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PCOS is one of the most common hormonal disorders in women of reproductive age. Women with PCOS have irregular menstrual bleeding and often face difficulty getting pregnant. The syndrome occurs when levels of hormones are abnormal. The name “polycystic ovarian syndrome” refers to the appearance of small cysts along the outer edge of the enlarged ovaries of women with this condition. The exact cause of PCOS is unknown, but experts believe it is related to the production of excess amount of androgens, a group of male sex hormones. Although all women produce some androgens, too much of this type of hormone prevents ovulation. Excess androgens also disrupt the normal menstrual cycle. They may cause infertility, acne and abnormal hair growth, such as excess facial hair or male pattern baldness. Many factors may play a role in the production of androgens, and thus the development of PCOS. For instance, excess insulin may be a factor in developing PCOS. Excess insulin leads to insulin resistance, which in turn decreases one’s ability to use insulin effectively. When the body cannot use insulin properly, it secretes more insulin to make glucose available to cells. The resulting excess insulin is thought to additionally boost androgen production by the ovaries. (Hignett & Kyle, 2011)
Polycystic ovary syndrome is the most common female endocrinopathy, affecting 5–10% of the female population. The overproduction of ovarian androgens leads to hirsutism, acne, anovulation and infertility. Hyperinsulinaemia, exacerbated by obesity, is often a key feature. Treatment depends on the presenting symptoms, which may often be ameliorated by weight loss where relevant. Anti-androgen preparations are used for hyperandrogenic symptoms, and clomiphene citrate (CC) is the first-line treatment for anovulation and infertility. Failure to conceive with CC can be treated in a number of ways, including the addition of insulin-lowering agents (mainly metformin), low-dose gonadotrophin therapy or surgically by laparoscopic ovarian drilling. Although the exact etiology of PCOS is not known, the therapeutic alternatives provide reasonably successful symptomatic treatment.
The definition accepted by most of the authors is the following: presence of ≥10 cysts measuring 2–8 mm in diameter arranged peripherally around a dense core of stroma or scattered through an increased amount of stroma. It includes the two main histological features of PCO, namely the excessive number of follicles, also termed multifollicularity, and stromal hypertrophy. (Adams et al., 1985) |
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