Testosterone is a common endocrinopathy defined by two criteria: ovarian cysts, oligo-anovulation, and hyperandrogenism in women. The latter may be true for some women with PCOS, even those without menstrual irregularities. Diagnosis includes ultrasound, urine test for luteinizing hormone and follicle-stimulating hormone levels (LH/FSH), and blood tests for testosterone levels. Testerone is a female hormone that underlies the development of reproductive as well as nonspecific estrogenic tissues and tissues that respond to estrogen, such as bone, blood vessels, and breast tissue. It can also be diagnosed from physical signs such as increased facial hair and irregular menses.
PCOS is a condition in which the ovaries produce more testosterone than normal. It often causes irregular cycles and infertility and makes it more likely to gain weight. The exact cause of PCOS is unknown, but certain things appear to make it more likely to develop. These include being overweight, having a family history of PCOS, and ethnicity (African American, Native American). Polycystic ovary syndrome (PCOS) is a condition that affects the reproductive system and is characterized by chronic anovulation, signs of hyperandrogenism, and polycystic ovaries on ultrasound (Anagnostis, Tarlatzis & Kauffman, 2018). It affects women of reproductive age and is most common in adolescents due to their high levels of androgens. PCOS can lead to anovulation, amenorrhea, and infertility. Polycystic ovary syndrome is a condition in which problems with the reproductive system affect many women. Typically, a woman with PCOS has irregular periods and acne. The hormone imbalance also increases their chance of developing diabetes. PCOS can be treated but sometimes is not curable. It often begins during puberty, so patients need to be aware of this condition early on when they grow and mature physically and mentally.
The patient may have polycystic ovary syndrome (PCOS). A differential diagnosis for secondary amenorrhea would include pregnancy and hypothalamic amenorrhea. The appropriate exam and lab tests to rule out these would be an ultrasound and serum prolactin levels, respectively. Treatment or management of PCOS for a patient not planning pregnancy involves changes in the way a person changes his way of living. When there is no improvement within six months of these changes, then add Metformin 500mg BID or a combination therapy with Metformin plus letrozole or flutamide or clomiphene citrate can be added to the regimen (Khan, M, Ullah, & Basit, 2019).
The patient presents with secondary amenorrhea, weight gain, and hirsutism. The patient is 22 years old and has a polycystic ovary syndrome (PCOS) history. Due to her current symptoms and risk factors, I would initially assess this patient with a gynecological exam to determine if there is any androgen hypervolemia with hair growth, evidence of virilization (increased muscle mass and acne), or the presence of increased B2-stimulating ovarian follicular size on transvaginal ultrasound. Treatment for PCOS in non-pregnant patients can be seen by optimizing insulin sensitivity through diet and exercise. Currently, Metformin helps increase endogenous insulin release and decrease peripheral insulin resistance but does not work for every patient due to variable response or intolerance. The gold standard for reducing testosterone levels requires anastrozole, which reduces ovarian production.
Polycystic ovary syndrome (PCOS) is a condition that causes abnormalities in a woman’s hormones and, as a result, impedes normal ovulation. Diagnosis is usually based on the presence of at least two of the following: 1) oligoovulation or anovulation (infrequent or absent menstruation), 2) hyperandrogenism (excessive levels of male sex hormones), 3) polycystic ovaries on ultrasound exam. Treatment options include lifestyle changes and medications to regulate hormone levels.
References
Anagnostis, P., Tarlatzis, B. C., & Kauffman, R. P. (2018). Polycystic ovarian syndrome (PCOS): Long-term metabolic consequences. Metabolism, 86, 33-43.
Khan, M. J., Ullah, A., & Basit, S. (2019). Genetic basis of polycystic ovary syndrome (PCOS): current perspectives. The application of clinical genetics, 12, 249.