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POLYCYSTIC OVARY SYNDROME (PCOS)

PREPARED BY :
MCMITCHELL ANAK MUDA
NURAFIQAH BINTI MOHAMAD MUSA
NUR ZAWANI BINTI ZAABA


POLYCYSTIC OVARY SYNDROME (PCOS)


INTRODUCTION


WHAT IS PCOS?

PCOS is a common problem among teen girls and young women. In fact, almost 1 out of 10 women has PCOS. Polycystic ovary syndrome (PCOS) is a hormone imbalance that can cause irregular periods, unwanted hair growth, and acne. PCOS begins during a girl’s teen years and can be mild or severe.

Polycystic ovary syndrome (PCOS) is a condition that affects a woman’s hormone levels. Women with PCOS produce higher-than-normal amounts of male hormones. This hormone imbalance causes them to skip menstrual periods and makes it harder for them to get pregnant.

PCOS also causes hair growth on the face and body, and baldness. And it can contribute to long-term health problems like diabetes and heart disease. Birth control pills and diabetes drugs can help fix the hormone imbalance and improve symptoms.

Symptoms of PCOS may begin shortly after puberty, but can also develop during the later teen years and early adulthood. Because symptoms may be attributed to other causes or go unnoticed, PCOS may go undiagnosed for some time.


MAIN CONTENTS


WHAT ARE THE SYMPTOMS OF PCOS?

Women with PCOS typically have irregular or missed periods as a result of not ovulating. Although some women may develop cysts on their ovaries, many women do not. Other symptoms include:

  •   Weight gain. About half of women with PCOS will have weight gain and obesity that is difficult to manage. Up to 80 percent of women with PCOS are overweight or obese.

  •   Fatigue. Many women with PCOS report increased fatigue and low energy. Related issues such as poor sleep may contribute to the feeling of fatigue.

  •   Unwanted hair growth (also known as hirsutism). Areas affected by excess hair growth may include the face, arms, back, chest, thumbs, toes, and abdomen. Hirsutism related to PCOS is due to hormonal changes in androgens.

  •   Thinning hair on the head. Hair loss related to PCOS may increase in middle age.
  •   Infertility. PCOS is a leading cause of female infertility. However, not every woman with PCOS is the same. Although some women may need the assistance of fertility treatments, others are able to conceive naturally.

  •   Acne. Hormonal changes related to androgens can lead to acne problems. Other skin changes such as the development of skin tags and darkened patches of skin are also related to PCOS.

  •   Mood changes. Having PCOS can increase the likelihood of mood swings, depression, and anxiety.

  •   Pelvic pain. Pelvic pain may occur with periods, along with heavy bleeding. It may also occur when a woman isn’t bleeding.

  •   Headaches. Hormonal changes prompt headaches.

  •   Sleep problems. Women with PCOS often report problems such as insomnia or poor sleep. There are many factors that can affect sleep, but PCOS has been linked to a sleep disorder called sleep apnea. With sleep apnea, a person will stop breathing for short periods of time during sleep.

  •   Darkening of the skin. Dark patches of skin can form in body creases like those on the neck, in the groin, and under the breasts.



HOW PCOS AFFECTS YOUR BODY?

Having higher-than-normal androgen levels can affect your fertility and other aspects of your health.

⁘   Infertility

     •   To get pregnant, you have to ovulate. Women who don’t ovulate regularly don’t release as many eggs to be fertilized. PCOS is one of the leading causes of infertility in women.

⁘   Metabolic syndrome

     •   Up to 80 percent of women with PCOS are overweight or obese. Both obesity and PCOS increase your risk for high blood sugar, high blood pressure, low HDL (“good”) cholesterol, and high LDL (“bad”) cholesterol.

     •   Together, these factors are called metabolic syndrome, and they increase the risk for heart disease, diabetes, and stroke.

⁘   Sleep apnea

     •   This condition causes repeated pauses in breathing during the night, which interrupt sleep.Sleep apnea is more common in women who are overweight — especially if they also have PCOS. The risk for sleep apnea is 5 to 10 times higher in obese women with PCOS than in those without PCOS.

⁘   Endometrial cancer

     •   During ovulation, the uterine lining sheds. If you don’t ovulate every month, the lining can build up.A thickened uterine lining can increase your risk for endometrial cancer.

⁘   Depression

     •   Both hormonal changes and symptoms like unwanted hair growth can negatively affect your emotions. Many with PCOS end up experiencing depression and anxiety.



WHAT ARE THE SIGNS OF PCOS?

Some of the most common signs of PCOS include:

 •   Irregular periods that come every few months, not at all, or too frequently

 •   Extra hair on the face or other parts of the body, called hirsutism

 •   Acne

 •   Weight gain and/or trouble losing weight

 •   Patches of dark skin on the back of the neck and other areas, called acanthosis nigricans

Doctors aren’t sure what causes PCOS. One theory is that insulin resistance may cause your body to make too many androgens.

Insulin is a hormone that helps the cells in your body absorb sugar (glucose) from your blood to be used as energy later. If you have insulin resistance, the cells in your muscles, organs, and other tissue don’t absorb blood sugar very well. As a result, you can have too much sugar moving through your bloodstream. This is called diabetes, and it can cause problems with your cardiovascular and nervous systems.


WHY DOES PCOS CAUSE WEIGHT GAIN?

PCOS makes it more difficult for the body to use the hormone insulin, which normally helps convert sugars and starches from foods into energy. This condition -- called insulin resistance -- can cause insulin and sugar -- glucose -- to build up in the bloodstream.

High insulin levels increase the production of male hormones called androgens. High androgen levels lead to symptoms such as body hair growth, acne, irregular periods -- and weight gain. Because the weight gain is triggered by male hormones, it is typically in the abdomen. That is where men tend to carry weight. So, instead of having a pear shape, women with PCOS have more of an apple shape.



COULD I HAVE PCOS?

If you have some or all of the above signs, you might have PCOS. There can be other reasons why you might have signs; however, only your health care provider can tell for sure.



WHY PCOS

PCOS is caused by an imbalance in the hormones (chemical messengers) in your brain and your ovaries. PCOS usually happens when a hormone called LH (from the pituitary gland) or levels of insulin (from the pancreas) are too high, which then causes the ovaries to make extra amounts of testosterone.

For a more detailed explanation, take a look at the female reproductive anatomy image:

The pituitary gland in your brain makes the hormones luteinizing hormone (LH) and follicle stimulating hormone (FSH).

After getting the signal from the hormones LH and FSH, the ovaries make estrogen and progesterone, the female sex hormones.

All normal ovaries also make a little bit of the androgen testosterone, a male sex hormone. The pancreas is an organ that makes insulin. High levels of insulin can also cause the ovaries to make more of the hormone testosterone.











WHY MY PERIODS ARE SO IRREGULAR?

Having PCOS means that your ovaries aren’t getting the right (hormonal) signals from your pituitary gland. Without these signals, you won’t ovulate (make eggs) every month. Your period may be irregular, or you may not have a period at all.


    Let’s review a regular menstrual cycle.

The menstrual cycle starts when the brain sends LH and FSH to the ovaries. A big surge of LH is the signal that causes the ovaries to ovulate, or release an egg.

The egg travels down the fallopian tube and into the uterus. Progesterone from the ovary causes the lining of the uterus to thicken.

If the egg isn’t fertilized, the lining of the uterus is shed. This is a menstrual period.

After the menstrual period, the cycle begins all over again.


Regular menstrual cycle vs. PCOS menstrual cycle

The diagram on the left shows a regular menstrual cycle, and the diagram on the right shows a PCOS cycle with no ovulation.

Now, let’s look at what happens during a menstrual cycle with PCOS.

With PCOS, LH levels are often high when the menstrual cycle starts. The levels of LH are also higher than FSH levels.

Because the LH levels are already quite high, there is no LH surge. Without this LH surge, ovulation does not occur, and periods are irregular.

Girls with PCOS may ovulate occasionally or not at all, so periods may be too close together, or more commonly too far apart. Some girls may not get a period at all.


DOES PCOS MEAN I HAVE CYSTS ON MY OVARIES?

The term “polycystic ovaries” means that there are lots of tiny cysts, or bumps, inside of the ovaries. Some young women with PCOS have these cysts; others only have a few. Even if you do have lots of them, they’re not harmful and they don’t need to be removed.


WHY DO I GET ACNE AND/OR EXTRA HAIR ON MY BODY?

Acne and extra hair on your face and body can happen if your body is making too much testosterone. All women make testosterone, but if you have PCOS, your ovaries make a little bit more testosterone than they are supposed to. Skin cells and hair follicles can be extremely sensitive to the small increases in testosterone found in young women with PCOS.


WHY DO I HAVE PATCHES OF DARK SKIN?

Many adolescents with PCOS have higher levels of insulin in their blood. Higher levels of insulin can sometimes cause patches of darkened skin on the back of your neck, under your arms, and in your groin area (inside upper thighs).


WILL PCOS AFFECT MY ABILITY TO HAVE CHILDREN SOME DAY?

Women with PCOS have a normal uterus and healthy eggs. Many women with PCOS have trouble getting pregnant, but some women have no trouble at all. If you’re concerned about your fertility (ability to get pregnant) in the future, talk to your health care provider about all the new options available, including medications to lower your insulin levels or to help you ovulate each month.


WHAT CAN I DO ABOUT HAVING PCOS?

The most important treatment for PCOS is working towards a healthy lifestyle that includes healthy eating and daily exercise. There are also excellent medications to help you manage irregular periods, hair growth, and acne. Ask your health care provider about the various treatment options.


IS THERE A CURE FOR PCOS?

There is no cure yet, but there are many ways you can decrease or eliminate PCOS symptoms and feel better. Your doctor may offer different medicines that can treat symptoms such as irregular periods, acne, excess hair, and elevated blood sugar. Fertility treatments are available to help women get pregnant. Losing as little as 5% excess weight can help women ovulate more regularly and lessen other PCOS symptoms. The ideal way to do this is through nutrition and exercise.

You may feel that it is difficult to lose excess weight and keep it off, but it is important to continue the effort. Your efforts help reduce the risk for developing serious health complications that can impact women with PCOS much sooner than women without PCOS. The biggest health concerns are diabetes, heart disease, and stroke because PCOS is linked to having high blood pressure, pre-diabetes, and high cholesterol.


☑ Birth control

Taking estrogen and progestin daily can restore a normal hormone balance, regulate ovulation, relieve symptoms like excess hair growth, and protect against endometrial cancer. These hormones come in a pill, patch, or vaginal ring.




☑ Metformin

Metformin (Glucophage, Fortamet) is a drug used to treat type 2 diabetes. It also treats PCOS by improving insulin levels.

One study found that taking metformin while making changes to diet and exercise improves weight loss, lowers blood sugar, and restores a normal menstrual cycle better than changes to diet and exercise alone.




☑ Clomiphene

Clomiphene (Clomid) is a fertility drug that can help women with PCOS get pregnant. However, it increases the risk for twins and other multiple births.




☑ Hair removal medicines

A few treatments can help get rid of unwanted hair or stop it from growing. Eflornithine (Vaniqa) cream is a prescription drug that slows hair growth. Laser hair removal and electrolysis can get rid of unwanted hair on your face and body.


☑ Weight Loss

Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a 10 percent loss in body weight (for example, a 150-pound woman losing 15 pounds) can help make your menstrual cycle more regular and improve your chances of getting pregnant.


☑ Surgery

Surgery can be an option to improve fertility if other treatments don’t work. Ovarian drilling is a procedure that makes tiny holes in the ovary with a laser or thin heated needle to restore normal ovulation.


WHEN TO SEE DOCTOR

See a doctor if:

 •   You’ve missed periods and you’re not pregnant.

 •   You have symptoms of PCOS, such as hair growth on your face and body.

 •   You’ve been trying to get pregnant for more than 12 months but haven’t been successful.

 •   You have symptoms of diabetes, such as excess thirst or hunger, blurred vision, or unexplained weight loss.

If you have PCOS, plan regular visits with your primary care doctor. You’ll need regular tests to check for diabetes, high blood pressure, and other possible complications.



HOW IS PCOS DIAGNOSED?

There is no single test to diagnose PCOS. To help diagnose PCOS and rule out other causes of your symptoms, your doctor may talk to you about your medical history and do a physical exam and different tests:

 •   Physical exam. Your doctor will measure your blood pressure, body mass index (BMI), and waist size. They will also look at your skin for extra hair on your face, chest or back, acne, or skin discoloration. Your doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland).

 •   Pelvic exam. Your doctor may do a pelvic exam for signs of extra male hormones (for example, an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.

 •   Pelvic ultrasound (sonogram). This test uses sound waves to examine your ovaries for cysts and check the endometrium (lining of the uterus or womb).

 •   Blood tests. Blood tests check your androgen hormone levels, sometimes called "male hormones." Your doctor will also check for other hormones related to other common health problems that can be mistaken for PCOS, such as thyroid disease. Your doctor may also test your cholesterol levels and test you for diabetes.

Once other conditions are ruled out, you may be diagnosed with PCOS if you have at least two of the following symptoms:

⁘   Irregular periods, including periods that come too often, not often enough, or not at all

⁘   Signs that you have high levels of androgens:

     •   Extra hair growth on your face, chin, and body (hirsutism)

     •   Acne

     •   Thinning of scalp hair

⁘   Higher than normal blood levels of androgens

⁘   Multiple cysts on one or both ovaries



CONCLUSION

As conclusion, PCOS is one of the most common disorders affecting women of reproductive age. As a syndrome, it has multiple components, including reproductive, metabolic, and cardiovascular, with long-term health concerns that cross the life span. Although not well understood, insulin resistance seems to underlie many of the clinical manifestations of PCOS. Insulin resistance also appears to increase the risk of glucose intolerance, type 2 diabetes, and lipid abnormalities. Treatment of this disorder should focus on reduction of androgenassociated symptoms, the protection of the endometrium, and reduction of the long-term risks of diabetes and cardiovascular complications. For many women with this syndrome, improving infertility is a primary goal of therapy. Nurse-midwives can assess and manage many of the presenting complaints and lifestyle issues, such as menstrual disorders, hirsutism, and obesity, which are associated with PCOS. See your doctor if you have skipped periods or you have other PCOS symptoms like hair growth on your face or body. Also see a doctor if you have been trying to get pregnant for 12 months or more without success.


REFERENCE

•   Centre for Young Women’s Health. PCOS (Polycystic Ovary Syndrome): General Information. Retrieved October 14, 2018 from https://youngwomenshealth.org/2014/02/25/polycystic-ovary-syndrome/

•   King, J. (2006). Polycystic Ovary Syndrome. Retrieved October 15, 2018 from https://www.medscape.com/viewarticle/551015_7

•   PCOS Awareness Association. (n.d). PCOS Symptoms. Retrieved October 15, 2018 from http://www.pcosaa.org/pcos-symptoms/

•   PCOS Awareness Association. (n.d). Is There A Cure For PCOS? Retrieved October 12, 2018 from http://www.pcosaa.org/is-there-a-cure-for-pcos/

•   Watson, S. (2017). Polycystic Ovary Syndrome (PCOS): Symptoms, Causes and Treatment. Retrieved October 18, 2018 from https://www.healthline.com/health/polycystic-

•   Web MD. What Are the Complications of PCOS. Retrieved October 14, 2018 from https://www.webmd.com/women/complications-pcos

•   Web MD. Polycystic Ovary Syndrome (PCOS) and Weight Gain. Retrieved October 14, from https://www.webmd.com/women/polycystic-ovary-syndrome-pcos-and-weight-

•   Women’s Health. Polycystic ovary syndrome (PCOS). Retrieved October 18, 2018

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