Polycystic Ovarian Syndrome (PCOS) by Alejandra Penagos

apenagos02_ — 2024-05-28 00:04:11 UTC

Polycystic Ovarian Syndrome (PCOS), also known as Stein-Leventhal syndrome is an endocrine disorder related to chronic anovulation. This disorder involves the imbalance of Lutenizing hormone (LH) and FSH (follicle-stimulating hormone) and results in abnormal estrogen and androgen (male sex hormones). When ovaries make more androgens, this keeps the ovaries from releasing the egg as it should during ovulation and causes irregular periods.

-LH is high (increased)

-FSH is low (decreased)

-Anti-Müllerian hormone (AMH) levels are generally increased.

PCOS affects the ovaries (female reproductive organs that make eggs) Function of Ovaries: To grow and mature oocytes (eggs) and release them into the fallopian tubes for fertilization or reproduction. The ovaries also produce two main hormones which are estrogen and progesterone.

apenagos02_ — 2024-05-28 00:06:26 UTC

apenagos02_ — 2024-05-28 00:10:53 UTC

Sonographic image of PCOS or "String of Pearls"

apenagos02_ — 2024-05-28 00:14:28 UTC

apenagos02_ — 2024-05-28 00:23:48 UTC

The EXACT cause of developing PCOS: Not clear.

Women having insulin resistance could play a role (excessive insulin builds up in the body and causes higher androgen levels.
Obesity may cause increased insulin levels
genetics may play a role as well. (*It's common for sisters or mother and daughter to have PCOS)

apenagos02_ — 2024-05-28 00:33:57 UTC

Clinical signs/symptoms include:

Infertility
Obesity
Amenorrhea (absence of period)
Missed periods, irregular periods, or very light periods
Acne or oily skin
Small pieces of excessive skin on the neck or armpits (skin tags)
Hirsutism (excessive hair)

apenagos02_ — 2024-05-28 00:39:43 UTC

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Sonographic findings:

Bilateral multiple cysts
12+ cysts per ovary
Ovarian volume >10 cm3
"String of Pearls" sign
Large ovaries

apenagos02_ — 2024-05-28 00:43:54 UTC

Polycystic ovary syndrome (PCOS). Johns Hopkins Medicine. (2022, February 28). https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos#:~:text=The%20exact%20cause%20of%20PCOS,may%20cause%20higher%20androgen%20levels.

apenagos02_ — 2024-05-28 00:52:02 UTC

PCOS shown on CT scan

apenagos02_ — 2024-05-28 00:54:52 UTC

apenagos02_ — 2024-05-28 00:56:14 UTC

Women with diagnosed PCOS are more at risk of developing certain medical conditions/complications.

Complications of PCOS:

Type 2 Diabetes
Hypertension (high blood pressure)
Cardiovascular disease
Endometrial cancer
Depression and anxiety
sleep disorders
Infertility problems

Various treament options

apenagos02_ — 2024-05-28 01:07:22 UTC

Treatment options depend on a few factors such as:

Age
Severity of symptoms
Overall health and well-being
Aiming to become pregnant in the future

apenagos02_ — 2024-05-28 01:08:57 UTC

Have plans to become pregnant:

A change in diet and activity
A healthier lifestyle can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.
Medications to cause ovulation (releasing of an egg or ova)

Medications to cause/ induce ovulation include clomiphene and letrozole are taken orally, while gonadotropins are given by injection.

Another option is IVF (in-vitro fertilization)

IVF is offered when women has PCOS and the medications provided may not seem to cause ovulation. An egg or ova is taken from the ovary and sperm from the partner are fertilized in a lab and inserted into the uterus.
Professinal,C.C. Medical (2023).

apenagos02_ — 2024-05-28 01:10:10 UTC

Don't have plans to become pregnant:

Hormonal Birth-control
Such as birth control pills, patches, shots, a vaginal ring or an intrauterine device (IUD).
Diabetes medication ( such as Metformin is a drug used to treat diabetes.) This medication helps the body regulate insulin.
Change in diet and activity (keeping a healthy and balanced diet and exercise)
Medications to treat symptoms such as excessive hair growth and acne. ( such as medications to block the effect of androgens)

apenagos02_ — 2024-05-28 01:14:13 UTC

PCOS seen on CT scan

apenagos02_ — 2024-05-28 03:00:14 UTC

apenagos02_ — 2024-05-28 03:05:25 UTC

apenagos02_ — 2024-05-28 03:12:44 UTC

**MRI is NOT routinely used to further evaluate or diagnose PCOS.

apenagos02_ — 2024-05-28 03:14:48 UTC

PCOS- describes MANY small cysts (fluid- filled sacs/structures) that form along the edge of the ovary

apenagos02_ — 2024-05-28 03:19:10 UTC

PCOS is seen in females in their late teens or early 20's and 30's.

PCOS affects 10-15% of women of childbearing age and is the most common cause of infertility. In the United States, an estimated 5 to 6 million women have PCOS.

apenagos02_ — 2024-05-28 22:47:07 UTC

Hagen-Ansert, S. L. (2017). Textbook of diagnostic sonography (8th ed., Vol. 2). Elsevier.

Normal Ovary appearance

apenagos02_ — 2024-05-28 22:50:51 UTC

Sonographically: homogenous echotexture, small peripheral cysts/follicles seen in cortex

Ovary: Are almond shaped structures, measure about 3 cm long. Lie posterior to the uterus at the level of the cornua.

apenagos02_ — 2024-05-28 23:04:44 UTC

Professional, C. C. Medical. (2023). PCOS (polycystic ovary syndrome): Symptoms & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos

apenagos02_ — 2024-05-28 23:18:04 UTC

Boldis, B. V., Grünberger, I., Cederström, A., Björk, J., Nilsson, A., & Helgertz, J. (2024, April 5). Comorbidities in women with polycystic ovary syndrome: A sibling study - BMC Women’s health. BioMed Central. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03028-9#:~:text=Women%20have%20a%20higher%20risk,syndrome%20as%20well%20%5B30%5D.

apenagos02_ — 2024-05-28 23:29:56 UTC

apenagos02_ — 2024-05-28 23:31:38 UTC

Risk Factors of PCOS

apenagos02_ — 2024-05-28 23:39:58 UTC

Risk factors of PCOS include:

Genetics (more likely to develop PCOS if mother or sister has been diagnosed with it.)
Obesity
Insulin resistance
female in childbearing years (late teens - 20's and 30's)

apenagos02_ — 2024-05-29 00:33:52 UTC

In conclusion, PCOS is an endocrine disorder that is related to anovulating (or not releasing an egg during ovulation) and involves the imbalance of LH and FSH hormones. It's an imbalance of hormones because LH is too high and FSH is too low. I found it most interesting that 10-15% of women have diagnosed PCOS and it's estimated that 50% of women have PCOS but have not been diagnosed. Therefore, this makes PCOS the most common cause of infertility among women. Another thing I found most interesting is that the main cause of PCOS is not clear or unknown, but women having insulin- resistance, obesity, and genetics with PCOS may play a role. In the research conducted, genetics plays a role because it's common for sisters or mother and daughter to have PCOS. This would affect me in a clinical setting, because when imaging an ovary and I see the "string of pearls" sign along with a large ovary, and the patient being in their child-bearing years, this will directly point me to PCOS.