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Polycystic ovarian syndrome

Polycystic ovarian syndrome, also known as Stein Leventhal syndrome is a medical condition characterized by stoppage of ovulation, excessive circulating male hormone (androgen) and high blood sugar level due to resistance of tissue to insulin. This condition is quite common in women of reproductive age group; about 5 to 10% of the women of this age group suffer from polycystic ovarian syndrome.
One of the most common complications of polycystic ovarian syndrome is infertility along with type 2 diabetes, abnormal lipid metabolism, elevated blood pressure, etc. Genetic factor is known to play a major role in causation of polycystic ovarian syndrome.
Treatment options include the administration of drugs to normalize the menstrual cycle, to facilitate ovulation and surgical interventions to facilitate ovulation.
The name of the disease is derived from the fact that the ovaries of most of the affected women are enlarged with numerous fluid filled cystic structures on the surface of the ovaries. In young women the disease may occur soon after initiation of menstruation (menarche) and absence or infrequent menstrual bleeding is the most common presenting symptom.
Other common presenting symptoms include lengthening of the menstrual cycle (often more than 35 days), infrequent bleeding (less than eight episodes of bleeding), scanty or excessive blood loss, missing periods for at least consecutively for four months, etc. However, this condition may also affect women in later years of reproductive age group; inability to conceive is the most common presenting symptom in them.
Other than abnormal menstrual cycle characterized the other two main symptoms include
1. Excessive circulating androgen characterized by excessive growth of facial and body hair, severe degree of acne and male type of hair loss. However, severity of the symptoms due to excess circulating androgen depend upon the ethnicity of the affected women; as in women with Asian or north European background these symptoms may not occur.
2. Ovaries with cysts: although the name the suggests presence of ovarian cysts, not all of the affected person show ovarian cysts upon ultrasonic investigation
Polycystic ovarian syndrome often leads to number of other health conditions especially if obesity coexists; these conditions are type 2 diabetes, elevated blood pressure, abnormal blood cholesterol levels, metabolic syndrome, non alcoholic inflammatory changes in the liver, increased risk of suffering from uterine (endometrial) cancer due to continuous exposure to high level of circulating estrogen, increased chance of suffering from (gestational) diabetes or high blood pressure during pregnancy etc
The exact underlying cause of polycystic ovarian syndrome is not yet clear however numbers of possible factors are identified; these are
1. Excessive circulating insulin: insulin is the hormone secreted by the pancreatic cells, which helps in glucose utilization by different organs of the body and thus helps to maintain normal glucose level in the blood. Sometimes the different organs become resistant to insulin, resulting in impairment of glucose utilization capacity of these organs. Pancreas tries to normalize the high circulating glucose level by secreting excessive amount of insulin and this high level of insulin may facilitate excessive androgen production by the ovaries
2. Low degree of inflammation may facilitate polycystic ovarian syndrome
3. Family history of polycystic ovarian syndrome especially in first degree relatives
4. Prolonged contact with high level of androgen during intra uterine period may alter the gene expression in a female body leading to polycystic ovarian syndrome in later life

The main approach of treatment of polycystic ovarian syndrome is management of individual symptoms. The options are
1. Drug therapy: hormonal birth control pills to normalize abnormal menstrual cycle, metformin to overcome insulin resistance, anti estrogen drugs like clomiphen to facilitate ovulation, spironolactone to counteract the effect of high level of androgen, etc.
2. Surgical intervention like laparoscopic ovarian drill to facilitate ovulation in women not benefitted with drugs.

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