Polycystic Ovarian Syndrome (PCOS)

Posted by Yakuti in Archives | 6 views since Jan 31, 2012 | 4 comments

Bose was a 25-year-old female, new patient, who came to my hospital with the complaint of problems getting pregnant. She had been happily married to her husband Femi and they had been trying to get pregnant since they tied the knot; it had been a year and a half now. They have been having normal sexual intercourse without any form of birth control and it was becoming quite frustrating month after month and not getting pregnant. Bose had always considered herself healthy. Sure, she was a little overweight but she had been trying…working out, dieting, etc, but nothing had worked so she gave up; it didn’t matter anyway because she had never been sick and her husband loved her just the way she was. She and her Femi were ready to become parents so they had decided to come see a doctor for help.

1st step- thorough History and Physical.

Pertinent information is as follows:

Physical examination
Vitals: normal blood pressure, temperature.
Physical Examination: Obese female, 5 Ft 5, 250lbs, Hirtuism (facial hair), Moderate acne, no previous illnesses, no pertinent family history
Obstetric History: Recently sexually active, no previous history of Sexually Transmitted Diseases, irregular periods since menarche, Normal PAP smear, normal pelvic exam
Labs: Elevated Blood sugars, Elevated Cholesterol, Elevated male and female hormones.

With the above labs, Polycystic Ovarian Syndrome was diagnosed.

POLYCYSTIC OVARIAN SYNDROME (PCOS)

Polycystic Ovarian Syndrome is one of the major causes of infertility among women. It is not easily diagnosed because it has no particular symptom of its own, most of its symptoms are general issues that can be easily associated with other diseases. The common ones are obesity, oligomenorrhea/amenorrhea (irregular menstrual/absent periods), facial hair, high blood sugar, and high cholesterol. The cause of PCOS is not completely understood and as of right now, according to medicine, it is only manageable (but ladies, as Christians… remember, we are more than conquerors in Christ Jesus).

As mentioned before, PCOS is a major cause of infertility because it affects the menstrual cycle. In a normal woman, every month, the brain, ovaries and uterus co-ordinate certain events that make menstrual periods possible. In a woman with PCOS, her hormone levels are so disrupted that menstruation never occurs.

Let me break it down. Each ovary contains many follicles (eggs). Every month, under the influence of hormones, one egg develops (so in essence, the ovary is like a hostel containing many young girls (eggs), and every month, the matron chooses one girl (egg) who shows herself the prettiest, strongest and best option to spend a day outside of the hostel (ovary) Anyone reminded of Queen Esther here…lol).

Now, when the egg is released, it stays for 24 hrs in the body, awaiting the possibility of fertilization by sperm and the consequential creation of a baby (so in essence, this young girl is supposed to only spend 24 hrs outside the hostel but if she meets the man of her dreams (sperm), she will go, get married and never return again to the hostel). Now in a situation of PCOS, every month, more than 1 follicle starts to mature but none of them are sizeable to trigger the release of an egg (so in essence, for reasons we don’t know, the matron chooses more than 1 girl for the special day out and the girls are so disoriented, they are not fully prepared to go… one has only one shoe on, another might have her hair in a mess, another might have her pants on backwards, basically no one is ready to go, so no one ends up leaving the hostel). Upon ultrasound investigation, the follicles are noticed to be polycystic (full of immature eggs in an arrested state of development); hence infertility.

Another known symptom of PCOS is hirsutim; defined as male pattern facial hair. WAIT, before you go and analyze that strand of hair you found on your chin, that’s not hirsutism. Hirsutism is severe facial hair, the kind of beard you see on your brother/husband/ uncle… get it? Not the few strands you might see on your chin or upper lip. To a degree, every woman has a certain level of male hormones in them. In PCOS, the male hormones are unusually high and this cause huge amounts of facial hair.

Last but not least, high blood sugar is another abnormal lab found in PCOS. Insulin is the hormone used to regulate blood sugar and keep it low, in PCOS, the body ignores insulin and this results in high glucose sitting in the blood. High blood causes so much trouble, it impairs wound healing, it is a pre-cursor to diabetes and it harms all your organs.

PCOS TREATMENTS

So basically in treating PCOS related infertility, we want to do anything that can increase ovulation and the chance of egg fertilization. This can be done by the following:

Birth Control Pills (OCP)- Yes, once again another disease treated by birth control pills. As I’ve mentioned, birth control pills help regulate menstruation and make them more frequent.

Hormones: As I mentioned before, the amount of male hormones are drastically increased in PCOS, overshadowing female hormones and making fertility hard. So by taking Progestin which is a female hormone, we create the proper hormonal balance and help fertility.

Weight Loss: This is a simple way to help manage symptoms, with weight loss, periods become more frequent increasing the chances of normal conception.

Clomiphene: This is a drug that helps the ovary release one or more eggs and the more eggs we release, the higher the chance of getting fertilized and conception.

PCOS is not commonly known in most African countries but with proper education and us taking charge of our health and safety as women, PCOS is a disease that can be successfully managed.

Follow up:

With proper exercise and hormonal treatment, Bose and Femi became proud parents of twins April 2010. Glory be to God!

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