Polycystic Ovary Syndrome (PCOS) Case Study: Pathology and Management

This case study presents a 32-year-old woman's diagnosis of polycystic ovary syndrome (PCOS), focusing on her symptoms of irregular periods, infertility, and excessive hair growth. The study delves into the epidemiology, aetiology, and pathophysiology of PCOS, highlighting the role of genetic and environmental factors, including insulin resistance and stress. It discusses clinical manifestations, diagnostic procedures, and pharmacological interventions like birth control pills and metformin, along with surgical options like ovarian drilling. The analysis emphasizes the importance of understanding PCOS's impact on women's health and the need for further research to improve treatment and patient outcomes. The study also provides a detailed overview of the patient's history, physical examination findings, and the diagnostic process, which ultimately led to the diagnosis of PCOS. Furthermore, the case study explores the various risk factors associated with PCOS, such as genetics, stress, and sleep apnea, and their potential implications on the disease's progression and management. The conclusion reiterates the need for ongoing research to develop more effective treatments and address the metabolic complications associated with PCOS.

Running Head: POLYCYSTIC OVARY: PATHOLOGY CASE ANALYSIS
POLYCYSTIC OVARY: PATHOLOGY CASE ANALYSIS
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Polycystic ovary syndrome is one of the major growing syndromes that is taking a toll on
the fertility rate of all the women all over the globe. The polycystic ovary syndrome has been
found out to increase the risk of infertility, abnormal glucose metabolism, endometrial cancer
and dyslipidaemia. The paper below discusses the case study of 32-year-old woman who has
been complaining of not being able to get pregnant. She had been facing the problem of having
irregular periods (4 to 6 per year) and had been taking prescribed oral contraceptive pills since
she was 17 years old. The paper discusses about the epidemiology, aetiology, pharmacological,
signs and symptoms, diagnostic procedures along with the other forms of the biomedical
treatments and intervention programs. Lastly, the paper discusses the prognosis, red flags and
their possible significance, and potential differential diagnosis of polycystic ovary syndrome.
Case Study:
The case study projects light on a 32 year old woman who is found with one of the main
problems of not being able to get pregnant. On further investigation, it has been known that she
was taking oral contraceptive pills since the age of 17 as she was having irregular periods
(maximum 4 to 6 a year). She further stated that she continued taking the said pills upto the age
of 30 years, and had stopped taking them when she and her husband decided to plan a baby. It
has been observed that since she had stopped taking the said oral contraceptive pills, she had
started gaining weight and started having facial hair growth faster than she used to. Additionally,
to her dismay she was not unable to get pregnant and had been having her periods only 3 to 5
times a year. The case clearly shows that the symptoms are of polycystic ovary syndrome and the
diagnosis is performed accordingly.

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Polycystic Ovary Syndrome:
Polycystic ovary syndrome (PCOS) (McCartney and Marshall, 2016) is considered as a
hormonal disorder and is found common in maximum of the women population who are of the
reproductive age. The said syndrome show that the women who are suffering from the syndrome
suffer from infrequent or prolonged menstrual periods. It has also been seen that they suffer from
excessive production of male hormones (androgen) levels. The syndrome arises when the ovaries
that are present, even though they develop into various and numerous small collections of fluid
or the follicles but are unable to release the eggs at regular intervals. This is regarded as one of
the most complex condition and is often diagnosed along with the presence of two of three
following criteria such as the hyperandrogenism, polycystic ovaries and ovulatory dysfunction.
Clinical Manifestations:
The clinical manifestations of PCOS are mainly the irregularity of periods along with the
excessive growth of male hormones. Here, in the case study it can be clearly observed that the
patient was facing problems regarding irregular periods since she was 17 and it started getting
worse post her stopping the taking of oral contraceptive pills when she tried getting pregnant.
She was also facing excessive growth of facial hair due to the more production of male hormones
in her body. The signs and symptoms are discussed accordingly in the table given below and are
evaluated as per the case study accordingly:
Signs / Symptoms Clinical relevance
Irregular Periods One of the first symptoms that determine the
occurrence of polycystic ovary syndrome

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(PCOS). The PCOS are observed with many
small, fluid-filled sacs that are found to grow
inside the ovaries. These particular sacs are
actually follicles, which carry immature eggs.
These eggs never mature enough to trigger
any kind of ovulation leading to the alteration
of the levels of the estrogen, FSH, LH and
progesterone. The progesterone and the
estrogen levels are usually found out to be
lower than the androgen levels, which are
higher in number. These extra male hormones
levels are found to disrupt the menstrual
cycle, leading to the occurrence of lesser
cycles of periods than usual.
Excessive hair growth Due to excessive production of male
hormone, they lead to the excessive growth of
facial hair or growth of hair on the chest, neck
or the chest. These are due to the lesser
production of oestrogen and progesterone in
the body.
Suddenly gaining weight The higher androgen levels in the body lead
to the triggering of gaining weight. The

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weight gets mainly deposited in the
abdominal region as this is where the men
tend to carry the weight due to the high
production of the androgen levels in the body.
The women who are suffering from PCOS are
found out to be apple shape and not their
usual pear shape.
Infertility Due to no ovulation or very less ovulation, the
hormonal balance is altered which in turn
interferes with the growth or the release of the
eggs from the ovaries. Thereby, getting
pregnant or conceiving gets difficult or is
next to impossible.
Epidemiology and Pathophysiology:
One of the most common endocrinopathy is PCOS (Dumesic et al. 2015), is found
amongst the women of the reproductive age all over the world. Although, the exact reason for the
cause of PCOS is unclear, the PCOS is considered to evolve from the complex interaction of
genetic and environmental traits. Out of many theories, one of the theories maintain that
underlying insulin resistance aggravates hyperandrogenism by the suppression of sex hormone
bounded with globulin. The pathogenesis has been linked to the altered luteinizing hormone
(LH) action, resistance, insulin and disposition to hyperandrogenism. This in turn lead to the

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increase in the adrenal and ovarian synthesis of androgens, which ultimately lead to the increase
in the androgen levels. Later on, these become the main reasons of irregular menses and
displaying physical manifestations of hyperandrogenism
Predisposing Risk Factors:
Over the years with active research, it has been found that PCOS are caused due to a
combination of genetic and environmental factors that play along and ultimately lead to the
occurrence of the polycystic ovary syndrome. This mainly can be defined by the factor that there
was a presence of genetic disposition in the body but due to some triggers in the environment
had led to the occurrence of PCOS. The six factors that might pose as the risk factors are
mentioned below:
1. Genetics play a big role to pose as a risk for PCOS:
Researchers have found evidences where it has been observed that the presence of PCOS in
the intermediate family of a person can lead to the occurrence of PCOS later. Studies show
that the rare variants of the gene (Glueck and Goldenberg, 2019) associated with the anti-
Mullerian hormone, or AMH (that is produced mainly by the cells present in the follicles) are
mainly involved in the occurrence of PCOS.
2. Certain change in the uterus may increase the risk of occurrence of PCOS:
Studies show that pregnant woman with PCOS had higher levels of AMH production with
respect to the other. The studies also project that there is a high possibility of the
development of PCOS when the baby is still in their mother’s womb.

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3. Stress can become the cause as well can pose as a symptom for the occurrence
of PCOS:
Psychological stress is one of the main and epitome reason for the cause of such a
complication like PCOS. Depression and anxiety can lead to the chronic inflammation, which
may be one of the main reason for the rise of underlying symptoms such as weight gain and
acne.
4. Insulin resistance and PCOS are said to be directly linked:
It has been observed in various studies that PCOS not only cause infertility but are also one
of the major cause of metabolic problems (Pasquali and Gambineri, 2014). This is such a
condition, which lead to the higher level of insulin production in the body, which in turn
leads to the hike in the production of androgen. It has also been observed that women with
PCOS have been found out to be insulin resistant, provided they stay inactive and have very
unhealthy lifestyle.
5. Sudden weight gain or loss are one of the most common risk factors:
Suddenly gaining weight or losing a huge amount of weight might be one of the basic signs
of the person getting PCOS. Usually, the doctors associate a patient’s weight problems with
one of the first step for diagnosing PCOS. Here in the case study it can be clearly seen that
the patient had experienced as sudden weight gain, which was a major sign of her condition
to be diagnosed as PCOS.
6. Sleep Apnoea acts another most major risk factor:
Many of the women face problem while sleeping and momentarily pauses to breathe. Studies
show that due to the low levels of progesterone. This condition is one of the main risk factors

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that might lead to the occurrence of PCOS.
Diagnosis:
The doctors usually diagnose (McLuskie and Newth, 2017) women on the basis of three
symptoms like acne, facial hair and body hair and sudden weight gain. A pelvic exam is also
conducted by the doctors to check for any type of growth in the uterus or the ovaries. The other
diagnostic procedures include conducting of blood test to check for the level of the male
hormones in the blood as well checking the cholesterol and the blood sugar level. Performing an
ultrasound might also help in determining the abnormal follicles or any other uterus related
problem.
Interventions and Pharmacological Treatments:
Birth control pills are one of the primary and most common way to treat PCOS and their
symptoms as such huge facial hair growth and acne. Taking progesterone and oestrogen regularly
can help maintain a perfect hormonal balance and regulate the process of ovulation. Metformin
(Sever et al. 2014) is one of the drug used to treat Type 2 diabetes but it also helps in the
improvement of insulin levels. Surgery is also one of the most common option to treat PCOS.
The process of ovarian drilling can help in restoring the process of normal ovulation by making
tiny holes into the ovary with a thin needle or by the use of laser treatment.
Conclusion:
With each passing day more and more research are going on and being conducted in
order to find out more definite ways to treat PCOS and also to find out the actual reason of the
cause of PCOS in an ovulating woman. The patients are found to have higher rate of metabolic

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complications and their effect on PCOS remains to be unclear. The paper clearly projects light on
the epidemiology, aetiology, diagnostic measures and the interventions of Polycystic Ovary
syndrome and helps in understanding the grave consequences it may cause if they remain to stay
untreated.

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References:
McCartney, C.R. and Marshall, J.C., 2016. Polycystic ovary syndrome. New England Journal of
Medicine, 375(1), pp.54-64.
McLuskie, I. and Newth, A., 2017. New diagnosis of polycystic ovary syndrome.
Sirmans, S.M. and Pate, K.A., 2014. Epidemiology, diagnosis, and management of polycystic
ovary syndrome. Clinical epidemiology, 6, p.1.
Dumesic, D.A., Oberfield, S.E., Stener-Victorin, E., Marshall, J.C., Laven, J.S. and Legro, R.S.,
2015. Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and
molecular genetics of polycystic ovary syndrome. Endocrine reviews, 36(5), pp.487-525.
Tso, L.O., Costello, M.F., Albuquerque, L.E.T., Andriolo, R.B. and Macedo, C.R., 2014.
Metformin treatment before and during IVF or ICSI in women with polycystic ovary
syndrome. Cochrane Database of Systematic Reviews, (11).
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metabolic disturbances. Arquivos Brasileiros de Endocrinologia & Metabologia, 58(2), pp.182-
187.
Sever, M.J., Kocjan, T., Pfeifer, M., Kravos, N.A. and Janez, A., 2014. Short-term combined
treatment with liraglutide and metformin leads to significant weight loss in obese women with
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syndrome during adolescence. Hormone research in paediatrics, 83(6), pp.376-389.
Pasquali, R. and Gambineri, A., 2014. THERAPY OF ENDOCRINE DISEASE: Treatment of
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