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Polycystic ovarian syndrome explained

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 often struggle to maintain a normal weight. Others may get depressed due to changes in their body habitus.

The cause of PCOS is not known, but there appears to be both genetic and environmental influences. The symptoms are related to abnormal glucose control and hormonal imbalance. Hence the problem with weight control, irregular periods, skin and hair changes. There are also some longer term health consequences that include late onset diabetes, cardiovascular disease and higher risks of cancer of the womb lining (endometrial cancer).

The diagnosis is made following typical symptoms, blood tests and ultrasound imaging of the ovaries. The ovaries are usually enlarged with multiple follicles (small cysts), hence the description polycystic ovaries. Blood tests normally check reproductive hormone levels, but may also include tests that check glucose control mechanisms.

Most women will have immediate concerns related to menstrual irregularity, skin and hair changes, or fertility. Treatment aims are focused on the overriding symptoms, but with a view to controlling the condition in order to negate longer term health risks. It is however important to appreciate that there is no absolute cure for PCOS.

Lifestyle modifications are crucial in managing PCOS. Healthy eating habits coupled with exercises will often maintain a near 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. There are also medications that may optimize glucose control, help with weight optimization and overall improvement of symptoms.

If infertility is associated with PCOS, reducing weight 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. A minority of women may still end up with more advanced fertility treatments

Follow-up for long term health effects should be discussed with your Gynecologist. Regular blood glucose 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.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. amurage@mygyno.co.ke

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