Polycystic

Ovary
Syndrome
(PCOS)
BY ALEANDRO DIZON BN4A
Case Scenario Mrs. De la Cruz is a 27-year-old female who was
referred to the OB GYN department complaining
of not having her period for six months. She has
been trying to conceive for the last 2 years without
success. She significantly noticed weight gain over
the last few months. She had her first
menstruation at the age of 15. Acne develops at
the age of 20 up to present and able to see
dermatologist. She engaged on psychotherapy
activities at the age of 24 to present for anxiety
and sleep disturbances. She has history of
amenorrhea and abnormal vaginal bleeding.
Bleeding duration between two to 15 days., Her
cycle ranges monthly to every three months.
Sexually active since 19-years-old with no history
of STD with same sexual partner for the last 4
years.
 Polycystic ovary syndrome (PCOS) is a
condition in which the ovaries produce an
abnormal amount of androgens, male sex
hormones that are usually present in women in
small amounts. The name polycystic ovary
syndrome describes the numerous small cysts
(fluid-filled sacs) that form in the ovaries.

PCOS is one of the most common causes of

female infertility. It can also increase your
risk for other health conditions. PCOS is very
common — up to 15% of women of reproductive
age have it. A woman can get PCOS any time
after puberty. Most people are diagnosed in
their 20s or 30s when they are trying to get
pregnant. You may have a higher chance of
getting PCOS if you are overweight or have
obesity, or if other people in your family
have PCOS.
 Higher levels of androgen: High androgen levels prevent the ovaries from
releasing eggs (ovulation), which causes irregular menstrual cycles. Irregular
ovulation can also cause small, fluid-filled sacs to develop in the ovaries. High
androgen also causes acne and excess hair growth in women.

Insulin Resistance: Insulin resistance means your body doesn't process insulin
correctly, leading to high glucose levels in your blood. Not all individuals with
Causes

insulin resistance have an elevated glucose or diabetes, but insulin resistance can
lead to diabetes. Being overweight or having obesity can also contribute to insulin
resistance. Increased insulin levels cause the ovaries to make and release male
hormone (androgens).

Low-grade inflammation: Chronic low-grade inflammation has emerged as a key

contributor to the pathogenesis of Polycystic Ovary Syndrome (PCOS). People with
PCOS tend to have chronic low-grade inflammation. Your healthcare provider can
perform blood tests that measure levels of C-reactive protein (CRP) and white
blood cells, which can indicate the level of inflammation in your body.
 The most common symptoms of PCOS include:
Symptoms
1) Irregular periods
2) Abnormal hair growth
3) Acne
4) Obesity
5) Darkening of the skin:
6) Cysts
7) Skin tags
8) Thinning hair
9) Infertility
 Diagnosis
In most cases, your healthcare provider can diagnose PCOS after an examination.
They may order blood tests or perform an ultrasound to help with the diagnosis.

Perform a physical exam, looking specifically for excess facial hair, hair loss,
acne, discolored skin and skin tags.

Ultrasound. This test uses sound waves and a computer to create images of
blood vessels, tissues, and organs. This test is used to look at the size of the
ovaries and see if they have cysts. The test can also look at the thickness of the
lining of the uterus (endometrium).

Blood tests. These look for high levels of androgens and other hormones. Your
health care provider may also check your blood glucose levels. And you may
have your cholesterol and triglyceride levels checked.

 Pharmacologic Treatment
Your healthcare provider will determine treatment based on your symptoms, medical history and other health
conditions, and if you want to get pregnant. Treatments can include medications, lifestyle changes or a combination
of both.

If you do not plan to become pregnant, treatments include:

Hormonal birth control: Options include birth control pills, patches, shots, a vaginal ring or an intrauterine
device (IUD). Hormonal birth control helps to regulate your menstrual cycle, improve acne and help with excess
hair growth.

Insulin-sensitizing medicine: Metformin is a drug used to treat diabetes. It works by helping your body process
insulin. Once insulin is controlled, some people with PCOS see improvements in their menstrual cycles.

Medications to block androgens: Some drugs can block the effect of androgens. This helps control acne or hair
growth caused by PCOS. Talk to your healthcare provider about whether they're right for you.

If you want to become pregnant now or in the future, treatment for PCOS includes:
Drugs to induce ovulation (releasing an egg): A successful pregnancy begins with ovulation. Certain drugs
have been proven to induce ovulation in women with PCOS. The medications clomiphene and letrozole are taken
orally, while gonadotropins are given by injection.
 Non-Pharmacologic Treatment

Lifestyle changes: Losing weight and eating a healthy diet can have a positive effect on insulin levels.
Surgery: A surgical procedure called ovarian drilling can trigger ovulation by removing tissues in the ovaries that
are producing androgen hormones. With newer medications available, surgeons now rarely perform this
procedure.

If you want to have a child

In vitro fertilization (IVF): Your egg is fertilized with your partner's sperm in a lab and then transferred to your
uterus. This is an option for women with PCOS when medication doesn't help with ovulation.
 Diet
Diet plays an important role in
controlling PCOS and maintaining
ideal body weight is important.
Women with PCOS should limit
their sodium intake to a
maximum of 2,300 milligrams per
day, or to be cautious 1,500
milligrams daily. (Fresh, frozen or
dried fruits, grains and beans,
fresh or frozen meat and poultry)
Exercise
Moderate exercise like brisk walking,
jogging, cycling or swimming are all great
activities that can help with PCOS. This
type of exercise increases your bodies
sensitivity to insulin, which reduces your
risk of cardiovascular disease and type 2
diabetes.
 Nursing Management

1) Advise patient regarding weight control and exercise as this

improves insulin sensitivity and reduces the risk of metabolic
syndrome.

2) Assess patient's mental status. Psychological comorbidity should

be considered in patients with PCOS, as anxiety or depression can
coexist.

3) Acknowledge and accept the client's situation.

 Continuum of Symptoms in Polycystic Ovary Syndrome (PCOS): Links
with Sexual Behavior and Unrestricted Sociosexuality
(Tzaldis & Oinonen, 2021)

Symptoms of polycystic ovary syndrome (PCOS) exist on a continuum, are associated with
hyperandrogenism, and have fertility implications. The present study investigated the relationship between
PCOS symptoms and sociosexuality in young women with a continuum of symptoms ranging from none to
clinical levels. Given that unrestricted sociosexuality, or one's orientation toward uncommitted sexual
activity, is associated with hyperandrogenism, we hypothesized that women experiencing more symptoms
of PCOS, and a greater likelihood of androgen excess, would have a more unrestricted sociosexual
orientation. Women completed questionnaires about PCOS symptoms, sociosexuality, and sexuality.
Unrestricted sociosexuality, unrestricted desire, romantic interest in women, and masturbation frequency
were all positively associated with PCOS symptoms (including male pattern hair growth). The sexuality
scores were also higher in women who scored above (versus below) the cutoff on a self-report PCOS
screening questionnaire. In addition, attraction to women was higher in participants reporting a past
diagnosis of PCOS. The findings are in line with theories that androgens play a role in sociosexuality and
sexual orientation.

 Reaction
The study talks about sociosexuality or sometimes called sociosexual orientation which is the
individual difference in the willingness to engage in sexual activity outside of a committed relationship
and its relation to PCOS. The study links sociosexuality and hyperandrogenism which means that the
more a woman has sexual activity outside a committed relationship or marriage, the more she is at risk
for PCOS. I think it is a very interesting topic since the exact cause of PCOS is not known until today.

My patient stated that she became sexually active at the age of 19. Future research should be done
regarding this topic in order to fully understand the cause or causes of PCOS. Finding specific causes
would also make us find specific interventions or cures for the disease.