Treatment for PCOS , Treat the Cause and Fix your hormones.

Polycystic ovary syndrome (PCOS) is not a simple pathophysiologic process for which one treatment addresses all manifestations. The clinical symptoms of PCOS, mainly hyperandrogenism and chronic an ovulation, typically develop during adolescence. Further, the onset of absence of menstrual periods may represent the initial clinical feature of PCOS for some women. By the time symptoms are presented for medical attention, this multi system disorder often has transformed in to a chain of derangement in which identification of initiating factors are difficult. Recent evidence from long-standing clinical investigations indicate a broad spectrum of inter playing causes for PCOS. PCOS treatment focuses on managing individual concerns such as infertility, hirsutism, acne or obesity. Specific treatment mostly comprises of  lifestyle changes or medication and in certain cases, a combination of both. Individualized treatment goals and target treatment to specific manifestations of PCOS holds good.

Insulin resistance

Insulin resistance is a condition where the body’s tissues are resistant to the effects of insulin. The body in response has to produce extra insulin to compensate. High levels of insulin makes the ovaries produce excess testosterone, which interferes with the development of the follicles or sacs in the ovaries where eggs develop and prevents normal ovulation. Insulin resistance can also lead to weight gain, which can make PCOS symptoms worse, as having increased fat causes the body to produce even more insulin.

Low-fat, high-carbohydrate diets might increase insulin levels. A low-carbohydrate diet or choosing complex carbohydrates which raise blood sugar levels more slowly are better for PCOS. Exercise helps lower blood sugar levels. With PCOS, increasing daily activity and participating in a regular exercise program may treat or even prevent insulin resistance and help keep the weight under control and avoid developing diabetes.

Metformin is a commonly used medicine in PCOS that improves insulin resistance and lowers insulin levels. It can help with weight loss and may protect from getting type 2 diabetes. It may also make the woman more fertile.

 

Obesity

Obesity is known to exacerbate many aspects of PCOS, especially cardiovascular risk factors such as glucose intolerance and dyslipidaemia. It is also highly associated with a poor response to infertility treatment and likely an increased risk for pregnancy complications in women who conceive. Although most treatments of obesity achieve modest reductions in weight and improvements in the PCOS characteristics, encouraging weight loss in the obese patient through a low-calorie diet combined with moderate exercise activities remains to be one of the front-line therapies. Even a modest reduction in weight as minimal as losing 5 percent of body weight might improve PCOS symptoms.

Weight loss can reduce insulin and androgen levels and may restore ovulation. A weight-control program and a strict diet plan can help in reaching weight-loss goals desired in the treatment of PCOS. Losing weight may also increase the effectiveness of medications for PCOS and can help with conception.

 

obesity

Hormone imbalance

Many women with PCOS are found to have an imbalance in certain hormones. Though the exact reason why these hormonal changes occur is not known, it has been understood that the problem may start in the ovary itself, in other glands that produce these hormones or in the part of the brain that controls their production. Hormones that manifest as symptomatic features in the treatment of PCOS are:

  • Testosterone, a male hormone although present in all women in small amounts is abnormally high in PCOS causing Acne, facial hair growth, male pattern baldness and an ovulation.
  • Luteinising hormone (LH) normally stimulates ovulation, but hyper secretion of LH  may have an abnormal effect on the the cells of ovaries leading to disturbed ovulation.
  • Sex hormone-binding globulin (SHBG) is a protein in the blood which binds to testosterone and reduces its effect, but insufficient amounts in the blood may alter blood levels of testosterone, keeping it always high.
  • Raised levels of prolactin, a hormone that stimulates the breast glands to produce milk in pregnancy is seen in some women with PCOS. A theory suggests that constant high levels of Oestrogen experienced in PCOS would stimulate prolactin production.

A combination birth control pills that contain oestrogen and progestin decrease androgen production and regulate oestrogen levels. Regulating these hormones can correct abnormal bleeding, excess hair growth and acne. Pills can be replaced by skin patch or vaginal ring that contains a combination of oestrogen and progestin.

Progestin therapy involves taking progestin for 10 to 14 days every one to two months that can regulate periods. Progestin therapy is not known to reduce androgen levels or prevent pregnancy. The progestin-only pill or progestin-containing intrauterine device is a better choice in women who wish to avoid pregnancy.

 

 

PCOS and Infertility

Women with Poly Cystic Ovaries comprise almost one fifth of the infertility population. The imbalance of hormones is key to why PCOS leads to infertility. Because the ovaries are not receiving the correct level of hormones they are unable to develop the eggs to maturity and so ovulation does not take place and the follicle may remain as a cyst. The excess amounts of male hormones released by the body also affect the way eggs are developed and released.

PCOS is described as a common and treatable cause of infertility. For PCOS women who may have difficulties becoming pregnant, starting earlier in life may possibly offer more time to try a range of fertility treatment options.  If getting pregnant is the ultimate goal, a gynaecologist or an infertility specialist can find the most effective treatment options, including fertility-boosting medications and high-tech modalities.

 

PCOS and irregular cycles

The first-line pharmacological treatment for inducing ovulation consists of medications for timed intercourse.

  • Clomiphene, an oral anti-oestrogen medication is taken during the first part of the menstrual cycle.
  • Letrozole is a medication in breast cancer treatment that can be used to stimulate the ovaries.

The second-line pharmacological treatment includes the administration of exogenous gonadotropins or laparoscopic ovarian surgery (ovarian drilling).

  • Gonadotropins are hormonal medications normally given by injection to facilitate maturation and release of eggs.
  • Ovarian drilling is generally performed when laparoscopy is indicated. Ovarian drilling breaks through the ovary’s thick outer layer, destroys small portions of it and boosts fertility. After ovarian drilling, testosterone production decreases and many women ovulate more regularly.

The third-line of treatment is the high-complexity reproduction treatment through in vitro fertilization (IVF) or cytoplasmic sperm injection (ICSI) and is medically recommended when the previous interventions fail. Women with PCOS generally respond well to IVF treatment. Women who attempt to conceive using IVF have up to a 70% chance of becoming pregnant. Once pregnant, these women also have up to a 60% chance of a successful live birth. ICSI works as a last resort for achieving pregnancy in women with PCOS along with a contributing male factor infertility.

 

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