Polycystic Ovary Syndrome Among

Women

Jéssica Oinonen
Puja Garbuja Pun

February 2021
Degree Programme in Nursing
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CONTENTS

1. INTRODUTION…………………………………………………………………….3
2. POLYCYSTIC OVARY SYNDROME…………………………………………….4
2.1 How does polycystic differs from normal ovulation………………………...5
2.2 Clinical presentation in PCOS …………………………………….…….......6
3. DIAGNOSIS………………………………………………………………………...7
4. TREATMENT AND EFFICACY...……………………………………………..….8
5. CONCLUSION…………………………………………………………………….10
6. REFERENCES…………………………………………………………………….11
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1. INTRODUCTION

The polycystic ovary syndrome is a hormonal disorder that affects some women during
in the reproductive age and one if its complication is infertility. That is the reason that
makes a great parcel of them to find out about the condition when they are trying to get
pregnant; when after several failed trials, that can be months or in some cases, even years,
they realize that might something abnormal is affecting their fertility (NHS UK 2019).

According to a research, it is estimated that up to 1 to in 5 women around the world have

experienced PCOS as it is one of the most common causes of female infertility in
childbearing age. The hormonal imbalance is a long-term disease and is affected by ge-
netics and environmental factors. It can cause diverse range of symptoms which can
sometimes be misleading for an adequate diagnosis, considering that it is important that
nurses have appropriate knowledge of the condition to be able to raise patient's awareness
and search for its detection and treatment (BBC 2018).

The diagnosis and treatment of the syndrome is crucial not only for the women fertility,
additionally, to prevent possible long term health consequences such as obesity, hyper-
tension, insulin resistance and increased risk of diabetes type 2.
There are different types of treatments developed along the years which are used depend-
ing on the patient’s condition such as surgical treatment, ovulation induction, insulin sen-
sitizing agents and in vitro fertilization (Kovacs & Norman 2007, 81, 82, 83, 215, 2016,
217).
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2. POLYCYSTIC OVARY SYNDROME

The polycystic ovary syndrome can affect females of all ages after puberty, however,
during the adolescence a girl passes through a vast hormonal changes and manifestations
that may cause a misinterpretation of the disorder (Peña, Witchel, Hoeger, Oberfield,
Vogiatzi, Misso, Garad, Dabadghao & Teede 2020, 12).

In the adulthood might be the phase in which its presence becomes more perceptible, after
the sexual life has started and the will of having a child. The diagnosis of syndrome is
done through different examinations, which includes primarily blood tests to measure the
hormonal levels and ultrasound to evaluate the ovaries appearance and thickness of the
uterus linings (Novel Insights into the Pathophysiology & Treatment of PCOS 2012, 14).

Although women who have PCOS can recover their fertility and the pregnancy is possible
with help of treatment to control the levels of hormones that disturbs the ovulation, these
patients have an increased risk for early pregnancy loss (in the first three months), occur-
ring with approximately 50% of the females; while compared with non-PCOS patients
have quite lower chances with the rate of 15% of EPL (Chakraborty, Goswami, Ra-
jani, Sharma, Kabir, Chakravarty & Jana 2013, 1). The medical treatment combined with
lifestyle change, having healthier behaviors has shown to play a big role in the manage-
ment of the disorder, actions such as eating breakfast every day, practicing exercises for
at least 1h per day, weighting themselves often and avoiding stress. In a study done by
The Fertility Fitness program, overweight women with PCOS went through a dietary life-
style changing with support of dietitian, fitness professional, psychiatrist and a nurse and
in the end of the disciplinary process was presented that there was a significant weight
loss and restoration of ovulation and fertility (Hoeger, Kochman, Wixom, Craig, Miller
& Guzick 2004, 423).
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2.1 How does polycystic differs from normal ovulation?

In a content of normal menstruation cycle. Normal ovulation works when a mature follicle
develops in ovaries. Several eggs are mature in follicles, from those eggs the fastest egg
is released from ovaries and moves down to the fallopian tube. In fallopian tube where
there is a good chance that those egg can be fertilized, if it meets with sperm women gets
pregnant. After around 14 days of ovulation if the women are not pregnant, they expected
to have a menstruation (Tommys 2021).

While in the case of PCOS the differences are that even if the polycystic ovaries have
many follicles with eggs, those follicles do not develop and matured enough, which leads
to no ovulation and it is known as anovulation. Similarly, due to the fact that the polycys-
tic ovaries do not get ovulated there will be no regular menstruation cycle and no pregnant
(Tommys 2021).
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2.2 Clinical presentation in PCOS

Women with PCOS have the history of most common clinical presentation that is oligo-
menorrhoea or an amenorrhea thus, leads to anovulation which means ovulation is not
regular (Ali Alchami et al. 2015).

Similarly, approximate 40-50 % women with Polycystic ovary syndrome have their body
mass index more than normal, in the range of overweight. Start to gain weight, especially
in waist and hip area and it is related with insulin resistance and lessen menstruation pe-
riod and fertility. When insulin level keeps on higher in body it increases androgen level.
Consequently, Obesity can also higher the androgen level and can worsen PCOS symp-
toms (Ali Alchami et al. 2015). Obese triples the risk of developing metabolic syndrome
and risk increases up to five time to fall in depression and anxiety (Oulu 2021).

Also, we can see the signs of hyperandrogenism in women with PCOS. Hyperandrogen-
ism sign such as acne in PCOS women is 30 %, hirsutism is 70 % and male pattern blading
is 10%. 1-3 % in adolescents signs like skin flexures, nape of the neck, muco-cutaneous
eruptions or acanthosis in axilla can be seen (Oxford Handbook of Women’s Health Nurs-
ing, 2021). The disturbances such as more production of androgen and cause such as
androgen producing tumor, Cushing's syndrome and the non-classical form of congenital
adrenal hyperplasia require to eliminate. Acanthosis nigricans is normally associate with
obese and PCOS which is the sign of insulin resistance (Ali Alchami et al. 2015).
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3. DIAGNOSIS

As PCOS affects all ages of women considering after puberty, noting medical history and
visible symptoms is crucial. Including physical and pelvic examination which find out
the condition of our reproductive organ both inner and external ways. Although above
discussed symptoms are PCOS, some of those symptoms only can also be a cause of other
related health problem. So, to be diagnosed blood test and ultrasound are done. In blood
test high androgens levels and increased of other hormones are checked and can be seen.
Level of blood glucose in blood can be analyzed. If not with PCOS other health problem
can be rule out. Test such as cholesterol, thyroid function, LHS & FHS is checked. An-
other way to be diagnosed is by ultrasound. Though ultrasound condition of blood vessels,
organs, tissues can be checked. This test can check the condition of uterus that is the
thickness of its lining. Furthermore, sizes of ovaries can be analyzed and if they have
cysts in there that also can be seen through ultrasounds (Polycystic Ovary Syndrome,
2021).
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4. TREATMENT AND EFFICACY

The ovarian polycystic syndrome management is started adopting a healthier routine, in-
corporating physical exercises and more balanced meals. As a person who has this con-
dition has a higher tendency to be overweight, it is essential to work on this issue and
improve the organism performance in the treatment. The patient’s motivation should be
stimulated reminding themselves how important the change is for their lives and that they
have to adaptation is needed in order to control the disorders’ symptoms. Small targets
may help a person to adapt to the new routine and making it easier to follow bigger goals
in a long term (Polycystic Ovary Syndrome 2008, 37, 107).

Setting big goals may not be the best way for a first step, instead a smaller weight loss
goal can be helpful, giving the impression that it is not difficult for someone to lose, for
instance in target of 500 mg or 1kg per week would be a good way to start with. A female
who is not overweight should still adapt to healthier diet, enriching meals with fruits,
cereals and proteins, seeing that those foods diminish the levels of insulin and conse-
quently relieve the symptoms (Polycystic Ovary Syndrome 2008, 36).

The regular practice of exercises is also recommended for all cases, for at least 30 minutes
3 times a week (Royal College of Obstetricians & Gynaecologists 2015, I).
Contraceptive pills are one of the most common methods of treatment for PCOS. Those
contain hormones such as estrogen, progestin that help both to control the androgenic
effects (alopecia, hirsutism, amenorrhea, etc.) and against glucose intolerance. A medic-
ament called metformin is an insulin sensitizer and is also used particularly by diabetes
type 2 patients. It works lowering down the levels of insulin and acting in the ovaries
(Chakraborty & Rehman 2015, 339).

Clomiphene is one of the main agents used to PCOS infertility, by stimulating the ovu-
lation in women and has shown significant results with woman who want to get preg-
nant (Chakraborty & Rehman 2015, 345).

A surgical intervention called Laparoscopic Ovarian Drilling is also an option to induce

the ovaries to ovulate. The technique consists of breaking a part of the ovaries as a trig-
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ger to normalize the ovulation capacity by lowering the levels of androgin. This proce-
dure is recommended to be performed in women who have tried other non-invasive
methods without success (Michigan Medicine 2020).
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5. CONCLUSION

There are different treatment methods which are indicated to women in determinated
stages of the syndrome, treating not only the infertility issue, but other side diseases which
can be caused by PCOS like diabetes. The symptoms of the syndrome might be a bit
confusing for most of the patient leading them to think they are having just stress or tired-
ness manifestation, misleading diagnosis and requiring several tests to confirm the disor-
der.

After the disorder diagnosis, the doctor evaluates what medication suits better to the
woman, taking into consideration the age, the symptoms and the will of the patient.
The change of life habits also plays a great role in the road of fertility as studies have
shown starting with small steps, including physical exercises, healthier foods (fruits, veg-
etables, cereals), avoiding stress and keeping mental health in a good balance. Those are
the crucial to boost the organism health and functioning.
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6. REFERENCES

NHS. 2019. Polycystic Ovary Syndrome – Symptoms. [online page] Updated at

01. Feb. 2019. Acessed on 06 March 2021. https://www.nhs.uk/conditions/poly-
cystic-ovary-syndrome-pcos/symptoms/

Tommys.org. 2021. PCOS and fertility: everything you need to know. [online]
Accessed 12 February 2021. Available at: <https://www.tommys.org/pregnancy-
information/planning-a-pregnancy/fertility-and-causes-of-infertility/pcos-and-
fertility-everything-you-need-know>

Polycystic Ovary Syndrome, edited by Gabor T. Kovacs, and Robert Norman,

Cambridge University Press, 2007. ProQuest Ebook Central, https://ebookcen-
tral.proquest.com/lib/tampere/detail.action?docID=288648.
BBC https://www.bbc.com/news/world-44127615

Peña, A.S., Witchel, S.F., Hoeger, K.M. et al. Adolescent polycystic ovary syn-
drome according to the international evidence-based guideline. BMC Med 18, 72
(2020). https://doi.org/10.1186/s12916-020-01516-x

Chakraborty P, Goswami SK, Rajani S, Sharma S, Kabir SN, Chakravarty B, Jana

K. Recurrent pregnancy loss in polycystic ovary syndrome: role of hyperhomo-
cysteinemia and insulin resistance. PLoS One. 2013 May 21;8(5):e64446. doi:
10.1371/journal.pone.0064446. PMID: 23700477; PMCID: PMC3660299.

Hoeger, Kochman, Wixom, Craig, Miller & Guzick. 2004. A randomized, 48-
week, placebo-controlled trial of intensive lifestyle modification and/or metfor-
min therapy in overweight women with polycystic ovary syndrome: a pilot study.
University of Rochester School of Medicine and Dentistry and School of Nursing,
Rochester, New York. Accessed on 3 March 2021.
https://www.fertstert.org/action/showPdf?pii=S0015-0282%2804%2900731-9

Oxford Medicine Online. 2021. Oxford Handbook of Women's Health Nursing.

[online] Accessed 3 March 2021. Available at: <https://oxfordmedi-
cine.com/view/10.1093/med/9780199239627.001.0001/med-9780199239627> .

Ali Alchami, Oliver O’Donovan, Melanie.” PCOS: Diagnosis and Management

of Related Infertility” Obstetrics, Gynaecology & Reproductive Medicine 25
(2015): 279-282. Web
2021. Polycystic Ovary Syndrome (PCOS). [online] Accessed 3 March 2021.
Available at: <https://www.hopkinsmedicine.org/health/conditions-and-dis-
eases/polycystic-ovary-syndrome-pcos>

Oulu.fi. 2021. Polycystic ovary syndrome impairs women’s quality of life longer
than previously thought. [online] Accessed 3 March 2021. Available at:
<https://www.oulu.fi/university/news/pcos-impairs-quality-of-life>.

Michigan Medicine. University of Michigan. 2020 [Online page] Released on

17.07.2020. Accessed on 03.03.2021. https://www.uofmhealth.org/health-li-
brary/tw9171#:~:text=Laparoscopic%20ovarian%20drilling%20is%20a,de-
stroy%20parts%20of%20the%20ovaries.
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Self-Evaluation

It was easy to decide our topic. We had Zoom meetings to discuss about the work and
we managed to find suitable time to work together equally as we have shared the work
file. We were able to find a plenty of materials and evidence-based articles, so it was
easy to write. We just had a bit of difficulty to filter the crucial information that would
be important to add in our work. We feel like we could learn a lot from our re-
search about our topic and also on thesis writing.