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Polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is a fairly common condition. The main symptoms include irregular or absent menstrual periods, reduced fertility,acne and abnormal hair distribution. Some women will be overweight and,others get depressed due to changes in their body habitus.

PCOS also has some longer term health consequences.The cause of PCOS is not known, but sometimes runs in families. The symptoms are related to abnormal hormone production, hence irregular periods and failure to ovulate regularly.

Women with PCOS have higher levels of testosterone, which is produced by the ovaries, and is associated with many of the symptoms.The diagnosis is made following typical symptoms, hormone tests and ultrasound imaging of the ovaries. The ovaries are usually enlarged with multiple follicles (small cysts), hence the description polycystic ovaries. However, some women will have a polycystic appearance of the ovaries without having the syndrome.

Most women will have immediate concerns related to menstrual irregularity, skin and hair changes or fertility. Longer term PCOS effects that may not be immediately apparent include disordered glucose control leading to diabetes, high blood pressure and heart disease in later life. With less than three menstrual periods a year, the lining of the uterus (endometrium) may thicken, leading to risk of endometrial cancer in a small number of women. PCOS however does not increase the risk of breast, cervical or ovarian cancer.

It is important to realise that there is no cure for PCOS. Medical treatments aim to manage and reduce the symptoms or consequences of PCOS.

Lifestyle modifications are crucial in managing PCOS. Healthy eating habits coupled with exercises will often maintain a normal weight and reverse most of the symptoms and associated consequences. Women should aim for a body mass index (BMI) between 19 and 25. Periods become more regular, the skin and hair changes reverse and chances of spontaneous pregnancy increase.

Hormone tablets can be used to induce regular periods and reverse physical changes. Skin and hair changes may take longer to improve, and some women will need to incorporate cosmetic measures like shaving.

If infertility is associated with PCOS, attaining a normal BMI is an important initial step, often leading to spontaneous conception. Some women will require ovulation medications, and if given and monitored appropriately, chances of pregnancy are pretty good. Such medications are not without risk on long term use, hence self-medication should be resisted.Ovarian surgical procedures to enhance ovulation and conception should be considered as last options.

Follow-up for long term health effects should be discussed with your Gynecologist. Regular blood sugar checks, blood pressure monitoring and related cardiovascular assessments may be advised. Some women may require ultrasound assessment of their uterine lining, and a biopsy may sometimes be advised.

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