Do you sometimes worry about your menstruation? Bakit hindi monthly dumarating ang period ko?
Or is your skin bothering you? You’ve tried all the creams, toners and lotions but your pimples don’t seem to go away.
Nagkaka-bigote ka ba? Are you constantly plucking or shaving your facial hair?
You might be suffering from Polycystic Ovary Syndrome. It is a common cause of irregular menstruation and excess male hormones in women. It occurs in 10% of all females.
The cause of PCOS is unknown. It is mainly due to too much androgen production by the ovaries. The current data shows that it is a combination of genetics and environment.
Most women with PCOS will have a mother with PCOS or a father with Metabolic Syndrome (it is a disease complex having all three illnesses: heart disease, stroke and diabetes). Thirty-percent (30%) of patients with PCOS will have a sister with PCOS.
Environmental factors involve exposure of a female fetus to excess male hormone during pregnancy, disturbed fetal nutrition while in the mother’s womb and being overweight during adulthood. All these lead to insulin-resistance and later to PCOS.
Different scientific groups have different criteria in diagnosing PCOS. Basically, the patient should have menstrual irregularity, physical or chemical evidence of increased male hormones (excessive facial hair, acne or male-pattern baldness) and/or PCOS by ultrasound.
PCOS may cause metabolic abnormalities like elevated cholesterol levels, insulin resistance and diabetes. It can also lead to infertility or pagkabaog.
The continuous absence of ovulation brought about by PCOS can increase the risk for endometrial hyperplasia and possibly, cancer of the uterus later in life.
Treatment of PCOS should be patterned towards the goals of the patient.
If obesity is the issue, then a weight loss regimen monitored by a nutritionist with an exercise program should be started along with metformin, which is an anti-diabetic drug. Its action is primarily to lower insulin levels. Metformin is usually given at 500 mg three times a day. Patients happily notice a decrease in their weight after a few months of metformin … coupled with exercise, of course. Even 30 minutes of walking after dinner is adequate exercise. No need to run a marathon or join a tri-team.
If infertility is the problem, then steps to improve fertility is the first priority. The patient may be given a trial of ovulation induction agents like clomiphene citrate beginning at 50 mg once a day for 5 days beginning on the 2nd to 6th day of her period. This can be done for a maximum of 3 cycles only. Prolonged intake of clomiphene may cause ovarian hyperstimulation syndrome. Approximately, 80% of women with PCOS will ovulate and 50% will get pregnant with this regimen.
If excess male hormones, like acne, baldness or too much facial hair (hirsutism), is the patient’s reason for consulting then anti-androgen medications should be initiated. Anti-androgen drugs are cyproterone and spironolactone. Cyproterone is available locally as part of the oral contraceptive pills: Diane and Althea.
Irregular menstruation may be treated with hormonal therapy in the form of oral contraceptive pills or cyclic progesterone tablets like Duphaston or Provera. These medications are taken once a day for 10 days of every month to allow regular menstrual flow.
Polycystic ovary syndrome as the name implies is a syndrome. It involves a group of symptoms affecting several organs in the body. There is not one drug to cure all problems. The doctor and the patient have to agree and prioritize what is most important for the patient to address at the moment.
If you suspect that you have PCOS, do a vaginal ultrasound even before you go to a doctor. This will save you one consultation visit and one day less absence from work.