Polycystic Ovarian Syndrome or PCOS/PCOD as the name signifies is actually a problem in Females associated with Ovarian dysfunction leading to various abnormalities like Excess Hair Growth, Obesity, Severe Acne, Menstrual Irregularity, Infertility etc.
Usually, the ovarian function is regulated by a complex interplay of certain chemicals known as Hormones which are usually present in the blood in minute quantities and initiate/catalyse various processes for proper ovarian functioning. Any disbalance in this delicate process may lead to abnormal ovarian function and lack of egg development leading to various clinical problems encountered.
Various hormones that are involved in the process include:
a) Female Hormones i.e. FSH [Follicle Stimulating Hormone], LH [Leutinizing Hormone]
b) Male Hormones [also found normally in miniscule amount in female bodies] i.e. DHEA & Testosterone
c) Female Hormones like 17-Hydroxyprogesterone & 21-Hydroxylase
d) Thyroid Hormones i.e. T3, T4, TSH [Thyroid Stimulating Hormone]
e) Lactational Hormone i.e. Prolactin
In addition to clinical abnormalities encountered, certain other diseases have been found to be associated with PCOS/PCOD leading to further problems in the patients. Various diseases associated with PCOD are:
a) Pre Diabetes/Diabetes: PCOD has been shown to have definite association with Insulin Resistance [Hormone for maintaining Glucose levels in the body] with a High Risk for Diabetes and its various complications.
b) Obesity: Obesity and High Cholesterol levels are also constantly associated with PCOD.
As discussed above, the diagnostic tests for PCOS aim to evaluate for various Hormonal levels and their abnormalities to determine the cause and treat accordingly with few tests being meant to assess for associated Diseases which are to be managed along with. Thus, the various tests that can be done are:
a) FSH & LH: Increased LH levels & normal or slightly reduced FSH levels with LH/FSH ratio of >3:1 in first half of menstrual cycle in indicative but not confirmatory of PCOS. However in few Patients, there may be normal FSH: LH ratio.
b) Testosterone levels: Total testosterone levels are more reliable. Levels are usually normal or slightly reduced in PCOS. Levels > 200ng/dL warrant further investigation to rule out Ovarian/Adrenal Tumor.
c) DHEA-S levels: Levels > 800µg/dL warrant further investigation to rule out Adrenal Tumor.
d) Prolactin: Patients with PCOS usually have mild and transient Prolactin elevation. Persistent elevation requires further investigations to rule out Pituitary tumor [Prolactinoma].
e) 17-Hydroxyprogesterone: A fasting, unstimulated level of < 200ng/dL is normal. A level > 200ng/dL requires post ACTH stimulation values for confirmation of 21-Hydroxylase deficiency.
f) 24 Hour Urine Cortisol levels may also be prescribed to rule out Cushing’s Syndrome
g) Serum Cholesterol Levels: Are important for assessment of associated Cardiac risks due to Obesity.
h) Glucose Tolerance Test & Fasting Glucose/Insulin Ratio: Impaired Glucose Tolerance & Fasting Glucose/Insulin ratio < 4.5 are diagnostic of Insulin Resistance.
USG may show increased size, increased stroma and multiple small peripheral follicles. However, USG may be normal in 30-50% cases of PCOS/PCOD.
Oral Contraceptives are mainstay of treatment along with Metformin & Weight Loss/Lifestyle modification to reduce Insulin Resistance, Cosmetic procedures & Antiandrogens like Spironolactone to counteract the effect of Male Hormones like Hirsutism; and Clomiphene Citrate & Thiazolididiones to treat associated Infertility by increasing Egg production and development.