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Polycystic Ovarian Syndrome (PCOS) Essay

Polycystic Ovarian Syndrome (PCOS) Assignment

A 22 year old patient presents to the clinic with secondary amenorrhea for 4 months. She has
reported that she gained about 40 pounds in the past 10 months and her period started to become
more and more irregular. Onset of menarche was age 13 and has had menstrual cycle from 30-45
days, but lately she’s been having menses every 35-65 days with the latest being 4 months apart.
She is unsure of what’s going on. During your physical exam you noted some facial hair and
acne. You suspect patient might have PCOS. Based on your working diagnosis, patient’s HPI,
and your physical assessment, create a 3–5 minute video and a 2-4 page write-up discussing the
following information:
• Definition of PCOS. What is this condition? Why is this important to address?
• Prevalence and risk factors
• PCOS can be a risk for developing what types of health complications?
• Presentation
• Pathophysiology
• Physical assessment and testing to confirm diagnosis
• Provide at least 1 differential diagnosis and an exam and/or lab test to rule out this
• diagnosis.
• Treatment or management of PCOS for a patient who is currently not planning a
• pregnancy
• Treatment or management of PCOS for a patient who is currently planning a pregnancy
Your video can be informative while your write-up will be more detailed. Be creative with the
video. There are many ways to complete this portion of the assignment. Here are some potential
ideas to help you brainstorm (these are just examples):
• Create an explainer video with animations and voiceover using Biteable, Canva, Powtoon,
Animaker, or any other software platform.
• Create a voiceover PowerPoint presentation or use Panopto to record your screen while you
present your slides and your narration.
Your write-up and your video must include at least 2 scholarly sources that are not from your
textbook nor any standard government or medical websites. Scholarly sources must be peer
reviewed articles. You do not have to write this paper in a SOAP format. You can use bullet
points; however, you must use complete sentences. Please reference and use in-text citations
properly and according to APA Style.
Please include a title page and a reference page for the write-up.

Solution – Polycystic Ovarian Syndrome (PCOS) Essay

Polycystic Ovarian Syndrome

Definition

Polycystic ovarian syndrome (PCOS) is an endocrine disorder in which form in the ovaries. PCOS affects women in the child bearing age, usually beginning during adolescence or the first onset of menstrual periods. It is associated with hormonal dysfunction, abnormality in menstrual cycle, and high androgen levels. It is important to address PCOS because it affects women’s reproductive, psychological, and metabolic health (Witchel et al., 2020).

Prevalence and Risk Factors

PCOS is estimated to affect 8 -13% of women of reproductive age across the world (Hoeger & Piltonen, 2020). People in some ethnicities may have a higher prevalence of PCOS, with people from South Asia, the Mediterranean, and Hispanic groups being most vulnerable. Factors that may increase the risk of PCOS include family history of PCOS, obesity and being overweight, insulin resistance, and imbalance in androgen levels.

Health Complications

PCOS puts women at a higher risk for serious health complications such as infertility, miscarriage or premature birth, insulin resistance, endometrial cancer, sleep apnea, high cholesterol and chronic diseases such as type 2 diabetes, high blood pressure, and cardiovascular diseases. PCOS may also cause anxiety and depression, and negative body image which causes eating disorders.

Presentation

PCOS may present with irregular menstrual cycles, weight gai or inability to lose weight, excessive androgen levels which may be characterized by facial hair and acne, infertility, ovarian cysts and male pattern baldness or thinning of hair, skin tags and dark skin patches (Hoeger & Piltonen, 2020). Some women may have all the symptoms of PCOS while others may have a few symptoms or none at all, though these symptoms may change as time goes on.

Pathophysiology

The pathophysiology of PCOS involves the combined effects of ovarian dysfunction and metabolic abnormalities. PCOS causes hormonal imbalance, which causes ovaries to fail to work properly and release eggs. Women with PCOS have enlarged polycystic ovaries in which multiple small follicles are developed and do not release eggs, and there is an endocrine abnormality in the ovaries that increases androgen levels. Insulin resistance is also involved in PCOS, as insulin stimulates androgen production, resulting in hyperandrogenemia and diseases like type 2 diabetes, hypertension, and cardiovascular disorders. This further leads to insulin resistance and other complications such as acne, and male-patterned hair growth (Witchel et al., 2020). PCOS is also affected by the dysfunction of the hypothalamic-pituitary-ovarian (HPO) axis, responsible for regulating reproduction. It affects the production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). When LH levels are elevated compared to FSH in PCOS, it leads to hyperandrogenism. Dysfunction in the HPO axis results in ovulation problems such as amenorrhea and may lead to infertility and a high risk of miscarriage (Rosenfield & Ehrmann, 2016).

Physical Assessment and Testing to Confirm Diagnosis

PCOS is diagnosed by using a criteria which defines some of the symptoms present in a patient and excluding other conditions which may look like PCOS. A diagnosis is confirmed if a patient has at least two of these three symptoms:

  • Irregular menstrual cycle or amenorrhea, characterized by irregular or missed periods.
  • Polycystic ovaries or the appearance of ovarian cysts are detected by an ultrasound.
  • Clinical or biochemical signs of hyperandrogenism are confirmed by a test indicating high androgen levels or physical examination identifying symptoms like acne, excessive hair growth, hair loss, and discolored skin (Hoeger & Piltonen, 2020).

A PCOS diagnosis can also be confirmed by tests such as

  • Glucose tolerance test.
  • Blood test to check hormone levels.
  • A pelvic exam to look for other causes of abnormal bleeding.
  • Liquid panel for cholesterol and triglyceride levels.

PCOS diagnosis by exclusion involves a test for differential diagnosis for a condition like hypothyroidism, which may appear like PCOS as it causes irregular menstrual cycles, weight gain, and fatigue. In such a case, hypothyroidism can be ruled out by conducting a thyroid-stimulating hormone (TSH) test.

Management and Treatment

Treatment for PCOS includes medication, lifestyle changes, or a combination of both. These may vary depending on the patient’s symptoms, their medical history, and whether they want to get pregnant. For patients who are not planning to become pregnant, treatment includes:

  • Hormonal birth control, like contraceptive pills and patches, helps regulate the menstrual cycle, reduce androgen levels, improve acne, and help with excess hair growth.
  • Insulin-sensitizing medications like metformin are given to address insulin resistance, reduce the risk of type 2 diabetes, promote weight loss, and regulate menstrual cycles (Hoeger & Piltonen, 2020).
  • Anti-androgen therapies are used to block the effect of androgens, controlling acne and hair growth.
  • Lifestyle modifications through diet and exercise help reduce insulin resistance and maintain a healthy body weight (Witchel et al., 2020).

Treatment for patients planning a pregnancy focuses on improving fertility, including:

  • Medications such as clomiphene and letrozole, and gonadotropins are given to induce ovulation (Rosenfield & Ehrmann, 2016).
  • Metformin is given to increase the chances of ovulation and as a treatment for diabetes.
  • Surgery can be performed to restore ovulation by removing the tissue in the ovaries that produce androgens.
  • Lifestyle changes can help with managing weight and balancing blood sugar levels, improving menstrual function and fertility.
  • In cases where medication does not help with infertility, patients can consider in vitro fertilization (IVF).

References

Hoeger, K. M., Dokras, A., & Piltonen, T. (2021). Update on PCOS: consequences, challenges, and guiding treatment. The Journal of Clinical Endocrinology & Metabolism, 106(3), e1071-e1083.

Rosenfield, R. L., & Ehrmann, D. A. (2016). The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine reviews, 37(5), 467-520.

Witchel, S. F., Teede, H. J., & Peña, A. S. (2020). Curtailing pcos. Pediatric research, 87(2), 353-361.