Polycystic ovarian syndrome, also known as PCOS, is a common disease affecting women at a young age. Even though this disease is common, researchers’ real explanation of the disease is still being explored. But one thing we knew about the disease is the roleplay of the hormones.
Let’s see simple pathophysiology of how this disease happened and its relation to the hormones. In a female body, there are two important hormones known as Luteinizing hormone (LH) and Follicular stimulating hormone (FSH) produced by the pituitary gland in an equal amount. LH is important for the production of testosterone, while FSH plays its role in producing estrogen. In PCOS, the ratio of these two hormones was disturbed by an unknown reason. The 1:1 ratio has now become 2:1 (LH: FSH). This will lead to increased production of testosterone hormone. Hence this disruption will produce certain symptoms to the women.
Symptoms of PCOS:
To diagnose the PCOS itself, patients need to show a few symptoms, including anovulation, hyperandrogenism clinically, and polycystic ovaries imaged by ultrasound. Here are some main symptoms that usually happen in a female with PCOS:
It’s a bit tricky to explain how anovulation occurs. During the development of an ovary, the growth of follicles produced in this organ somehow paused and stopped. This happened due to the low production of FSH by the pituitary. But other factors such as gonadotropin action and anti-Mullerian hormones are also being said to affect this process. It is likely that two major pathways, central brain center and ovarian intrinsic, have impacted the ovulation. Thus, women with PCOS have sub-fertility or infertility problems in their life. But little that they know this condition can be treated in many ways and they can resume the problem.
Low FSH, no follicle production, and no ovulation will result in little or no progesterone hormone in patients. The estrogen will keep rising and unopposed by any other hormones. This will thicken the endometrial wall or also known as endometrial hyperplasia. This wall is full of blood that is waiting to break down through the vagina. Once the time has come, the patient will bleed heavily and irregularly. This condition is called menometrorrhagia.
When your body’s chemical reaction doesn’t meet the actual process, the patient will easily get certain diseases. In PCOS, the two most common metabolic syndrome reported is diabetes mellitus type 2 and dyslipidemia. Insulin resistance is a major contribution to diabetes occur. We don’t really know what is going on in there, but some said that the transduction process of insulin receptors was disrupted. This can happen in both lean and obese patients. Due to the stated problem, it will lead to metabolic syndromes such as diabetes, dyslipidemia, obesity, heart problem, and hypertension.
Acne, hirsutism (excessive growth of abnormal hair), and androgenic alopecia are some examples of excessive androgen in females. Androgen, including testosterone, is a male sexual hormone that gives sexual characteristics to them. On top of the excess production of testosterone by LH, there is a theory that another hormone called sexual hormone-binding globulin (SHBG) is involved. This hormone usually binds to testosterone to be functioning. But because of metabolic abnormality, this hormone depletes and causes a lot more free testosterone circulating in the patient’s body. High testosterone level causes male characteristics such as hirsutism and deep voice. These conditions have a lot of psychological effects on the patient.
To diagnose PCOS, you need to exclude everything else first that might cause a similar disease presentation. Women with PCOS can get a normal lifestyle by following a healthy diet and scheduled treatments by physicians. In fact, they still can conceive. The management of PCOS is tailored to each woman’s needs.
Some might start treatment with exercise, and some need medications to help them out. A lot of women with PCOS are mentally affected by the disease consequences itself, good moral support and knowledge will help them out from that situation.