Not many people know about PCOS or polycystic ovary syndrome. Even though PCOS that is not handled properly can bring serious health problems. Untreated PCOS can also reduce the quality of life for sufferers and make it more difficult for people with polycystic ovarian syndrome to get pregnant.
What is Polycystic Ovary Syndrome?
PCO or known as Polycystic Ovary is a condition of hormonal imbalance that causes egg cells to remain small, none of which develop into large and mature egg cells to be fertilized by sperm cells. Ovulation or rupture of the mature egg does not occur, so it is not surprising that PCO sufferers come to a fertility specialist with complaints of difficulty getting pregnant and irregular menstruation. The hormonal imbalance that occurs involves the interaction of various hormones including reproductive hormones such as LH, FSH, Prolactin, Estrogen and Testosterone, as well as the hormones Insulin and Leptin (hormones produced by fat). This condition in addition to causing egg cells that cannot develop also reduces the quality of egg cells. Hormonal imbalances that often occur in people with PCO are elevated LH and testosterone hormones, resistance to the action of the hormone insulin and resistance to the hormone leptin. The insulin hormone works by keeping blood sugar levels from getting too high by getting blood sugar into the cells.
Who is potentially affected by PCOS?
Patients with PCO often have high levels of the hormone insulin even though blood sugar levels are still normal, as evidenced by the ratio of fasting blood sugar to fasting insulin which is less than 10. This condition is called insulin resistance where insulin is needed that is higher than it should be to lower blood sugar levels. or keep blood sugar normal. Conditions of prolonged insulin resistance will cause a person to fall into a condition of diabetes or diabetes.
So people with PCO with insulin resistance, even though they don't want to get pregnant, still have to be treated because in the next few years they can fall into a condition of diabetes. Apart from diabetes, other metabolic syndromes that can be suffered by untreated PCO patients include hypertension (high blood pressure), hypercholesterolemia (high cholesterol), hypertriglyceridemia (high blood triglycerides or fats) and obesity. Elevated LH and testosterone hormones cause some PCO sufferers to have hyperandrogenic signs such as the growth of fine hairs on the lips, chest, legs, arms, stomach or around the chin, back and breasts, excess acne on the face or chest and back, facial skin, and oily head. Two-thirds of PCO patients have an overweight or obese body mass index. This excess fat produces the hormone leptin.
In normal people, the excess of the hormone leptin will prevent someone from overeating when sufficient calorie conditions have been reached. It is different with PCO which causes a condition of leptin resistance, namely a condition in which leptin cannot work so that PCO patients tend to continue eating even though sufficient calories have been achieved. In other words, this leptin resistance condition causes a high satiety threshold or difficulty feeling full. This also causes PCO patients to fall into obesity or overweight and diabetes.
The interaction between reproductive hormones with Insulin and Leptin forms complex hormonal imbalance conditions that must be treated one by one so that optimal hormonal conditions can be achieved so that the egg cell will develop and burst (ovulation). This of course takes months, sometimes years, depending on how severe the condition of the hormonal imbalance is, which is of course different for each PCO patient.
How is PCOS diagnosed?
PCO patients generally come to a fertility specialist with complaints of irregular menstruation or have been married for a long time but never get pregnant. The diagnosis of PCO is determined based on finding 2 of 3 clinical symptoms as follows, namely irregular menstruation, signs of hyperandrogenic and polycystic ovarian appearance on ultrasound examination. Afterwards, a hormone profile examination will be carried out to determine whether there is insulin resistance, elevated LH hormone or other reproductive hormone abnormalities. The therapy that is carried out will depend on the clinical complaints and symptoms that are determined and the hormonal abnormalities obtained from the results of laboratory tests.
What is the treatment for PCOS?
The first line of therapy is a change in lifestyle and diet (Lifestyle Modification). PCO patients are advised to exercise regularly, for example walking in the morning or cycling for 30 minutes every day or 3-4 times per week. PCO patients are advised to lose 10% weight by exercising and choosing healthy foods. Live as organically as possible by avoiding junk food (instant food, fried chicken , burgers) and processed meats that contain preservatives and coloring agents (eg sausages, meatballs, dumplings). Also avoid foods with high levels of sugar or salt. Avoid environmental pollutants and chemicals in food. Expand fibrous foods, namely fruits and vegetables.
This therapy is carried out concurrently with drug therapy as needed. PCO patients who want to get pregnant will be given drugs that will enlarge their egg cells so that ovulation can occur and be fertilized by sperm. There are various medicines to enlarge the eggs and will usually start from the simplest and can be increased or changed depending on the response of the ovaries with PCO. A good response can be seen from the presence of a large egg during an ultrasound examination on the 11th day of the menstrual cycle. PCO patients with insulin resistance conditions will be given drugs that will increase sensitivity to the insulin hormone. This drug does not lower blood sugar levels so patients taking this drug need not be afraid of hypoglycemia or low blood sugar. A good response to treatment will be seen from the regularity of the menstrual cycle and the enlargement of the egg when stimulated. If you still don't get the desired response, then further therapy can be increased by performing LOD (Laparoscopy Ovarian Drilling) or by injecting recombinant FSH (Follicle Stimulating Hormone).
Of course, this will be discussed with the patient beforehand. The patient's wishes will always be the doctor's priority. LOD is an operative procedure with minimally invasive principles in which a camera and a small tool are inserted through a small hole (0.5 – 1 cm) in the stomach to drill or make 4 to 6 small holes in polycystic ovaries. This drilling action is intended to remove excess LH and androgen hormones to achieve hormonal balance so that the ovaries will respond better to drugs that will enlarge the egg cells. This action only requires 1 day of hospitalization and the patient can return to normal activities the next day. Another option is to inject recombinant FSH every day until a large egg is obtained. In PCO patients who are resistant to stimulant drugs such as Clomiphene Citrate, recombinant FSH is needed to enlarge their eggs if LOD measures are not performed. FSH is given in small and long doses, increased gradually until large egg cells are obtained.
In conclusion, PCO is a condition of hormonal imbalance that keeps the egg cells small so that there are no mature eggs for sperm to fertilize. PCO can be treated with several therapies, such as life style modification, administration of stimulant drugs that enlarge the egg cells, overcoming insulin resistance conditions and finally with LOD or FSH. The long-term impact of PCO besides infertility or difficulty getting pregnant is Metabolic Syndrome (Hypertension, Diabetes, Hypercholesterolemia, Hypertriglyceridemia and Obesity). It's a good idea for you or someone you care about to consult with an obstetrician (obstetrics and gynecology specialist) to get the right diagnosis and treatment.
This article was written by Dr. Caroline Tirtajasa, Sp.OG(K) (Obstetric and Gynecology Specialist at EMC Pulomas Hospital).