PCOS Diagnostic Process

For one to be accurately diagnosed with PCOS, there must be comprehensive medical history as well as physical examinations conducted by a trained physician or nurse practitioner. The medical history and physical examinations would identify any presence of androgen excess resulting in hirsutism, acnes or alopecia and check whether there is normal ovulation or not. Through physical exams, one would also be able to ascertain whether there is hypertension or increased abdominal obesity which would put such an individual at risk of developing diabetes or heart diseases.

Further diagnostic tests include carrying out various blood tests to check whether the ovaries are functioning normally or overproduction of androgens. Ovarian ultrasound would also be conducted to establish the size of the ovaries and the presence of polycystic ovaries. Various pituitary, thyroid and adrenal abnormalities as well as rarer tumors could also be detected. Blood tests of fasting glucose, triglyceride and cholesterol are also taken along with measuring blood glucose 2 hours after taking oral glucose solution.

Infertility due to Polycystic Ovary Syndrome

One should first understand the potential risks associated with PCOS, such as development of diabetes and high blood pressure during pregnancy. Thus, medical advice is recommended to improve chances of having a normal pregnancy prior to conception in any PCOS patient.

Inability to ovulate (releasing an egg each month by the ovary) is the leading factor contributing to infertility in PCOS women, while some individuals may also have higher rates of miscarriages. In some PCOS patients who are overweight, dieting and exercise can restore ovulation without taking drugs. On the other hand, there are many drugs which help restore ovulation in PCOS patients. Clomiphene is taken orally to stimulate natural production of FSH from the pituitary gland in the skull to induce ovarian follicles' development. Another option would be injecting gonadotrophins with FSH and LH subcutaneously to achieve the same results.

Both methods will result in multiple pregnancies, but FSH injection is more powerful compared to the other drug. There are also other drugs, for example, metformin, which sensitizes insulin, reduces its levels slowly along with androgens and restores ovulation.

Anti-estrogen drugs that cause inhibition of estrogen synthesis leading to stimulation of FSH secretion (Letrozol) are also available, however more research studies are required in order to incorporate these drugs as routine treatment. Since the majority of PCOS women ovulate with medication treatments, surgery and IVF are typically considered only when PCOS women do not ovulate despite medication treatment or when they suffer from some fertility issues apart from PCOS.

Medication therapy helps to inhibit hair growth, but does not remove hair. Hence, medication therapy requires the use of hair removal techniques such as electrolysis and laser techniques in addition to medications. Electrolysis involves insertion of electrode into each hair follicle which destroys it.

It is common, safe, and highly effective as well as being used for the removal of hair from face and body parts. Laser therapy is costlier than electrology, but it is quick and causes minimal pain and discomfort to the patient and needs fewer visits. The laser works on the basis of destruction of melanin in the hair shafts and works best in cases of dark hair and pale skin.

High-wavelength lasers and those having cooling mechanisms can be used in case of red, true blonde, and white hair as well as black or dark skin.

By proper therapy, about 70% reduction in the density of the hair can be achieved with reduced thickness of hair shafts within 3-6 months. Maintenance treatments may be needed after regular intervals of 6-12 months.

Acne is mainly treated with the use of contraceptives and other local or systemic agents. Hair loss can be treated with androgen suppression along with antiandrogenic therapy and promoting hair growth locally.

Diabetes and cardiovascular diseases prevention

An oral glucose tolerance test, which takes 2 hours, can be done very conveniently to identify the risk of diabetes among PCOS women. If required, prevention of diabetes will involve lifestyle modifications like weight loss, exercise and diet, and the use of insulin sensitizers like metformin, among other drugs. Lipid profiles in the fasting state can be done to detect the risk for future heart disease and may need modification of lifestyles in addition to taking oral drugs like statins to reduce raised triglycerides and LDL-cholesterol and/or lower HDL cholesterol.

Improving quality of life

There are increasing studies showing that mood disorders, especially severe depression, exist among PCOS women, where the low quality of life due to poor body image results in fatigue, lack of sleep and alterations in eating patterns. Furthermore, women with PCOS find themselves abnormal and unfeminine, being embarrassed because of unwanted hair growth, making them hide their hair growth and even cover their faces while speaking with people around. It is important to know how the patient feels about herself and modify this aspect in order to help her have an improved overall quality of life.