PCOS

Polycystic ovarian syndrome (PCOS) is the most common endocrine abnormality in women of reproductive age. It may be associated with anovulation, infertility, hyperandrogenism, and long-term metabolic sequelae.
Insulin resistance is central to this syndrome, driving increased. androgen levels and resulting in impaired glucose tolerance and, potentially, an increase in cardiovascular disease.

The prevalence of PCOS is estimated conservatively at 6-7 percent of the population(or 400,000 Australian women) but recent studies from the Robinson Institute in Adelaide suggest a much higher prevalence especially in the Aboriginal population.

Obesity aggravates insulin resistance, and as obesity in the community increases, the prevalence of, and complications from, PCOS are expected to rise. Women with PCOS should be fully informed about the long-term health consequences of this condition and advised about how they may reduce their risk.

Polycystic ovary syndrome signs and symptoms often begin soon after a woman first begins having periods (menarche). In some cases, PCOS develops later during the reproductive years, for instance, in response to substantial weight gain. PCOS has many signs — things you or your doctor can see or measure — and symptoms — things that you notice or feel. All of these can worsen with obesity. Every woman with PCOS may be affected a little differently.

The Rotterdam criteria require two of the three following for the diagnosis of PCOS:

• Polycystic ovaries (either 12 or more peripheral antral follicles or increased ovarian volume).
• Oligomenorrhea anovulation
• Clinical and/or biochemical signs of hyperandrogenism..

* Treatment *
There are a number of options available, depending on the main issue you are experiencing.

• Weight loss can be more difficult because of the higher levels of testosterone, but it has a very beneficial effect on balancing hormones and restoring regular periods in obese women. So exercise and a change of diet could have a significant impact.
• Insulin sensitisers, such as Metformin reduce the impact of insulin resistance and can also assist in weight loss.
• Ovulation inducing drugs such as Clomiphene (Serophene or Clomid) can stimulate the ovaries.
• If you do not respond to Clomiphene, injectable drugs (FSH) can be used, but these require specialist facilities and close monitoring of the response to avoid severe side effects and multiple pregnancies.
• IVF treatment may be necessary in very difficult situations.