Opinion Article - (2024) Volume 11, Issue 3
Received: Aug 26, 2024, Manuscript No. JEBMH-24-147193; Editor assigned: Aug 28, 2024, Pre QC No. JEBMH-24-147193 (PQ); Reviewed: Sep 12, 2024, QC No. JEBMH-24-147193; Revised: Sep 20, 2024, Manuscript No. JEBMH-24-147193 (R); Published: Sep 27, 2024, DOI: 10.18410/jebmh/2024/11/03/123
Citation: Topkara S. Hormonal Imbalances in Polycystic Ovary Syndrome: Pathophysiology and Treatment. J Evid Based MedHealthc 2024;11(03):1-2.
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, characterized by a range of symptoms including irregular menstrual cycles, anovulation and hyperandrogenism. The hormonal imbalances in PCOS are central to its pathophysiology and significantly impact treatment strategies. This discuss into the underlying hormonal disturbances in PCOS and discuss current treatment approaches.
One of the most prominent features of PCOS is insulin resistance, where the body’s cells become less responsive to insulin. This resistance leads to elevated insulin levels (hyperinsulinemia), which in turn can exacerbate hormonal imbalances. Insulin resistance is thought to play a role in the development of PCOS and is present in the majority of women with the syndrome. Elevated insulin levels stimulate the ovaries to produce more androgens (male hormones such as testosterone). These androgens interfere with the normal function of the ovaries, contributing to symptoms such as hirsutism (excessive hair growth), acne and alopecia (hair loss). Hyperandrogenism is a sign of PCOS, characterized by elevated levels of androgens, including testosterone and androstenedione. This condition contributes to various symptoms such as acne, hirsutism and scalp hair thinning. In PCOS, increased androgen production primarily originates from the ovaries, though adrenal glands may also contribute. The excess androgens disrupt normal ovarian follicle development, leading to the formation of cysts and irregular menstrual cycles. One of the most effective initial treatments for managing PCOS is lifestyle modification. Adopting a balanced diet and engaging in regular physical activity can help improve insulin sensitivity, reduce hyperinsulinemia and promote weight loss. Weight reduction can also help decrease androgen levels and improve menstrual regularity. Behavioral therapy and structured weight- loss programs can support long-term adherence to lifestyle changes and enhance overall treatment outcomes. Oral Contraceptives (OCs) are commonly prescribed to manage menstrual irregularities and reduce hyperandrogenic symptoms. They work by providing a steady level of estrogen and progestin, which helps regulate the menstrual cycle, reduce ovarian androgen production and improve acne and hirsutism. Medications such as spironolactone and finasteride are used to directly counteract the effects of androgens. Spironolactone is a potassium-sparing diuretic with anti-androgenic properties that helps reduce symptoms like hirsutism and acne. Finasteride inhibits the conversion of testosterone to Dihydrotestosterone (DHT), another potent androgen. Metformin, a common insulin sensitizer, helps improve insulin sensitivity and can reduce insulin levels, thereby lowering androgen production. Metformin can also support weight management and restore menstrual regularity in some women with PCOS. For women seeking pregnancy, medications like clomiphene citrate and letrozole can induce ovulation. These drugs work by stimulating the ovaries to produce mature follicles and promote ovulation. For women who cannot take combined hormonal contraceptives or who have contraindications, progestin- only therapies can help regulate menstrual cycles and protect the endometrium from hyperplasia. Gonadotropin-Releasing Hormone (GnRH) agonists are used in some cases to suppress ovarian function temporarily. They can help manage symptoms in women with severe PCOS who do not respond to other treatments.
Laparoscopic ovarian drilling is a surgical procedure used for women with PCOS who do not respond to medical treatment. The procedure involves creating small holes in the ovarian surface to reduce androgen production and restore normal ovulation. For women with severe menstrual bleeding due to endometrial hyperplasia, endometrial ablation can be considered to reduce bleeding and improve quality of life. Some herbal supplements, such as spearmint tea, have been suggested to have anti-androgenic effects and may help with symptoms like hirsutism. However, more research is needed to establish their efficacy and safety. Hormonal imbalances in Polycystic Ovary Syndrome (PCOS) are complex and multifaceted, involving insulin resistance, hyperandrogenism and disruptions in the hypothalamic-pituitary-ovarian axis. Effective treatment requires a combination of lifestyle modifications, pharmacological interventions and sometimes surgical procedures. By addressing these hormonal disturbances and tailoring treatment to individual needs, healthcare providers can help manage symptoms, improve quality of life and reduce long-term health risks associated with PCOS. Ongoing research and advances in understanding the pathophysiology of PCOS will continue to refine treatment approaches and improve patient outcomes.
