Understanding polycystic ovary syndrome
What you need to know:
- According to a study done at Kenyatta National Hospital, up to 37 per cent of women who sought services at the gynaecology clinic due to menstrual disorders were diagnosed with PCOS.
- However, the overall prevalence in the Kenyan population is yet to be established. This scarcity of epidemiological data is also a challenge in developing nations.
Polycystic ovary syndrome (PCOS) is a common infertility disorder affecting a significant proportion of the global population. It is a major cause of infertility in women. According to a study done at Kenyatta National Hospital, up to 37 per cent of women who sought services at the gynaecology clinic due to menstrual disorders were diagnosed with PCOS. However, the overall prevalence in the Kenyan population is yet to be established. This scarcity of epidemiological data is also a challenge in developing nations.
The cause of the hormonal condition is multifactorial and complex and, therefore, it is often difficult to diagnose due to overlapping symptoms. While a specific cause is not yet identified, it has been linked to genetics, metabolic disorders and hormonal imbalance. Research shows that in some families, first-line relatives have a high incidence of polycystic ovaries.
PCOS is characterised by infertility, acne, amenorrhea or oligomenorrhea (lack or reduced frequency of menstruation), hirsutism (abnormal growth of hair on a woman’s face and body), insulin resistance, obesity, hyperandrogenism (excess of male sex hormones such as testosterone), and polycystic ovaries.
Women do not necessarily present with all these symptoms and sometimes it requires a high index of suspicion for a health care provider to suspect PCOS when attending to women who have few signs and symptoms.
On average, it takes longer for women living with PCOS to conceive compared to women with normal ovulation. Women who conceive have a higher risk for gestational diabetes, preeclampsia, cesarian delivery, preterm delivery or post-datism (increased gestation above 42 weeks). Fortunately, there is no increased risk of stillbirth or neonatal death.
Long-term effects of PCOS include Type II diabetes, hypertension (high blood pressure), dyslipidemia (high cholesterol and other lipids), heart disease, endometrial cancer and increased risk of mental illness due to anxiety, depression and negative body image.
It is therefore important to have early detection and treatment to either improve or avoid these chronic health conditions. A multidisciplinary team of healthcare providers is best placed to investigate and treat this disorder; and manage any complications that may arise. This is even more important for women who are planning to conceive.
Laboratory testing involves assessing potential causes of menstrual disorders (blood levels of luteinising hormone, follicular stimulating hormone, prolactin, thyroid hormones), androgen excess (testosterone levels, 17-hydroxyprogesterone), metabolic derangement (blood glucose, cholesterol levels, insulin levels) and assessment of possible causes of infertility.
Recently, genetic testing has gained popularity to identify associated heritable disorders that may affect families or may be passed to unborn babies.
PCOS may occur with other disorders associated with a genetic predisposition. Interestingly, one gene has been associated with both PCOS and male pattern balding. However, no single gene is sufficient to make a diagnosis when detected. Therefore, genetic laboratories offer wide panels of tests using modern technologies to accurately detect involved genes.
PCOS has no cure. Some symptoms can be improved through lifestyle changes, medications and fertility treatments.
Lifestyle changes include weight loss, exercise and dietary restriction of foods with a high caloric intake. Treatment depends on a few factors including age, severity of symptoms and overall health status such as body mass index . The type of treatment may also depend on whether a woman desires to become pregnant in the future.
Dietary therapy and exercise have been shown to ameliorate resistance to insulin, irregular menstrual cycles and obesity. For those with failed dietary intervention, bariatric surgery is showing promising results so far in controlling some of these effects of PCOS.
The most common pharmacologic intervention includes prescribing combined oral contraceptive pills to help with regulating menstrual cycles. They also improve the symptoms of hirsutism and acne. Assisted reproductive therapy is recommended to treat fertility challenges in women with PCOS.
Dr Ngari is a clinical pathologist and head of Clinical Pathology Pathologists Lancet Kenya
