Patients’ stories:
A lady in her early twenties came to the Endocrine clinic with complaint of increased hair growth on the face, arms, chest and back, oily skin and acne. The facial hair was above the upper lip and chin. She had to remove it once every three days. She had been to a dermatologist and had tried a few treatments, but of no avail.
Another young lady came to the clinic with weight gain and mood swings. She had been to an anger management program in the recent past. Despite regular exercise and restricting calorie intake, her weight was static.
18 year old girl complained of absence of periods. She never had onset of menstruation despite attaining puberty.
A lady in her 30s came to the clinic with infertility despite unprotected intercourse with her partner for two years.
All these patients were later diagnosed with polycystic ovarian syndrome.
Wide ranging symptoms in Polycystic Ovary Syndrome:
Polycystic ovary is a syndrome with wide range of symptoms, varying between patients. Patients usually have one or two primary symptoms, the underlying aetiology being excessive androgen hormones due to change in frequency of gonadotropin releasing hormone (GnRH) from the hypothalamus. This may result in a lack of egg release from ovary (an-ovulation) which causes infertility, irregular menstrual periods or complete absence of periods. Another common presentation is an increase in facial hair and acne which is cosmetically unacceptable. Weight gain, insulin resistance and metabolic syndrome do commonly occur. We diagnose PCOS if the patient meets at least two out of three criteria on the Rotterdam consensus. These are oligo anovulation, clinical and/or biochemical hyperandrogenism and Ultrasonographic evidence of polycystic ovaries.
Treatment of Polycystic Ovary Syndrome:
There is no permanent cure for Polycystic Ovarian Syndrome. The treatment is usually directed towards the primary symptoms. New weight loss medications such as GLP-1 agonists or GIP/GLP-1 have shown promising results but should be given and monitored by expert Endocrinologist with appropriate Dietician input. Topical Eflornithine ointment and oral anti-androgens have shown good results to restrict growth of hair follicles. Fertility improves with weight loss and many patients are able to conceive with normal body mass index. Additionally, we may prescribe drugs to induce ovulation. Oral contraceptives help to regularize menstrual cycle and have additional anti-androgen effect.
Summary:
In summary, treatment is directed towards symptoms and a good control can be achieved. Patients are able to live a normal healthy life.
Dr Oraizi Jafery
Consultant in Endocrine, Diabetes, Lipids,
Obesity and Medical Specialist.
Bedfordshire, United Kingdom
