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This article deals with PCOS based on pathophysiology. Dr Mirudhubashini, the clinical director of Women’s Centre, Coimbatore, discusses PCOS in depth to enlighten the readers, both doctors and patients, about PCOS and how to manage it based on a pathophysiological perspective.
What PCOS is
Polycystic ovary syndrome is also known as PCOS, a hormonal disorder causing the enlargement of ovaries with small cysts around the outer edges. PCOS is a syndrome and not a disease and is not caused by any agent outside the body. It is a metabolic problem not caused by the ovaries but is peculiar to the ovaries. It involves the interaction of genetic traits with one or more other factors such as epigenetic, congenital or environmental factors. An interaction between at least two of these factors is required before the disorder manifests.
The genetic combination of this disorder varies because people have different genetic compositions. This means that the degree of manifestation is different from person-to-person. Understanding this variation is very important in knowing the right course of treatment for each unique patient.
There are proposals to rename the syndrome, and one of the considered names is Reproductive Metabolic Syndrome.
The syndrome is present during the foetal stage of the child. It is affected by certain factors such as the testosterone level of the mother, the growth rate of the child in the womb, and so on. Children also show signs during early childhood but a diagnosis cannot be made then.
Individuals are diagnosed with PCOS in their adolescent years when symptoms are observable. Symptoms are seen around the time of puberty where hormones kick in and change the pulse frequency. In some people, these changes include increased androgen levels or in others an increase in their insulin levels.
These changes are underlying factors that cause PCOS, and the increase in insulin harms almost every organ and their functionality. Obesity could also contribute to the over secretion of insulin in the body, which increases the rate of PCOS becoming manifest.
In young ladies, two common factors are responsible for the exhibition of symptoms which are hyperinsulinemia and hyperandrogenemia. It is not always the same in all patients and sometimes involves a combination of both.
Caution should be taken before making a diagnosis of PCOS, and should not be mistaken for physiological pubertal changes.
There are two principles of management which are to correct the underlying pathophysiology and the correction of resultant clinical problems. Different approaches are taken to treat patients with PCOS, such as combined oral contraceptive (COC) for patients with abnormal bleeding. There are benefits and risks of any form of treatment, but the benefits outweigh the risks in the long run.
Other forms of medication are combined to treat the issues that PCOS presents, and the management of PCOS does not interfere with managing irregular periods or hirsutism.
To know more about the other forms of treatments, advantages and disadvantages of these treatments, and the long term effect of PCOS, you can watch the full session with Dr Mirdhubashini.