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Polycystic ovary syndrome (PCOS) is a group of disorders that consists of excess androgens, menstrual irregularities, and chronic lack of ovulation. About six percent to 20 percent of women in the reproductive age group (15-45 years) are affected by PCOS, and sometimes it is an incidental finding during a routine transvaginal ultrasound scan. The symptom of the disorder may be observed during the teenage pubertal period like acne, male pattern of hair growth in females such as facial hair, abdomen, buttocks, and menstrual irregularities. Older women tend to present with irregular menstruation and infertility. Other symptoms of the syndrome include obesity in about 50 percent of PCOS women and elevated insulin levels- the hormone involved in blood sugar control. 10 percent of women with PCOS by age 40 are overweight and develop abnormally high blood sugar levels, whereas 35 percent of them develop pre-diabetes (high levels of sugar but not enough to be diabetic). Both obesity and elevated insulin levels further worsen the high androgen levels in PCOS.

The precise cause of PCOS is unknown, but several possible reasons could result from a combination of genetic, lifestyle, and health factors. Recent studies have now shown more light on the precise cause of PCOS. As a result of such publications and the International Environmental Committees’ report that I am a member of, we now know the fact. Endocrine-disrupting chemicals (EDCs) or endocrine disruptors are “exogenous substances or mixtures that alter function(s) of the endocrine system and consequently cause adverse effects in an intact organism or its progeny or (sub) populations.” Advanced glycation end products (AGEs) have raised one of the recent decades’ most controversial environmental questions that require urgent answers. The Western diet and lifestyle can be a significant environmental source of these toxicants that are potentially involved in the pathogenesis of PCOS. Extensive data from different scientific models collected in recent years have confirmed their damaging role in the pathophysiology of PCOS and their negative epigenetic impact.

Therefore, strategies and strong recommendations should be targeted to reduce human exposure to protect next generations from steadily rising adverse health effects.

Processed, canned, and especially animal-derived foods are examples of sources of high exposure to both suspected environmental toxins, EDCs, and AGEs, which may lead to endocrine, metabolic, and reproductive disruption, resulting in PCOS phenotypes and adverse health effects. Other products include petrochemical products, oil fossils in the oil-producing regions such as the Niger Delta in Nigeria and some African countries like Angola. The EDC and

Genetic variations in genes cause an increase in the production of luteinizing hormones and anti-Mullerian hormones and androgen production necessary for ovulation and a decrease in genes related to follicle-stimulating hormones. These are thought to impact negatively on follicular development in women with PCOS. Other genes related to inflammatory responses, insulin production and regulation, and those associated with fat production may also contribute to PCOS development. The common risk factors for PCOS are diabetes, obesity, and sedentary (inactive lifestyle). Furthermore, about 20-40% of women with PCOS have an affected mother or sister, which is also a risk factor for developing PCOS.

Diagnosing PCOS

There is no specific test to diagnose PCOS, but diagnosis begins with the history of menstrual irregularities- more than 35 days between menses and weight gain. On examination, acne, excessive hair growth- face, chest, abdomen, buttocks, etc. Blood test for excess androgens- high levels of testosterone.

The American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE), and Androgen Excess and PCOS Society (AES) in November 2015 released new guidelines in the diagnosing and managing PCOS comprises of;

-two of the following three criteria, chronic inability to produce eggs, excess androgens, and polycystic ovaries on a transvaginal ultrasound scan- more than 25 oocytes in one ovary arranged marginally.

 

PCOS involves multiple organs with metabolic and reproductive effects, and the treatment is individualized depending on the patient’s complaints and their desire for pregnancy.

Lifestyle modification is central to the management of PCOS. For example, making healthier food choices, like swapping caffeine for more nutritious drinks, eating more fiber-rich foods, foods rich in omega H3 like avocadoes, and exercise would help weight loss.

For women with anovulation and infertility, ovulation induction medications such as clomiphene and letrozole may help with egg production and improve the chances of pregnancy. It gives a better outcome when coupled with weight loss.

If the woman is concerned about only menstrual irregularities, the endocrine society recommends oral contraceptive pills, which would help in menstrual regulation. Other things used include progesterone-only pills, intrauterine system, and dermal patch depending on the patient’s preferences.

When acne is the issue, drugs like oral contraceptive pills can help reduce the symptoms or combine with other acne medications such as benzoyl peroxides, antibiotics, and retinoids

Polycystic ovarian syndrome and fertility

Dealing with Infertility

. At the same time, we manage hirsutism with drugs like spironolactone, which is minimally effective. Other therapies such as lasers or electrolysis may help as a single medication or in combination with others.

Surgery is considered in some cases, such as laparoscopic ovarian drilling, ovarian wedge resection may help restore spontaneous ovulation in those patients. However, issues of reduced ovarian mass and damage to the ovarian tissue may occur sometimes. Therefore, it is occasionally recommended.

In cases where ovulation induction does not work or is coupled with male factor infertility, the patient may need to consider other options such as in vitro fertilization (IVF) and or intracytoplasmic sperm injection (ICSI). It has been very successful in helping many PCOD patients have their babies. Many of such patients go through one IVF cycle and end up with enough embryos that are frozen. They end up having two or three babies from the batch of frozen embryos over a period of 4fours with one baby at a time.

In summary, PCOS poses some challenges in diagnosis and management, but effective and successful treatment is possible. Our understanding of EDC and AGEs has enabled us to perfect the technology to remove these toxins from the body before conception with positive results. Lifestyle medications, complete body detoxification for removing heavy metals and other EDC are pivotal to their treatment, and we urge PCOS patients to explore such options.