Polycystic Ovarian Syndrome
In PCOS, under-developed follicles accumulate in the ovaries. Since they fail to mature, they accumulate as cysts in the ovaries. The low levels of follicle stimulating hormone (FSH) and elevated levels of androgens may be the reasons for this condition. When there is no ovulation, the progesterone hormone is not created and the lining of the uterus is not shed in a timely fashion. This increases the chances of endometrial hyperplasia and even cancer.
Another feature associated with PCOS is hyper androgenism or increased responsiveness to testosterone. This usually shows up in oily skin and acne. Excess hair may be noticed on the face and other parts of the body. Women suffering from PCOS have a weight problem, especially around the waist. Insulin resistance is also noticed in some women. This increases the risk of developing diabetes in later years.
Polycystic Ovarian Syndrome Symptom
High levels of insulin can result in symptoms such as high androgen levels, infertility and lack of ovulation. These symptoms are usually noticed when women are in their 20s or 30s. Diagnosis of PCOS is after a physical examination and laboratory tests. Thyroid and prolactin levels in the blood are tested. Serum levels of male hormones (DHEA and testosterone) are tested for higher than normal levels. Tumors in the ovary or adrenal glands can be diagnosed with vaginal and abdominal ultrasounds. Insulin resistance is vital in the diagnosis of PCOS. Insulin is instrumental in regulating the ovarian function. An ovarian biopsy may also be done.
Treatment for Polycystic Ovarian Syndrome
Treatment for women with Polycystic Ovarian Syndrome depends on what stage of a woman's life this condition has manifested and her fertility desires. Birth control pills are prescribed to regularize the menstrual cycle and reduce the risk of uterine cancer. Other medications used in the treatment of PCOS are flutamide and spironolactone.
Clomiphene induces the pituitary gland to secrete more FSH and this stimulates release and maturity of ova. Insulin resistance is reduced with drugs such as Metformin (Glucophage) and Troglitazone. 'Ovarian drilling' is a process of using laser to place small holes in the ovaries so as to normalize the hormonal environment and allow normal ovulation.
Luteinizing Hormone LH is another important hormone for reproduction. In men, LH promotes secretion of testosterone. In women, LH surge in the second part of the menstrual cycle triggers ovulation. LH is released when a woman is ovulating, and causes the ovaries to release an egg. LH and FSH are closely linked. At the beginning of the menstrual cycle, FSH and LH are secreted to stimulate ovarian follicles. Mid-cycle, the growing follicle will inhibit FSH secretion and increase estrogen. This is a trigger for sudden release of LH that leads to release of the mature egg.
The LH Surge is vital for pregnancy - as it causes the matured egg to be released. The next 24 - 36 hours are the fertile window when a woman can get pregnant. Ovulation Predictor Kits that are available measure LH level in the urine - identifying the best time to conceive. Reduced levels of LH in females indicate ovarian hyperfunction.
LH and PCOS
In females suffering from PCOS - Polycystic Ovarian Syndrome, the LH levels are already elevated when compared to FSH. Since there is no LH surge, ovulation does not take place. Elevated LH levels cause release of androgens from the ovaries leading to acne and Hirsutism. Infertility and miscarriage are common. Studies have shown that there is a direct relation between insulin resistance and elevated LH levels.
In females, the LH levels in the blood can vary based on stage of menstrual cycle, age, pregnancy and other pituitary gland disorders. It can be measured by a blood test or urine test. Usually this test is prescribed for women with irregular periods trying to get pregnant or assessing if a woman has entered menopause. Men with low testosterone levels or having very late puberty are asked to take the LH test.
High levels of Luteinizing hormone are most often caused by ovarian tumors or improperly-developed ovaries. Thyroid or Adrenal disease can elevate LH levels. PCOS and Autoimmune disorders also cause the levels of Luteinizing hormone to rise. Low levels of Luteinizing hormone indicate ovarian failure or primary testicular failure. This can happen due to viral infections such as mumps, autoimmune disorders, radiation exposure and tumors.
Early phase of menstrual cycle: 0.5 to 16.9 IU/L
Peak of menstrual cycle: 8.7 to 76.3 IU/L
Using contraceptives: 0.7 to 5.6 IU/L
Pregnant: less than 1.5 IU/L
Menopause: 15.9 to 54.0 IU/L
Between 20 years and 70 years: 0.7 to 7.9 IU/L
Over 70 years: 3.1 to 34.0 IU/L
Hirsutism is a condition where a woman has male-pattern hair growth. It results in excessive coarse dark hair where women don't generally have hair, such as the face, chest and back. It can happen due to high androgen levels or increased skin sensitivity to androgens caused due to certain medical conditions. Else it could be traced to ethnicity and genes.
Excessively high androgen levels are most often the cause for Hirsutism. Some signs of virilization might be noticed along with Hirsutism such as acne, balding, deepening voice, enlarged clitoris and reduced breast size. Other causes include:
Anti-androgens are often prescribed to block the androgen effect thereby reducing the excessive hair growth. The effect is slow as the hair takes about 6 months to get thinner and less noticeable. Oral contraceptives, Finasteride, Spironolactone and Cyproterone are commonly prescribed anti-androgens.
Women resort to waxing and shaving to get rid of unwanted hair. Depilatories and eflornithine cream are also self-care options. Laser treatment or IPL (Intense Pulsed Treatment) are undertaken to destroy the hair root permanently. They are done over several sittings and must be done under qualified practitioners.
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Bibliography / Reference
Collection of Pages - Last revised Date: January 27, 2023