Detailed Report on Polycystic Ovary Syndrome (PCOS) - Biomedicine

This report provides a comprehensive overview of Polycystic Ovary Syndrome (PCOS), a common gynaecological condition affecting women. It covers the definition, epidemiology, aetiology, and pathophysiology of PCOS, including genetic predisposition, hormonal imbalances, and insulin resistance. The report details the clinical signs and symptoms, such as irregular periods, hirsutism, and infertility. It also explores differential diagnosis techniques, including biochemical testing, ultrasound, and the use of anti-Mullerian hormone (AMH). The report examines both orthodox medical treatments, such as contraceptive pills and metformin, and natural medicine approaches, emphasizing the importance of lifestyle interventions like diet and exercise. Furthermore, it discusses the prognosis, potential complications like metabolic syndrome, and the importance of early diagnosis and management for women with PCOS. The report is supported by references to current research and medical literature.

Running head: POLYCYSTIC OVARY SYNDROME (PCOS)
Polycystic Ovary Syndrome (PCOS)
Name of the Student
Name of the University
Author Note

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POLYCYSTIC OVARY SYNDROME (PCOS)
Definition of the Disease
Polycystic Ovary Syndrome (PCOS) is a common gynaecological condition
that affects the normal functioning of either one or both the ovaries of a woman. It is
characterised by appearance of multiple small cysts over the surface of the
ovary/ovaries and hence the name polycystic (National Health Service (NHS) 2020).
Epidemiology
National Health Service (NHS) (2020) report highlights that, it is difficult to
know the exact percentage of women having PCOS. It is a common disease and
nearly one out of five women in the UK are affected with this syndrome. PCOS can
happen to women of diverse ages. Teenage girls and young females are vulnerable
towards developing this syndrome and the disease vulnerability decreases post-
menopause. As per the NHS (2020) reports, teenage girls and the young adult
females, who follow unhealthy lifestyles like the smoking of cigarettes and
consumption of the alcohol, are vulnerable to PCOS.
Aetiology and Pathophysiology
The exact causes of the PCOS is unknown nonetheless, genetic pre-
disposition plays an important role behind the development of this syndrome within
families. The presence of high levels of male hormones like testosterone is regarded
as one of the driving factors behind the polycystic ovary development. Testosterone
imposes male characteristics while secreted at higher levels (higher than normal) in
women's body. The high secretion of testosterone causes expression of secondary
male sexual characteristics among women like excess facial and body hair and
frontal baldness. Males do not have ovaries and thus, male hormone testosterone

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when secreted at high level inside the female's body hampers the proper functioning
of the ovaries, leading to the development of cysts. Insulin resistance and presence
of high level of inflammation within the body also increase the chances of developing
PCOS (Escobar-Morreale 2018). Ramya, Mamatha and Ann (2018) are of the
opinion that unhealthy lifestyle habits like obesity, drinking of alcohol and smoking of
cigarettes, consumption of junk food and sedentary lifestyle habits also increase the
vulnerability of developing PCOS among the teenage girls and young women. These
can be considered as associated risks of developing PCOS. The study conducted by
Sedighi et al. (2015) highlighted that there is a significant relationship between
PCOS, inappropriate diet (p= 0.009) and low levels of physical activity (p=0.009).
Sedighi et al. (2015) found no significant relationship between PCOS and other
unhealthy behaviours. Escobar-Morreale (2018) stated that obesity or sedentary
lifestyle increases the chance of developing insulin resistance. Insulin resistance
triggers higher level of insulin secretion in body and this in turn increases the activity
of other hormones like testosterone and thereby increasing the chances of
developing cysts.
Polycystic ovaries are characterised by a large number of harmless follicles
with size up to 8mm (0.3 inches). These follicles are mainly under-developed sacs
under which the development of eggs occurs. In case of PCOS, these sacs are
unable to release egg during the ovulation phase of female menstrual cycle. This
leads to cessation of ovulation and irregular periods (Orio and Muscogiuri 2018).
Fauser et al. (2017) stated that the endocrinologic abnormality associated to PCOS
initiates after menarche. Elevated levels of Luteinizing hormone (LH) and insulin
resistance are regarded as two most common endocrine aberrations witnessed in
PCOS. Fauser et al. (2017) further stated that neither an elevated hormonal level nor

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insulin resistance are comprehensive indication towards explaining the causes of
developing cysts in ovary/ovaries.
Clinical signs and symptoms
Irregular periods or no periods at all, are few of the signs, indicating the
chances of developing PCOS. Other signs include difficulty in getting-pregnant
resulting from irregular ovulation, unwanted growth of body hair (hirsutism) and
massive weight gain. Loss of hair from head, acne breakout and oily skin are also
regarded as few notable symptoms of PCOS. Not all the women suffering from
PCOS will develop these symptoms. Symptoms may vary from mild to severe,
across different age groups (Palomba et al. 2015).
Differential Diagnosis
Oligo-ovulation
At least 70% to 80% of the women with PCOS develop oligo/anovulation
(OA). OA is associated with irregular menstrual bleedings. Nevertheless, PCOS
women exhibit regular menstrual bleedings with or without the presence of the
subclinical ovulation disorders. In order to differentiate PCOS from other
gynaecological complication, the follicular growth monitoring is done with the
subsequent measurement of the progesterone level of blood. Progesterone levels
during the mid luteal phase can help in ascertaining the assessment of regular
menstrual cycle (Goldrat and Delbaere 2018).
Biochemical testing
When the signs of hirsutism are absent, biochemical testing is undertaken to
detect PCOS. Biochemical test include testing the level of testosterone (TT) in blood,

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ascertaining the concentration of Sex Hormone Binding Globulin (SHBG) and Free
Androgen Index (FAI) in blood. FAI is measured based on the ratio between TT and
SHBH and delta-4-androstenedione levels (Patel 2018). Non-classic congenital
adrenal hyperplasia (NCCAH) has identical clinical presentation to that of PCOS. In
order to conduct differential diagnosis, 17, hydrooxyprogesterone (17 – OHP) is
measured during the early follicular phase or randomly in amenorrheic women to rule
out the chance of NCCAH. Other bio-chemical testing (hormonal), that is used for the
differential detection of PCOS include investigation of serum total and free
testosterone, investigation of serum dehydroepiandrosterone sulfate (DHEAS),
serum 17 – hydrooxyprogesterone and serum prolactin. The second level of
investigation that can be used for the confirmation of PCOS further includes
measurement of the luteal phase progesterone and serum androstenedione (Goldrat
and Delbaere 2018).
Ultra-sound technique
One of the confirmatory techniques that are used for immediate detection of
the PCOS includes conduction of ultra-sonography in the lower pelvic area.
Moreover, the cut-off value of ovarium volume must be adjusted based on the
initiation date of the menstrual cycle and ethnic origin of the women. For example,
the volumes of the pair of ovaries of the women who are from the Asian origin are
less in comparison to Caucasians women. This technique is one of the confirmatory
tests for PCOS and it helps to differentiate PCOS from hyper thyroidism. In case of
hyper-thyroidism, there occurs weight gain, loss of hair and irregular periods.
Nonetheless, hyperthyroidism does not lead to the development of ovarian cysts
(Priya and Jeevitha 2019). Bachanek et al. (2015) stated that the sonographic
assessment of the pair of ovaries is regarded as one of the obligatory criteria for the

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detection of PCOS. The presence of more than 12 follicles within the ovary with a
diameter of 2 to 9 mm and an ovarian volume more than 10 cm3 mainly provide
positive indication for PCOS. PCOS along with the testing of concentration of anti-
Mullerian hormone (AMH) are regarded as two of the standardised approaches for
the detection of PCOS while ruling out the chances of uterine tumour.
Anti-Mullerian Hormone (AMH)
AMH is secreted from the granulose cells of prenatal and small antral growing
follicles. Significant increase in the level of follicles lead to increase in the secretion
of the AMH (much above the permissible range) and thus indicating the chances of
developing POCS. Reduction in AMH level from the normal parameters signifies that
the stored eggs in the ovaries are exhausting and the woman is moving towards
menopause. AMH is mainly used as a marker for fertility or decrease in the egg
reserve in the ovaries (Teede et al. 2019).
Inflammatory markers
Inflammatory markers of type 2 diabetes and obesity which are associated co-
morbidities of PCOS are often use for the differential diagnosis of PCOS with
hyperprolactinemia. Hyper-prolactinemia is characterised with excess production of
prolactin from the pituitary gland leading to irregular menstruation and lactation.
PCOS also leads to irregular menstruation and triggers high prolactin secretion
(Goldrat and Delbaere 2018). Hyper-prolactinemia is common in Prolactinoma, a
condition where pituitary tumour leads to the development of hyperprolactinemia.
Prolactinoma are benign tumours. Thus differential diagnosis of PCOS from
Prolactinoma is done with the help of the inflammatory markers of diabetes and
obesity. Confirmatory test for Prolactinoma includes test with tumour markers
(Goldrat and Delbaere 2018).

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Investigations
Not a single test can be used as the sole investigation tool for the diagnosis of
PCOS. The doctors are required to rely on the blood tests, physical exams and
ultrasound of the lower pelvic area in order to confirm PCOS. At times, the tests for
PCOS include detection of higher levels of androgen (male hormones) in blood and
proper observation of symptoms like acne breakout, male-balding pattern and
additional growth of body hair (Teede et al. 2019).
Orthodox Treatment
The PCOS Society India (2018) stated that the orthodox treatment of PCOS
includes use of the mild to moderate contraceptive pills. The use of contraceptive
pills helps to regularize the menstrual cycle, as they are rich in progesterone. Use of
pills can never be regarded as a long-term therapy procedure with most of the pills
can only be used for a maximum tenure of 3 months. Co-cyprindrol is licensed for
the treatment for acne and hirsutism that are common among the PCOS women. It
helps in regularization of the endometrial bleeds and thus helping to reduce the risk
of endometrial carcinoma (Patient Info, 2020). Metformin is off-licence medication for
PCOS however; National Institute for Health and Care Excellence (NICE) stated that
the side-effects and cost out-weighs the benefits of the medication. The long-term
health benefits of metformin are unproven. Eflornithine is used for the treatment of
hirsutism while Orlistat used for treating weight-loss in PCOS women (Patient Info,
2020).
Natural medicine
The research conducted by Jiskoot et al. (2018) stated that observance of
healthy lifestyle habits like healthy diet and conduction of mild to moderate physical

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exercise, help in reducing the vulnerability of PCOS. Jiskoot et al. (2018) conducted
a randomised control trial over 209 women who are diagnosed with PCOS and have
high BMI (above 25 kg/m2). The main interventions provided by Jiskoot et al. (2018)
include education and awareness about healthy eating and exercise. The authors
also provide 20 sessions of cognitive behavioural therapy (CBT) for 1 year over the
selected candidates. The analysis of the result showed that CBT, education about
diet and physical activity help to increase the level of awareness among the PCOS
women with high BMI. The increase in the level of awareness was reflected in
decrease in the BMI and thus decreasing the severity of PCOS. The use of
randomised control trial and large sample size can be regarded as principal strength
of the study and thus helping in generation of generalised and unbiased results.
Moran et al. (2017) highlighted in their population-based observational cross-
sectional study that healthy lifestyle interventions like healthy diet that is rich in
vegetables and is devoid of junk food along with conduction of physical exercise
(mild to moderate) help in reduction of body weight and severity of type 2 diabetes.
Reduction in these two parameters helps to reduce the risk of developing polycystic
ovary/ovaries and regularization of the menstrual cycle.
As per my opinion, rather than orthodox treatment, focus must be given on
natural treatment for treating PCOS. In relation to this, The PCOS Society of India
(2018) stated that PCOS can never be cured under the application of
pharmacological medications. Pharmacological medications are associated with
several side-effects and long-term use of the same might lead to the development of
infertility. Use of natural remedies like non-pharmacological interventions, that do not
have any side-effects and also promise to cure PCOS, must be employed.

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POLYCYSTIC OVARY SYNDROME (PCOS)
Prognosis and Complications
PCOS is regarded as one of the common endocrinopathies of the women in
their reproductive age. It is one of the leading causes of female infertility. The
syndrome is associated with insulin resistance and development of metabolic
syndrome like diabetes (Mohammad and Seghinsara 2017). Paliwal et al. (2017)
stated that irregular periods occurring as 15-day menstrual cycle lead to the
degeneration of anaemic tendency among the women, leading to haemoglobin
deficiency and development of fatigue and nausea. Mohammad and Seghinsara
(2017) further highlighted that irregular periods occurring after every two or three
months (condition common in majority of the cases) leads to the generation of mood
swings and development of irritable behaviour.
PCOS is a heterogeneous yet multifaceted disorder and has multiple
reproductive and metabolic phenotypes leading to the development of long-term and
short-term syndromes. Women suffering from PCOS mainly report adverse
reproductive profile like higher risk of miscarriages, gestational diabetes mellitus
and preeclampsia (Palomba et al. 2015). Patients who are suffering from PCOS also
develop hypertension, cardio-vascular disease and dys-lipidemia in the long run.
Other psychological complications include depression, anxiety and mood swings.
The women who are suffering from PCOS are vulnerable to endometrial cancer in
comparison to the non-PCOS healthy women, mainly during the premenopausal
period (Palomba et al. 2015).

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References
Bachanek, M., Abdalla, N., Cendrowski, K. and Sawicki, W., 2015. Value of
ultrasonography in the diagnosis of polycystic ovary syndrome–literature
review. Journal of ultrasonography, 15(63), p.410.
Escobar-Morreale, H.F., 2018. Polycystic ovary syndrome: definition, aetiology,
diagnosis and treatment. Nature Reviews Endocrinology, 14(5), p.270.
Fauser, B., 2017. PCOS a multifaceted disease in need of a multidisciplinary
approach. Maturitas, 100, p.95.
Goldrat, O. and Delbaere, A., 2018. PCOS: update and diagnostic approach. Clinical
Biochemistry. 62, p.21-31.
Jiskoot, G., Timman, R., Beerthuizen, A., Dietz de Loos, A., van Busschbach, J. and
Laven, J., 2018. Results Of A Lifestyle Intervention Involving Healthy Diet, Exercise
and Cognitive Behavioral Therapy In Polycystic Ovary Syndrome (PCOS). American
Journal of Physiology: Endocrinology and Metabolism.
Mohammad, M.B. and Seghinsara, A.M., 2017. Polycystic ovary syndrome (PCOS),
diagnostic criteria, and AMH. Asian Pacific journal of cancer prevention:
APJCP, 18(1), p.17.
Moran, L.J., Brown, W.J., McNaughton, S.A., Joham, A.E. and Teede, H.J., 2017.
Weight management practices associated with PCOS and their relationships with
diet and physical activity. Human Reproduction, 32(3), pp.669-678.

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National Health Service (NHS). 2020. Polycystic Ovary Syndrome. Access date:
06.03.2020. Retrieved from: https://www.nhs.uk/conditions/polycystic-ovary-
syndrome-pcos/
Orio, F. and Muscogiuri, G., 2018. Diagnostic Criteria for PCOS. In Infertility in
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Patel, S., 2018. Polycystic ovary syndrome (PCOS), an inflammatory, systemic,
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biology, 182, pp.27-36.
Patient Info. (2020). Polycystic Ovary Syndrome. Access date: 17th April 2020.
Retrieved from: https://patient.info/doctor/polycystic-ovary-syndrome-pro
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Sedighi, S., Akbari, S.A.A., Afrakhteh, M., Esteki, T., Majd, H.A. and Mahmoodi, Z.,
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