Polycystic Ovarian Syndrome (PCOS)

Features

1. Hormonal Imbalance: Elevated LH (Luteinizing Hormone) levels with an LH
ratio around 2:1.
2. Insulin Resistance: Increased insulin levels leading to insulin resistance, often presenting as Acanthosis Nigricans (dark, velvety patches of skin on the neck, armpits, and groin).
3. Androgen Excess: Elevated androgen levels causing symptoms such as acne and hirsutism (excessive hair growth).
4. Menstrual Irregularities: Amenorrhea (absence of menstruation) or oligomenorrhea (infrequent menstruation).
5. Fertility Issues: Infertility or subfertility.
6. Obesity: Many women with PCOS are overweight or obese.

Investigations

i. Pelvic Ultrasound: Used to visualize the ovaries and check for the presence of multiple cysts.
ii. Blood Tests: To measure levels of LH, FSH, insulin, and androgens.

Management:

First-Line Management

Weight Loss: Fundamental in managing PCOS symptoms, improving insulin resistance, hormonal balance, and overall symptoms.

Menstrual Irregularities

Hormonal Contraceptives: Combined Oral Contraceptive Pills (COCP) or Levonorgestrel Intrauterine System (IUS, Mirena) to regulate menstrual cycles.

Fertility Treatment

i. Medications: Clomifene citrate (first-line treatment) to induce ovulation, sometimes combined with Metformin to improve insulin sensitivity.
ii. Surgical Option: Laparoscopic ovarian drilling may be considered if medications are not effective.