PCOS Peer Response

Peer Responses – Pratiksha

Length: A minimum of 170 words per post, not including references

Citations: At least two high-level scholarly reference in APA per post from within the last 5 years

• Relate to another journal readingFor peer posts and subsequent posts under the initial discussion board thread add in second and third line treatments and additional considerations (250 word maximum for responses). Example requirement, only evidence-based sources, such as AAFP, CDC, IDSA, ADA, JNC 8 etc. (textbook resources and internet sites affiliated with medical associations are considered credible sources to obtain the information on the most up to date guidelines). Add in the link to the guideline(s) within the discussion board for further reading by your peers.
• Polycystic ovary syndrome, also known as PCOS or Stein Leventhal syndrome is a disorder that primarily affects women in their childbearing years. It is a condition characterized by periods, difficulty getting pregnant, excessive hair growth, acne and weight gain. The causes of PCOS are varied. Include factors, insulin resistance and environmental influences. Factors such as levels of hormones disruptions in hormone release from the brain and irregular development of ovarian follicles play a role in the development of this syndrome. (Singh et al 2023) 
• Epidemiology 

Globally Polycystic Ovary Syndrome (PCOS) affects around 8% to 20% of women during their years according to diagnostic criteria (Singh et al., 2023). The prevalence varies across populations due, to environmental factors. 

Pathophysiology 

The underlying mechanisms of PCOS involve metabolic disruptions mainly characterized by levels of androgens and insulin. Increased androgen levels originating from the ovaries and adrenal glands result in symptoms such as hair growth (hirsutism) and acne while disturbing ovarian function (Witchel et al., 2019). Imbalances in the ovarian axis worsen excess androgen production, influenced by genetic factors affecting steroid production. Additionally, insulin resistance contributes to insulin levels, which in turn stimulate androgen production and lower sex hormone binding globulin levels intensifying the effects of androgens. 

Clinical Presentation 

Common symptoms include cycles, hirsutism, acne, weight gain and difficulty conceiving. Long term implications involve metabolic issues, like diabetes, abnormal lipid levels and cardiovascular problems (Bulsara et al., 2021). 

Diagnostic Criteria 

To diagnose syndrome (PCOS) healthcare providers consider various criteria outlined by the Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group in 2004. These criteria involve the presence of two out of three key features; hyperandrogenism (HA) ovulatory dysfunction (OD) and polycystic ovarian morphology (PCOM) observable on ultrasound scans. The Androgen Excess and PCOS Society (AE PCOS) criteria also consider hyperandrogenism and ovarian dysfunction for diagnosis. Anti Mullerian hormone (AMH) plays a role as an indicator in PCOS reflecting the maturation and development of ovarian follicles. Elevated levels of AMH can hinder development contributing to the dysfunction commonly seen in PCOS cases. 

Non-Drug Treatment Approaches 

For women with PCOS lifestyle modifications are fundamental in managing the condition alongside medication. Engaging in activity is vital as it improves insulin sensitivity and overall metabolic health. Including both aerobic exercise and resistance training in routines has been shown to enhance insulin sensitivity and regulate androgen levels. Following glycemic index (LGI) diets that’re high in fiber and plant-based fats can provide metabolic benefits by helping to regulate glucose levels and hormones that control appetite. 

It’s important to steer diets that’re high in calories, sugar and saturated fats to help reduce inflammation and insulin resistance linked to PCOS (Singh et al., 2023). 

Pharmacological Management 

Oral contraceptives (OCPs), including both progesterone-only pills and combined estrogen-progesterone pills, serve as first-line therapy for menstrual irregularities and ovulation suppression (Bulsara et al., 2021). Antiandrogens such as spironolactone, flutamide, and cyproterone acetate are preferred for managing hirsutism. Insulin sensitizers like metformin improve insulin resistance and restore menstrual regularity, while thiazolidinediones (TZDs) offer additional benefits in improving ovulation and reducing androgen levels (Bulsara et al., 2021). 

Education

Patient education on lifestyle modifications, contraception, and long-term health risks is crucial. Encourage adherence to treatment and regular follow-ups. 

Follow-up 

Regular monitoring of menstrual cycles, androgen levels, and metabolic parameters is essential. Adjust management strategies based on patient response and goals.