PCOS is a common hormonal disorder in women of reproductive agegroup and Adolescents. In India one and five women or adolescent girls sufferfrom PCOD. It is due to increase in male hormone testosterone or androgens andusually manifests as irregular menstrualcycles. This can be in the form of scanty menses, prolonged menstrualcycles, prolonged and heavy menses or absent menses, obesity, hirsuitsm(malepatterned hair growth), pimples,infertility, stress, anxiety and depression. it is a disease ofreproductive age group but its long term consequences can be seen beyond Menopause in the form of metabolicsyndrome manifested as heart disease,  diabetes,high blood pressure, obesity, and uterine and breast cancers etc.

Exact cause of PCOS is not known but there is evidence thatgenetics play a role. Several other factors also play a role in causing PCOS:Higher levels of male hormones called androgens and high levels of Insulinprevent the ovaries from releasing eggs (ovulation), which causes irregularmenstrual cycles and other features of PCOS.

Risk Factors of PCOS·      

  • Early or late Menarche- age of first menses.·       
  • Obesity.·       
  • Family History of PCOS, irregular periods orDiabetes.·        
  • Sedentary lifestyle.

PCOS is of Two Types

  1. lean PCOS 20 to 30 %     
  2. Obese PCOS 70 to 80 %

Tests to be done inPCOS

Usually one can make diagnosis by symptoms and clinicalexamination.·        

  • All women with suspected PCOS should be screenedfor thyroid disease with TSH and hyperprolactinemia with serum prolactin.·       
  • Pelvic ultrasound – May show PCO ovaries in 25%cases.·        
  • Testosterone level·        
  • Fasting blood sugar·        
  • Lipid profile

Management of PCOS –Management depends upon the symptoms with which patient has come.Lifestyle modificationis the main stay of treatment for all.  Itincludes

Weight loss - Inobese PCOS weight reduction by 10 % can normalize periods and show improvementin many symptoms. Weight loss can often be achieved with programmed diet andexercise.

Diet - It isrecommended to follow calorie restricted diet (low carbohydrate, fat, and highprotein and fibre rich diet) Weight loss surgery may be an option for severelyobese women with PCOS.

Oral contraceptives - Oral contraceptives (combined estrogen and progestin) are the most commonlyused treatment for regulating menstrual periods in women with polycystic ovarysyndrome (PCOS). OCs protects the woman from endometrial (uterine) hyperplasiaor cancer by inducing a monthly menstrual period. OCs is also effective fortreating hirsuitsm and pimples.

Anti-androgen drugs(such as spironolactone) decrease the effect of androgens. These treatmentscan be used in combination to reduce and slow hair growth. Oral contraceptivesand anti-androgens can also reduce acne.

Other Medicines – sometimes we do use Metformin and inositols in the form of myoinositol andchiroinositol which increases Insulin sensitivity thereby improvement insymptoms of PCOS.Treatment ofinfertility – It is usually due to anovulation. Normally every month an eggis released from the ovary but in PCOS due to hormonal imbalance this does nothappen.The primary treatment for women who are unable to becomepregnant and who have PCOS is lifestyle modification and weight loss. Even amodest amount of weight loss may allow the woman to begin ovulating normally.In addition, weight loss can improve the effectiveness of other infertility treatments.Ovulation inducing drugs (like clomiphene etc.) are also used in conjunctionwith Metformin. 

Ovarian drilling - Ovarian drilling, also known as multiperforation or laparoscopic ovariandiathermy, is a surgical technique of puncturing the ovary with a laser beam ora surgical needle using minimally invasive laparoscopicprocedures. 

Prevention-(PCOS) cannot be prevented. But early diagnosis and treatment helpsprevent long-term complications, such as infertility, metabolic syndrome, obesity,diabetes, and heart disease.