PCO Symptoms, Causes, Diagnosis & Management

Polycystic Ovary Syndrome Definition Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts. Characterized by numerous small cysts (fluid-filled sacs) that form in the ov...

Polycystic Ovary Syndrome Definition Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts. Characterized by numerous small cysts (fluid-filled sacs) that form in the ovaries ,it can affect women menstrual cycle ,fertility,hormones ,insuline production ,heart, blood vesseles and appearance the woman's body. Characteristics Women With PCOS  Polycystic ovaries mutiple small cysts around the periphery of the ovary High level of male hormones Called androgen.signes of androgen excess ,acn,hirutism ,temporal balding ,male pattern ,hair loss and clitoromegaly. menstrual irregularities (oligomenorrhea or polymenorrhea). Causes and risk factor of PCOS A. Heredity. If your mother or sister has PCOS, you might have a greater chance of having it, too. B. Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar (glucose) — your body's primary energy supply. If you have insulin resistance, your ability to use insulin effectively is impaired, and your pancreas has to secrete more insulin to make glucose available to cells. The excess insulin might boost androgen production by your ovaries. C. Weight : over weight , obesty, exess fat ,can make insuline resistence worse.this may then causes the level of insulin to rise,and boost androgen production by your ovaries, even further high levels of insulin can contribute to further weight gain D. Low-grade inflammation. Your body's white blood cells produce substances to fight infection in a response called inflammation. When this happens, white blood cells produce substances that can lead to insulin resistance and cholesterol accumulation in blood vessels (atherosclerosis). Atherosclerosis causes cardiovascular disease. E. Abnormal fetal development. Some research shows that excessive exposure to male hormones (androgens) in fetal life may permanently prevent normal genes from working the way they're supposed to — a process known as gene expression. This may promote a male pattern of abdominal fat distribution, which increases the risk of insulin resistance and low-grade inflammation. Researchers continue to investigate to what extent these factors might contribute to PCos Symptoms of PCOS  Menstrual abnormality This is the most common characteristic. include Oligomenorrhea, amenorrhea — irregular, few, or absent menstrual Excess androgen Elevated levels of male hormones (androgens) may result in physical signs, such as excess facial and body hair including the chest, stomach, and back (hirsutism); acne or oily skin Ovaries that are large or have many cysts Weight gain, especially around the belly (abdomen)  Male-pattern baldness or thinning hair Infertility Small pieces of excess skin on the neck or armpits (skin tags) Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts  Pelvic pain. Type 2 diabetes. High cholesterol. High blood pressure Diagnosis of PPCOS  Medical history: Your doctor may ask questions about your menstrual periods, weight changes and other symptoms. Physical examination: During your physical exam, your doctor will note several key pieces of information, including your height, weight and blood pressure.  Pelvic examination: During a pelvic exam, your doctor visually and manually inspects your reproductive organs for signs of masses, growths or other abnormalities.. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts Vaginal Ultrasound: to examine the ovaries for cysts &the endometrium the uterine lining may become thickened of these has not been irregular period.  Laboratory test:(Hormonal Level): blood may be drawn to measure the levels of several hormones to exclude possible causes of menstrual abnormalities or androgen excess that mimic PCOS. Additional blood testing may include fasting cholesterol and triglyceride levels and a glucose tolerance test, in which glucose levels are measured while fasting and after drinking a glucose-containing beverage Ultrasound: to check the ovaries and endometrial or lining of the uterus The Effect Of (PCSO) On Pregnancy: 1- 1-Higher rate of miscarriage. 2- 2-Gestational Diabetes. 3- 3-pregnancy induced blood pressure. 4- 4-premature delivery in women with PCSO. Possible complications 1. type 2 diabetes, 2. high blood pressure, problems with the heart and blood vessels, 3. uterine cancer. Irregular menstrual periods leads to thickenes of endometrium due to absence of progesterone which Increased risk of endometrial hyperplesia or cancer. 4. Infertility Management Medical treatment of PCOS is tailored to the patient's goals. Broadly, these may be considered fewer than four categories: - Lowering of insulin levels - Restoration of fertility - Treatment of hirsutism or acne - Restoration of regular menstruation, and prevention of endometrial hyperplasia and 1endometrial cancer 1-Diet Where PCOS is associated with overweight or obesity, successful weight loss is the most effective method of restoring normal ovulation/menstruation, but many women find it very difficult to achieve and sustain significant weight loss. Low- carbohydrate diets and sustained regular exercisemay help. Some experts recommend a low GI diet in which a significant part of total carbohydrates are obtained from fruit, vegetables and whole grain sources Vitamin D deficiency may play some role in the development of the metabolic syndrome, so treatment of any such deficiency is indicated. 2-Medications(Diabetic Medication): Reducing insulin resistance by improving insulin sensitivity through medications such as 1metformin 500 to 1000 mg bid is used to help increase insulin sensitivity if weight loss is unsuccessful or menses do not resume. Metformin can also reduce free testosterone levels. When metformin is used, serum glucose should be measured, and kidney and liver function tests should be done periodically. Because metformin may induce ovulation, contraception is needed if pregnancy is not desired. For women who desire pregnancy, infertility treatments (eg, clomiphene, metformin ) are used. Weight loss may also be helpful. Hormone therapy that may have contraceptive effects is avoided. 3-Fertility Medication: Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used. Also, some fertility medications increase the risk for multiple births Treatment options include:Clomiphene ,Metformin and Gonadotropins. 4-Hirsutism and acne For hirsutism, physical measures (eg, bleaching, electrolysis, and plucking, waxing, depilation) can be used. Eflornithine cream 13.9% bid may help remove unwanted facial hair. In adult women who do not desire pregnancy, hormone therapy that decreases androgen levels or spironolactone can be tried. Acne can be treated with the usual drugs (eg, benzoyl peroxide, tretinoin cream, topical and oral antibiotics). 5-Menstrual irregularity and endometrial hyperplasia (Brith Control Pills): Thus reduce risks of estrogen excess (eg, endometrial hyperplasia) and androgen excess (eg, cardiovascular disorders). Women who do not desire pregnancy are usually given an intermittent progestin (eg, medroxyprogesterone 5 to 10 mg po once/day for 10 to 14 days every 1 to 2 mo) or oral contraceptives to reduce the risk circulating androgens and usually help make menstrual cycles more regular. 6-Surgery finally surgical procedure known as ovarian drilling can help to induce ovulation in some women who have not respond ed to other treatment for PCOS.in this procedure small portion of ovarian tissue is destroyed by an electrical current delivered though the needle inserted in to the ovary. Role of Nurses 1- provide support for women dealing with negative self-image secondary to the physical manifestations of PCOS, through education; help the women understand the syndrome and it is associated risk factors to prevent long-term health problems. 2- Encourage women to make positive life style changes. 3- Diagnostic test arrangements. 4- Provide support for women dealing with negative self image secondary to the physical manifestation of PCOS and reassurance during the diagnostic period to alleviate anxiety in the client and her family. 5- Reassure the woman that the majority of ovarian cysts are benign, but regardless stress the importance of follow-up care. 6- Listen to the woman’s concerns about her appearance, infertility, and facial hair growth. 7- Offer suggestions to help the woman feel better about herself and her health. 8- Make community referrals to local support groups to help the woman built her coping skills. 9- The nurse plays acrucial role in clarifying lines of treatment for women with PCOS. 10- Encourage the women to make positive live style changes. 11- Advice the women with PCOS to follow recommendation diet for live style changes.