due to chronic anovulation, the cycle length is more than 35 days. A hormonal profile containing serum testosterone, free androgen index, sex hormone binding globulin, follicle-stimulating hormone, luteinizing hormone, dehydroepiandrosterone sulfate levels, and 17-OH progesterone are measured. Sonography shows polycystic ovarian morphology and increased endometrial thickness. Evaluation of associated conditions like a 2-hour oral glucose tolerance test, lipid profile, etc., may be required.
Management is mainly focused on lifestyle modification. Weight loss is essential as loss of 5-10% of body weight regularises menstrual cycle in 44-50% of women. Atkins's diet containing low glycaemic index such as fruit, vegetables, fibre, whole grain foods, and high protein from vegetable sources is advised and refined carbohydrates and transfats containing dehydrogenated oils are avoided. Calorie intake should be restricted to 1,000-1,200kCal/day, aerobic exercise of 3-4 times/week for 30-40 min, pharmacological agents are advised. In morbidly obese women, with BMI > 40 kg/m^2, bariatric surgery is advised. Dermatological interventions like electrolysis, waxing, plucking, depilation, bleaching for hirsutism and medications like anti-androgen for hirsutism/acne. Combined oral contraceptive pills for both hirsutism and menstrual irregularities are advised, and the treatment of associated conditions.
