Eulalee ThompsonTHE WOMAN with polycystic ovarian syndrome (PCOS) is typically overweight, hypertensive and grows an excessive amount of hair on her face and body. She will also complain of irregular periods and infertility and upon medical examination will have many cysts on her ovaries.
However, gynaecologist, Dr. Errol Daley, said the condition may exist at a more subtle level in many women. In fact, he said doctors, may find that, upon ultrasound testing, there are no cysts on the ovaries but the woman still has a diagnosis of PCOS.
"It is very important to stress that you don't have to have cysts on the ovaries to come up with a diagnosis of PCOS. What they complain of mostly is irregular periods and their cycles might vary from one to six months.
Sometimes they have no periods at all. The irregular period usually makes her infertile, so she will also complain of not being able to become pregnant," he said.
PCOS, Dr. Daley said, is a group of disorders. The patient is usually making good levels of the female hormone, oestrogen, but is also producing a reasonable amount of male hormone, androstenedione. It is the abnormal production of the male hormone that produces the hirsutism (the excessive body hairs) and the hormonal imbalance tends to make her overweight.
Dr. Daley said since these patients are usually overweight, the fat inhibits the action of oestrogen in the body but the effect of the male hormone is not affected. Hypertension in these patients is often associated with their overweight condition.
The doctor may feel the cysts on the ovaries upon examination but as mentioned before, the patient might not have any cysts. Blood tests to assess hormonal levels are therefore very useful. The blood tests would assess two hormones released by the pituitary gland. These are luteinising hormone (LH) that stimulates ovulation and follicle-stimulating hormone (FSH) that stimulates the production of oestrogen.
Dr. Daley said that in the patient with PCOS, the body attempts to make the resistant ovaries ovulate by producing more LH than usual. The ratio of LH to FSH, he said may be as high as three to one.
These patients will also have an abnormality in the handling of insulin and one of the treatment modalities (which Dr. Daley said is the easiest way to treat the condition) is to administer doses of the antidiabetic drug Metformin. The dose is normally 500 mg or one tablet three times per day.
"Unfortunately it gives them a little diarrhoea when they first start using it but the good thing about it, is that it makes them lose weight and very often after a few months of Metformin alone they start to ovulate on their own and have regular periods. In fact, very often they become pregnant if they want to," he said.
The patient could also be given a drug called Clomiphene. This drug stimulates ovulation. Normally, Dr. Daley said the dosage starts out at one tablet per day for five days. The dosage is usually increased to three tablets per day . Various tests can be done to verify ovulation, for example, the woman's body temperature can be checked or a blood test can be done to determine her progesterone level.
If drug therapy doesn't work, then surgical procedures can be attempted. The amount of male hormone can be reduced, for example, by puncturing the ovaries or performing an old operation called a wedge resection. However, Dr. Daley said the results of the surgical methods are temporary and the condition will return within five to six years.
If the patient is not interested in becoming pregnant, she is simply put on the contraceptive pill or given progesterone so she can have regular periods. Dr. Daley said that it is important for her to have periods regularly to shed the lining of the womb. The influence of too much oestrogen and irregular periods will thicken the lining of the womb placing the patient at an increased risk for cancer of the womb.
