OVERVIEW

Introduction:

Polycystic ovary syndrome (PCOS) is a health problem that affects 1 in 10 women of childbearing age. Women with PCOS have a hormonal imbalance and metabolism problems that may affect their overall health and appearance. PCOS is also a common and treatable cause of infertility.

Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be.

How PCOS affects your body

Having higher-than-normal androgen levels can affect your fertility and other aspects of your health.

Infertility

To get pregnant, you have to ovulate. Women who don’t ovulate regularly don’t release as many eggs to be fertilized. PCOS is one of the leading causes of infertility in women (12).

Metabolic syndrome

Up to 80 percent of women with PCOS are overweight or obese (13Trusted Source). Both obesity and PCOS increase your risk for high blood sugar, high blood pressure, low HDL (“good”) cholesterol, and high LDL (“bad”) cholesterol.

Together, these factors are called metabolic syndrome, and they increase the risk for heart disease, diabetes, and stroke.

 

Sleep apnea

This condition causes repeated pauses in breathing during the night, which interrupt sleep.

Sleep apnea is more common in women who are overweight — especially if they also have PCOS. The risk for sleep apnea is 5 to 10 times higher in obese women with PCOS than in those without PCOS (14).

Endometrial cancer

During ovulation, the uterine lining sheds. If you don’t ovulate every month, the lining can build up.

A thickened uterine lining can increase your risk for endometrial cancer (15).

Depression

Both hormonal changes and symptoms like unwanted hair growth can negatively affect your emotions. Many with PCOS end up experiencing depression and anxiety

The 3 main causes of PCOS are:

• Irregular period– which means your ovaries do not regularly release eggs (ovulation)
• excess androgen – high levels of “male” hormones in your body, which may cause physical signs such as excess facial or body hair
• polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs (but despite the name, you do not actually have cysts if you have PCOS)

If you have at least 2 of these features, you may be diagnosed with PCOS.

Few of the common of the symptoms of PCOS include:

They can include:

1. irregular periods or no periods at all
2. difficulty getting pregnant as a result of irregular ovulation or failure to ovulate
3. excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks
4. weight gain
5. thinning hair and hair loss from the head
6. oily skin or acne

 Causes of polycystic ovary syndrome (PCOS)?

The exact cause of PCOS is unknown, but it often runs in families.

It’s related to abnormal hormone levels in the body, including high levels of insulin.

Insulin is a hormone that controls sugar levels in the body.Many women with PCOS are resistant to the action of insulin in their body and produce higher levels of insulin to overcome this.This contributes to the increased production and activity of hormones like testosterone.Being overweight or obese also increases the amount of insulin your body produces.

Diagnosis criteria

A diagnosis of PCOS can usually be made if other rare causes of the same symptoms have been ruled out and you meet at least 2 of the following 3 criteria:

you have irregular periods or infrequent periods – this indicates that your ovaries do not regularly release eggs (ovulate) 

blood tests showing you have high levels of “male hormones”, such as testosterone (or sometimes just the signs of excess male hormones, even if the blood test is normal)

scans showing you have polycystic ovaries

As only 2 of these need to be present to diagnose PCOS, you will not necessarily need to have an ultrasound scan before the condition can be confirmed.

Managing PCOS

Polycystic ovary syndrome (PCOS) cannot be cured, but the symptoms can be managed.

Treatment options can vary because someone with PCOS may experience a range of symptoms, or just 1.

The main treatment options are discussed in more detail below.

Lifestyle changes

In overweight women, the symptoms and overall risk of developing long-term health problems from PCOS can be greatly improved by losing excess weight.

Weight loss of just 5% can lead to a significant improvement in PCOS.

You can find out whether you’re a healthy weight by calculating your body mass index (BMI), which is a measurement of your weight in relation to your height.

A normal BMI is between 18.5 and 24.9. Use the BMI healthy weight calculator to work out whether your BMI is in the healthy range.

You can lose weight by exercising regularly and eating a healthy, balanced diet.

Your diet should include plenty of fruit and vegetables, (at least 5 portions a day), whole foods (such as wholemeal bread, wholegrain cereals and brown rice), lean meats, fish and chicken.

Your GP may be able to refer you to a dietitian if you need specific dietary advice.

Read more about losing weight, healthy eating and exercise.

Medications

A number of medications are available to treat different symptoms associated with PCOS.

These are described below.

Irregular or absent periods

The contraceptive pills may be recommended to induce regular periods, or periods may be induced using an intermittent course of progestogen tablets

Fertility problems

With treatment, most women with PCOS are able to get pregnant.

The majority of women can be successfully treated with a short course of tablets taken at the beginning of each cycle for several cycles.

If these are not successful, you may be offered injections or IVF treatment. There’s an increased risk of a multiple pregnancy (rarely more than twins) with these treatments.

Unwanted hair growth and hair loss

Medications to control excessive hair growth (hirsutism) and hair loss (alopecia).

These medications work by blocking the effects of “male hormones”, such as testosterone, and some also suppress production of these hormones by the ovaries.

Surgery

A minor surgical procedure called laparoscopic ovarian drilling (LOD) may be a treatment option for fertility problems associated with PCOS that do not respond to medication.

Pregnancy risks

If you have PCOS, you have a higher risk of pregnancy complications, such as high blood pressure (hypertension), pre-eclampsia, gestational diabetes and miscarriage.

These risks are particularly high if you’re obese. If you’re overweight or obese, you can lower your risk by losing weight before trying for a baby.

Take away:

PCOS can disrupt a woman’s menstrual cycles and make it harder to get pregnant. High levels of male hormones also lead to unwanted symptoms like hair growth on the face and body.

Lifestyle interventions are the first treatments doctors recommend for PCOS, and they often work well. Weight loss can treat PCOS symptoms and improve the odds of getting pregnant. Diet and aerobic exercise are two effective ways to lose weight.

Medicines are an option if lifestyle changes don’t work. Birth control pills and metformin can both restore more normal menstrual cycles and relieve PCOS symptoms.

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Suggested Reading: ovarian cancer | cervical cancer

 

 

Why is it so deadly, and what can you do about it? 

About the ovaries

The ovaries are part of a woman’s reproductive system. There are 2 ovaries, with 1 located on each side of the uterus. In premenopausal women, they are almond-shaped and about 1.5 inches long. These glands contain germ cells, also called eggs. Ovaries are the primary source of estrogen and progesterone. These hormones influence breast growth, body shape, body hair, and regulate the menstrual cycle and pregnancy. During and after menopause, the ovaries stop releasing eggs and producing certain hormones.

Ovarian cancer happens when cells that are not normal grown in one or both of your ovaries, two small glands located on either side of your uterus.

Doctors are unsure of what exactly causes ovarian cancer, but they have identified several risk factors associated with a higher likelihood of developing the disease. These are:

Age:

Women of all ages have a risk of these cancers, but women over 50 are more likely to develop these cancers. About half of the women diagnosed with ovarian cancer are 63 years or older.

Obesity.

 If your Body Mass Index (BMI) is 30 or higher, your risk goes up.

Hormone replacement therapy. Some studies suggest using estrogen after menopause increases your risk.

Smoking:

Increased risk of serous ovarian tumors associated with smoking

Poly-cystic ovary syndrome, a problem with your endocrine system that leads to enlarged ovaries

Family history:

A strong family history of breast or ovarian/fallopian tube cancer puts women at higher risk for ovarian/fallopian tube cancer. Doctors believe this is because many of these families have genetic mutations (changes in the gene) that are passed from generation to generation

Weight:

Recent studies show that women who were obese in early adulthood may have an increased risk to develop ovarian/fallopian tube cancer.

Genetics:

About 10% to 15% of ovarian/fallopian tube cancers occur because a genetic mutation, or change, has been passed down within a family. This inherited risk is called a germline mutation.

There are several other genetic conditions that cause ovarian/fallopian tube cancer. Some of the most common include:

Lynch syndrome. 

Lynch syndrome, also known as hereditary non-polyposis colorectal cancer, increases a woman’s risk of ovarian/fallopian tube cancer and uterine cancer. It is caused by mutations in several different genes. Lynch syndrome also increases the risk of colorectal cancer and several other cancers.

Peutz-Jeghers syndrome (PJS). 

PJS is caused by a specific genetic mutation. The syndrome is associated with multiple polyps in the digestive tract that become noncancerous tumors and with increased pigmentation (dark spots on the skin) on the face and hands. PJS raises the risk of ovarian/fallopian tube cancer, breast cancer, colorectal cancer, cervical cancer, and several other types of cancer.

Nevoid basal cell carcinoma syndrome (NBCCS). 

Women with NBCCS, also called Gorlin syndrome, have an increased risk of developing fibromas. Fibromas are benign fibrous tumors of the ovaries. There is a small risk that these fibromas could develop into a type of ovarian cancer called fibrosarcoma.

It’s possible for women with ovarian  cancer to not show any symptoms. It’s also important to note that symptoms are not specific and may be caused by a different medical condition that is not cancer.

Symptoms:

• Abdominal bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Urinary symptoms, such as urgency or frequency
• Fatigue
• Upset stomach
• Indigestion
• Back pain
• Pain with intercourse
• Constipation
• Menstrual irregularities
• Swelling in the pelvis or abdomen
• Vaginal discharge, which may be clear, white, or tinged with blood

For many women, these symptoms occur often and are different from what is normal for their bodies. Women who have any of the symptoms listed above everyday for more than a few weeks should see their primary care doctor or a gynecologist.

Diagnoses:

 Abdominal-pelvic examination:

Usually, the first exam is the abdominal-pelvic examination. The doctor feels the uterus, vagina, ovaries, bladder, and rectum to check for any unusual changes, such as a mass. Some cancers are very small before they spread and cannot be reliably felt and detected by pelvic examination.

Imaging Tests:

A physical exam cannot only reveal so much. Your doctor may want to use imaging tests to get a clearer picture of your ovaries.

One such test in a transvaginal ultrasound. During the procedure, the doctor inserts a probe (also called a transducer) into your vagina. The probe bounces soundwaves off the structures of your body, and those waves make echoes, which in turn form a picture on a computer screen.

Another imaging test is a CT scan, which stands for “computed tomography.” In a CT scan, an X-ray beam rotates around your body and takes images from various angles. A computer puts together all that information to produce a detailed look at that section of your body.

Blood Tests

There is no single blood test that shows whether you have ovarian cancer.

The main one that you may get is called the CA-125 test. It looks for a protein linked to ovarian cancer cells. But it’s not enough to make a diagnosis.

Some rarer types of ovarian cancer raise levels of other substances in the blood. Your doctor may order tests to look for higher levels of one or all of these:

Human chorionic gonadotropin (HCG)

Alpha-fetoprotein (AFP)

Lactate dehydrogenase (LDH)

Another type of ovarian tumor can raise the amount of estrogen and testosterone in your blood, and also a substance called inhibin. You may have a blood test to check these levels.

Biopsy

The only way to know for sure whether you have ovarian cancer is with a biopsy. It’s usually done by a doctor called a gynecologic oncologist. It usually involves surgery to take out the area where cancer is suspected, after which it is sent to a lab for testing. A specialist called a pathologist will look at the tissue under a microscope and test it to find out if it’s cancer.

After diagnostic tests are done, your doctor will review all of the results with you. As noted above, surgery and an examination of the lymph nodes may be needed before results are complete. If the diagnosis is cancer, these test results help the doctor describe the type & stage of cancer.

Types of Ovarian Cancer

There are three main types of ovarian cancer – each is distinguishable by the type of cell where cancer begins. These types include:

• Epithelial tumors. About 90% of ovarian cancers fall into this category. This type of cancer begins in the thin layer of tissue that covers the outside of the ovaries.
• Stromal tumors. About 7% of ovarian cancers fall into this category. This type of cancer begins in the ovarian tissue that contains cells that produce hormones.
• Germ cell tumors. This is the rarest form of ovarian cancer, and it tends to occur in younger women. This form of ovarian cancer begins in the egg-producing cells.

Stages for Ovarian Cancer

The stage provides a common way of describing the cancer, enabling doctors to work together to plan the best treatments. Doctors assign the stage of cancer using the FIGO system.

Stage I: The cancer is only in the ovaries or fallopian tubes.

Stage II: The cancer involves 1 or both of the ovaries or fallopian tubes and has spread below the pelvis, or it is peritoneal cancer.

Stage III: The cancer involves 1 or both of the ovaries or fallopian tubes, or it is peritoneal cancer. It has spread to the peritoneum outside the pelvis and/or to lymph nodes in the retroperitoneum (lymph nodes along the major blood vessels, such as the aorta) behind the abdomen.

Stage IV: The cancer has spread to organs outside of the abdominal area.

Ovarian Cancer Treatment Options

Treatment for ovarian cancer typically involves some combination of medications and surgery.

Ovarian Cancer Surgery

Surgical options for ovarian cancer will depend on the stage of your cancer. The options include:

Removing one ovary

Removing both ovaries

Removing both ovaries and the uterus

Surgery with chemotherapy for advanced cancers

In cases where just one or both of the ovaries are removed, women may still be able to have children.

Prevention

Although there is no proven way to prevent these diseases completely, you may be able to lower your risk. 

Certain factors may reduce a woman’s risk of developing ovarian/fallopian tube cancer:

Taking birth control pills:

Women who took oral contraceptives for 3 or more years are 30% to 50% less likely to develop ovarian/fallopian tube cancer. The decrease in risk may last for 30 years after a woman stops taking the pills.

Breastfeeding:

The longer a woman breastfeeds, the lower her risk of developing ovarian/fallopian tube cancer.

Pregnancy:

 The more full-term pregnancies a woman has had, the lower her risk of ovarian/fallopian tube cancer.

Surgical procedures.:

Women who have had a hysterectomy or a tubal ligation may have a lower risk of developing ovarian/fallopian tube cancer.

Surviving Cancer

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

• Understanding the challenge you are facing
• Thinking through solutions
• Asking for and allowing the support of others
• Feeling comfortable with the course of action you choose.

For many people, survivorship serves as a strong motivator to make lifestyle changes.

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Most  women are at risk for Gynecological cancers, and risk increases with AGE.

Any cancer that starts in a woman’s reproductive organ is term to be Gynecology cancer.

There are five main types of cancer affect a woman’s reproductive organs are 

Cervical

Ovarian

Uterine

Vaginal 

Vulvar

 As a group, they are referred to as gynecologic cancer. 

A sixth type of gynecologic cancer is the very rare fallopian tube cancer.

The five gynecologic cancers begin in different places within a woman’s pelvis, which is the area below the stomach and in between the hip bones. Each gynecologic cancer is unique, with different signs and symptoms, different risk factors and different prevention strategies. When gynecologic cancers are found early, treatment is most effective. 

lets know what Cervical Cancer actually is

Cervical cancer:

Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix.

Signs and symptoms of cervical cancer include 

pelvic pain.

Vaginal bleeding (including bleeding after sexual intercourse).

Unusual vaginal discharge

Pain during sexual intercourse.etc

Tests that examine the cervix are used to detect (find) and diagnose cervical cancer.

The following procedures may be used:

 

Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease.

 A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.

Biopsy: If abnormal cells are found in a Pap test, the doctor may do a biopsy. A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer. A biopsy that removes only a small amount of tissue is usually done in the doctor’s office.

The prognosis (chance of recovery) depends on the following:

The stage of the cancer (the size of the tumor and whether it affects part of the cervix or the whole cervix, or has spread to the lymph nodes or other places in the body).

1.The type of cervical cancer.

2.The patient’s age and general health.

3.Whether the patient has a certain type of human papillomavirus (HPV).

4.Whether the patient has human immunodeficiency virus (HIV).

5.Whether the cancer has just been diagnosed or has recurred.

There are three ways that cancer spreads in the body.

Tissue. 

The cancer spreads from where it began by growing into nearby areas.

Lymph system. 

The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.

Blood.

 The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

After cervical cancer has been diagnosed, tests are done to find out if cancer cells have spread within the cervix or to other parts of the body.

The process used to find out if cancer has spread within the cervix or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

 

The following stages are used for cervical cancer:

Stage I

In stage I, cancer has formed and is found in the cervix only.

Stage II

In stage II, cancer has spread to the upper two-thirds of the vagina or to the tissue around the uterus.

Stage III

In stage III, cancer has spread to the lower third of the vagina and/or to the pelvic wall, and/or has caused kidney problems, and/or involves lymph nodes.

Stage IV

In stage IV, cancer has spread beyond the pelvis, or has spread to the lining of the bladder or rectum, or has spread to other parts of the body.

 

The following tests and procedures may be used in the staging process:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine..

PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. 

Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas.

Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the lymph node tissue under a microscope to check for cancer cells.

There are different types of treatment for patients with cervical cancer.

• Surgery

Surgery – removing the cancer in an operation is sometimes used to treat cervical cancer.

• Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.

 There are two types of radiation therapy:

External radiation therapy

 uses a machine outside the body to send radiation toward the cancer. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue.

Internal radiation therapy 

uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy are used to treat cervical cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life.

• Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

• Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

• Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.

Cervical Cancer Prevention

The following protective factors decrease the risk of cervical cancer:

Getting an HPV vaccine

Vaccines that protect against HPV infection greatly reduce the risk of cervical cancer. These vaccines do not protect women who are already infected with HPV.

Harms of HPV vaccines include dizziness, feeling faint, headache, fever, and redness, tenderness, or warmth at the place of injection. Allergic reactions are rare. Getting the HPV vaccine while pregnant does not have a harmful effect on the pregnancy.

Avoiding sexual activity

Nearly all cases of cervical cancer are caused by HPV infection, which is spread through sexual activity. Women who are not sexually active have almost no risk of cervical cancer.

Using barrier protection during sexual activity

Some methods used to prevent sexually transmitted diseases (STDs) decrease the risk of HPV infection. The use of a barrier method of birth control, such as a condom or diaphragm, helps protect against HPV infection.

New ways to prevent cervical cancer are being studied in clinical trials.

Avoiding risk factors and increasing protective factors may help prevent cancer.

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