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Management of Abortion
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What is Polycystic Ovary Syndrome (PCOS)?
Polycystic (pah-lee-SIS-tik) ovary syndrome (PCOS) is a health problem that can affect a woman's:
- Menstrual cycle
- Ability to have children
- Blood vessels
With PCOS, women typically have:
- High levels of androgens (AN-druh-junz). These are sometimes called male hormones, though females also make them.
- Missed or irregular periods (monthly bleeding)
- Many small cysts (sists) (fluid-filled sacs) in their ovaries
How many women have PCOS?
Between 1 in 10 and 1 in 20 women of childbearing age has PCOS. As many as 5 million women in the United States may be affected. It can occur in girls as young as 11 years old.
What causes PCOS?
The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.
A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.
Researchers also think insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen. High androgen levels can lead to:
- Excessive hair growth
- Weight gain
- Problems with ovulation
What are the symptoms of PCOS?
The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:
- Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
- Infrequent, absent, and/or irregular menstrual periods
- Hirsutism (HER-suh-tiz-um) — increased hair growth on the face, chest, stomach, back, thumbs, or toes
- Cysts on the ovaries
- Acne, oily skin, or dandruff
- Weight gain or obesity, usually with extra weight around the waist
- Male-pattern baldness or thinning hair
- Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
- Skin tags — excess flaps of skin in the armpits or neck area
- Pelvic pain
- Anxiety or depression
- Sleep apnea — when breathing stops for short periods of time while asleep
Why do women with PCOS have trouble with their menstrual cycle and fertility?
The ovaries, where a woman's eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.
In women with PCOS, the ovary doesn't make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman's menstrual cycle is irregular or absent. Plus, the ovaries make male hormones, which also prevent ovulation.
Does PCOS change at menopause?
Yes and no. PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.
There is no single test to diagnose PCOS. Your doctor will take the following steps to find out if you have PCOS or if something else is causing your symptoms.
Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.
Physical exam. Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.
Pelvic exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.
Blood tests. Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.
Vaginal ultrasound (sonogram). Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (en-do-MEE-tree-uhm) (lining of the womb). This lining may become thicker if your periods are not regular.
Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:
Lifestyle modification. Many women with PCOS are overweight or obese, which can cause health problems. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level. Healthy eating tips include:
- Limiting processed foods and foods with added sugars
- Adding more whole-grain products, fruits, vegetables, and lean meats to your diet
This helps to lower blood glucose (sugar) levels, improve the body's use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.
Birth control pills. For women who don't want to get pregnant, birth control pills can:
- Control menstrual cycles
- Reduce male hormone levels
- Help to clear acne
Keep in mind that the menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone (proh-JES-tuh-rohn), like Provera, to control the menstrual cycle and reduce the risk of endometrial cancer (See Does PCOS put women at risk for other health problems?). But, progesterone alone does not help reduce acne and hair growth.
Diabetes medications. The medicine metformin (Glucophage) is used to treat type 2 diabetes. It has also been found to help with PCOS symptoms, though it isn't approved by the U.S Food and Drug Administration (FDA) for this use. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. Metformin will not cause a person to become diabetic.
Fertility medications. Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used. Also, some fertility medications increase the risk for multiple births (twins, triplets). Treatment options include:
- Clomiphene (KLOHM-uh-feen) (Clomid, Serophene) — the first choice therapy to stimulate ovulation for most patients.
- Metformin taken with clomiphene — may be tried if clomiphene alone fails. The combination may help women with PCOS ovulate on lower doses of medication.
- Gonadotropins (goe-NAD-oh-troe-pins) — given as shots, but are more expensive and raise the risk of multiple births compared to clomiphene.
Another option is in vitro fertilization (IVF). IVF offers the best chance of becoming pregnant in any given cycle. It also gives doctors better control over the chance of multiple births. But, IVF is very costly.
Surgery. "Ovarian drilling" is a surgery that may increase the chance of ovulation. It's sometimes used when a woman does not respond to fertility medicines. The doctor makes a very small cut above or below the navel (belly button) and inserts a small tool that acts like a telescope into the abdomen (stomach). This is called laparoscopy (lap-uh-RAHS-kuh-pee). The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But, these effects may only last a few months. This treatment doesn't help with loss of scalp hair or increased hair growth on other parts of the body.
Medicine for increased hair growth or extra male hormones. Medicines called anti-androgens may reduce hair growth and clear acne. Spironolactone (speer-on-oh-LAK-tone) (Aldactone), first used to treat high blood pressure, has been shown to reduce the impact of male hormones on hair growth in women. Finasteride (fin-AST-uhr-yd) (Propecia), a medicine taken by men for hair loss, has the same effect. Anti-androgens are often combined with birth control pills. These medications should not be taken if you are trying to become pregnant.
Before taking Aldactone, tell your doctor if you are pregnant or plan to become pregnant. Do not breastfeed while taking this medicine. Women who may become pregnant should not handle Propecia.
Other options include:
- Vaniqa (van-ik-uh) cream to reduce facial hair
- Laser hair removal or electrolysis to remove hair
- Hormonal treatment to keep new hair from growing
Other treatments. Some research has shown that bariatric (weight loss) surgery may be effective in resolving PCOS in morbidly obese women. Morbid obesity means having a BMI of more than 40, or a BMI of 35 to 40 with an obesity-related disease. The drug troglitazone (troh-GLIT-uh-zohn) was shown to help women with PCOS. But, it was taken off the market because it caused liver problems. Similar drugs without the same side effect are being tested in small trials.
Researchers continue to search for new ways to treat PCOS. To learn more about current PCOS treatment studies, visit ClinicalTrials.gov. Talk to your doctor about whether taking part in a clinical trial might be right for you.
Women with PCOS appear to have higher rates of:
- Gestational diabetes
- Pregnancy-induced high blood pressure (preeclampsia)
- Premature delivery
Babies born to women with PCOS have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets).
Researchers are studying whether the diabetes medicine metformin can prevent or reduce the chances of having problems while pregnant. Metformin also lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.
Metformin is an FDA pregnancy category B drug. It does not appear to cause major birth defects or other problems in pregnant women. But, there have only been a few studies of metformin use in pregnant women to confirm its safety. Talk to your doctor about taking metformin if you are pregnant or are trying to become pregnant. Also, metformin is passed through breastmilk. Talk with your doctor about metformin use if you are a nursing mother.
Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:
- More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
- The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.
- Women with PCOS are at greater risk of having high blood pressure.
- Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
- Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.
Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.
Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.
If you have PCOS, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOS, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include:
- Eating right
- Not smoking
Having PCOS can be difficult. You may feel:
- Embarrassed by your appearance
- Worried about being able to get pregnant
Getting treatment for PCOS can help with these concerns and help boost your self-esteem. You may also want to look for support groups in your area or online to help you deal with the emotional effects of PCOS. You are not alone and there are resources available for women with PCOS.
Hello Dr. I am 28 yrs. Old and I am pregnant second time. My first baby is by LSCS before 3 yrs. Now prob. Is I ve hypothyroidism from last 2 yrs. Nd pcos also. Now my progesterone level is low nd hb is 10.6 gm/dl. Now I ve severe pain in lower abd. My Dr. Suggest me to take sustain tab. 100 mg. Bt my pain is still severe. So what should I do? My LMP 23/06/17. please suggest me.
I haven't got periods for 3 months. I just have periods which is prolonging for more than 10days now. What should I do to stop it? Am a PCOD patient.
Hello doc, I had unprotected sex with woman. I am 100% assured that these two women don't have hiv Do I have to fear ?
We had sex on 23 Aug it was her 4th day of periods her cycle is for 28 Days and due to condom burst it was unprotective so she took i-pill after 7 Hrs and after i-pill approx 6 Hrs she vomited and yesterday her periods started or can b slight bleeding due to I pill is she hv chances of pregnancy? When she can test using advance prega news?
I am 17 year old girl I got intimate with my bf last week he touch my vagina but did not ejaculate nor put finger in it we had wore clothes he just rubbed his penis on my vagina I don't think so sperm has reached there but still have doubt shall I get periods what will happen if I am pregnant.
From past 3 month I am doing regular sex with my wife without any kind of protection. Every month she miss her period by 5 to 10 days and then suddenly her periods starts. My question is despite regular sex why she is not getting pregnant. Is there something to worry about because we both are healthy?
I delivered my baby 3 months back through c section. Till now I didn't get my periods after the first period which I got from the delivery day. I'm both breast feeding and formula feeding my baby. Is this normal? And am I still ovulating now and do we need to use protection while periods are not coming.
hello. I have pcod my age 21. I took deviry 10mg for 5days since I do not hve periods since 3months. I got periods aftr 10days stopping tablet. Bt the problem is when I go to bed its ok when I get up from sleep there is an heavy flow. Is this any problem please suggest me.
I have a problem regarding period. My periods is not on time and also not coming on this month what will do what medicine you refer me.
10 CARDINAL SYMPTOMS OF VITAMIN D DEFICIENCY-
1-EXCESSIVE BODYACHE- THIS IS MAIN SYMPTOM OF VITAMIN D DEFICIENCY. IF YOU FEEL THAT YOU HAVE LOSS ALL YOUR ENERGY AT THE END OF THE DAY AND IF YOU BECOME TIRED EVEN AFTER SLIGHT WORK, IT MAY REPRESENT VITAMIN D DEFICIENCY
2-UNEXPAINED DEPRESSION-IF YOU HAVE LOW MOOD, WHICH IS UNEXPLAIN BY YOUR SITUATION, THAN YOU HAVE TO GO FOR VITAMIN D TEST
3- TINGING AND NUMBNESS OF LIMBS-IF YOU FEEL PIN PRICKING SENSATION IN YOUR HANDS AND FEETS, THAN YOU MAY HAVE VITAMIN D DEFICIENCY
4- MUSCULAR CRAMPS-SUDDEN TIGHTNESS OF MUSCLES ESPECIALLY IN CALF AREA. SOMETIME IN ANKLE, THIGH, ARM, WRIST, FINGERS ETC. SUGGESTIVE OF VITAMIN D DEFICIENCY
5-RESTLESS LEGS AT NIGHT-IF YOU FEEL THAT YOUR BODY IS PAINING SPECIELLY LEGS, WHEN YOU ARE RELAXING. YOU FEEL SOME RELEIF BY MOVING YOUR LEGS. IT GENERALLY HAPPENS IN NIGHT AND FEELING OF RELATION BY STRACHING OF LEGS REMAIN UNTILL YOU ARE NOT FALLING IN SLEEP.IT ALSO SUGGESTIVE OF VITANIN D DEFICIENCY
6- UNCONTROLLED DIABETES- IF YOUR SUGAR IS NOT CONTROLLED BY MEDICATION, EVEN AFTER APPROPRIATE DOSE AND SUGAR LEVEL HAS FLUACTUATIONS THAN GO FOR VITAMIN D TESTING
7- RECURRENT INFECTION-IF YOU GET COLD/COUGH/FEVER ON SLIGHT CHANGE IN WHETHER OR SLIGHT CHENGE IN DIET, IT MEANS YOU MAY HAVE VITAMIN D DEFICIENCY
8-NECK PAIN- IF YOU SUFFER FROM NECK PAIN A ND YOU THINK THAT IT IS DUE TO SO CALLED “CERVICAL”, THAN YOU MAY BE WRONG. MOST OF NECK PAIN IS DUE TO LACK OF VITAMIN D
9- BACKACHE AND LUMBER ACHE-IF YOU HAVE PROBLEM IN LIFTING HEAVY WEIGHT, BENDING, OR YOU HAVE PERSISTENT LOW BACKACHE SOMETIME CALLED AS “DISC BULGE” AND “SCIATICA”, THAN IT IS POSSIBLITY THAT YOU MAY SUFFER FROM VITAMIN D DEFICIENCY
10- SKIN PROBLEM LIKE PSORIASIS-IF YOUR SKIN PROBLEM LIKE PSORIASIS IS NOT COMES UNDER CONTROL EVEN AFTER PROPER MEDICATION OR IT REAPPEAR AFTER SOMETIME , THAN GO FOR VITAMIN D TESTING.
I am 26 years old had history of 3 miscarriages 1st one unkwn reason, 2nd one rubella infection 3rd molar pregnancy. Now I am conceived my LMP date is 23-dec 16. Doctor has asked to test somany tests. TSH value came as 6.1 so doctor given THYRONORM. I want to know details regarding this. Doctor said I have hypothyroidism. But previously always I have normal TSH only. Some are telling its common to spike TSH during early pregnancy. Is it very common. And what foods should I avoid to control my TSH. ?CAN I USE ZANDU BALM or AMRUTANJAN BALMs for headache?
Im 30 years trying for pregnancy I had 2eggs in my right ovaries at13th day is it normal or otherwise what can I do for my egg growth for pregnancy.
My wife having bleeding after menstrual cycle on day of 8th and 9th, what are the causes or is there any thing serious please let me know.
I had an unprotected sex with my would be wife on 20th October. I am not sure if I have given any drop inside her. Probably not but I am scared for that. Can she use unwanted 72? She had her period 10 the October. Will her period be irregular? Will there be huge bleeding after taking the medicine? After sex she felt bleeding a little bit.
New study published in Journal of Biological Chemistry, NewYork, that "Lack of Vitamin-A found in many fruits, vegetables, meat & dairy products may be also the one factor in development of Diabetes(type-2)". Vitamin A helps to boosts the activity of Beta cells(Insulin producing cells).