A lady in her early twenties came to the Endocrine clinic with complaints of increased hair growth on the face, arms, chest, and back, oily skin, and acne. Facial hairs were above the upper lip and chin. She had to remove it once every three days. She had been to the dermatologist and tried a few treatments but to no avail.
Another young lady came to the clinic with weight gain and mood swings. She had been to an anger management program in the recent past. Despite restricting calorie intake and regular exercise, her weight was static. An 18-year-old girl complained of the absence of periods. She never had the onset of menstruation despite attaining puberty.A lady in her 30s came to the clinic with infertility despite unprotected intercourse with her partner for two years. All these patients were later diagnosed with Polycystic ovarian syndrome.
Polycystic ovary
Polycystic ovary is a syndrome with a wide range of symptoms, varying between patients. Patients usually have one or two primary symptoms. The underlying etiology is excessive androgen hormones due to changes in the frequency of gonadotropin-releasing hormone (GnRH) from the hypothalamus. This may result in a lack of egg release from the ovary (an-ovulation) which causes infertility, irregular menstrual periods, or complete absence of periods. Another common presentation is an increase in Facial hair and Acne which is cosmetically unacceptable. Weight gain, insulin resistance, and metabolic syndrome do commonly occur.
Diagnose. We diagnose PCOS if the patient meets at least two out of three Criteria on the Rotterdam consensus.These are oligo-anovulation, clinical and/or biochemical hyperandrogenism, and Ultrasonographic evidence of polycystic ovaries
Cure. There is no permanent cure for Polycystic Ovarian Syndrome. Treatment is usually directed towards the primary symptoms. New weight loss medications such as GLP-1 agonists or GIP/GLP-1 have shown promising results but should be given and monitored by an expert Endocrinologist with an appropriate Dietician input.Topical Eflornithine ointment and oral anti-androgens have shown good results to restrict growth of hair follicles. Fertility improves with weight loss and many patients are able to conceive with a normal body mass index. Additionally, we may prescribe drugs to induce ovulation.Oral contraceptives help to regularise the menstrual cycle and have an additional anti-androgen effect.
Summary. In summary, treatment is directed toward symptoms and good control can be achieved. Patients are able to live a normal healthy life.
