Women’s Health Discussion: Polycystic Ovary Syndrome Essay

Women’s Health Discussion: Polycystic Ovary Syndrome Essay

Women’s Health Discussion Polycystic Ovary Syndrome Essay

 

Polycystic Ovary Syndrome (PCOS) is a syndrome of ovarian dysfunction characterized by abnormalities in the metabolism of estrogen and androgens and the control of the production of androgen hormone (Sirmans & Pate, 2014). In addition to ovarian dysfunction, PCOS presents with cardinal characteristics of hyperandrogenism and polycystic ovary morphology.

Pathophysiology: The exact pathophysiology of PCOS is unclear, but the condition is thought to be a result of abnormal function of the Hypothalamus-Pituitary-Ovarian axis (Escobar-Morreale, 2018). The pathophysiology of PCOS is linked to altered activity of the luteinizing hormone, insulin resistance, and probable predisposition to hyperandrogenism (Williams, Mortada & Porter, 2016). Insulin resistance worsens hyperandrogenism as it suppresses the synthesis of sex hormone-binding globulin and increases the adrenal and ovarian synthesis of androgens hence increasing androgen levels (Williams, Mortada & Porter, 2016). The androgens cause irregular menstruation and the physical features of hyperandrogenism.

Epidemiology: PCOS has a prevalence of 4-12% in the US, and about 10% of these women are diagnosed with the condition during gynecologic check-up visits (Williams, Mortada & Porter, 2016). PCOS occurs in premenopausal women, and the onset is mostly during the perimenarchal period that is around 16 years (Sirmans & Pate, 2014). Significant ethnic variability is observed in hirsutism. For instance, Asian women have a lesser degree of hirsutism than Caucasian women despite having the same serum androgen levels.

Risk Factors: The risk factors for PCOS include obesity with obese people having a higher incidence of PCOS than individuals with a normal BMI. Besides, female children born with a high birth weight by mothers with obesity and PCOS are at risk of developing PCOS in adolescence (Williams, Mortada & Porter, 2016). A family history of PCOS is also a risk factor since the X-linked dominant mode of inheritance is involved. Individuals with a history of smoking, sedentary lifestyle, and exogenous hormone administration are also at risk of developing PCOS(Sirmans & Pate, 2014). Other factors include a family history of hypertension and diabetes, engaging in heavy exercises and a history of tuberculosis, and thyroid disease.

Clinical Assessment

The typical clinical assessment findings in PCOS include menstrual dysfunction, anovulation, hyperandrogenism, and hirsutism. Menstrual dysfunction manifests as abnormal menstruation patterns associated with chronic anovulation (Pfieffer, 2019). A patient often has a history of menstrual disturbance since menarche. Some patients present with oligomenorrhea or secondary amenorrhea. The anovulatory menstrual cycles can result in dysfunctional uterine bleeding or infertility (Matheson & Bain, 2019).

Hyperandrogenism is characterized by excess terminal body hair that has a male distribution pattern. Hair commonly grows on the chin, upper lip, around the nipples, and the linea alba of the lower abdomen (Williams, Mortada & Porter, 2016). It also manifests with acne and hair loss in a male pattern known as androgenic alopecia. Hyperthecosis, which is an extreme form of PCOS, presents with symptoms of hyperandrogenism, such as increased muscle mass, voice deepening, and clitoromegaly (Matheson & Bain, 2019). Hirsutism manifests with excessive body hair in a male distribution pattern and acne, which occur as a result of hyperandrogenism.

Differential Diagnoses

Iatrogenic Cushing Syndrome: Cushing syndrome represents signs and symptoms that arise as a result of excess free plasma glucocorticoids. The excess glucocorticoids are usually from increased endogenous production or due to prolonged exposure to exogenous administration of glucocorticoid products (Zil-E-Ali, Janjua, Latif & Aadil, 2018). Women with Cushing syndrome experience menstrual irregularities such as amenorrhea and oligomenorrhea and infertility (Zil-E-Ali et al., 2018). Besides, patients with the Cushing are typically obese with an increased adipose tissue in the upper back at the base of the neck, I the face, and above the clavicles.

Idiopathic Hirsutism: Hirsutism is an endocrine disorder and is defined as excessive hairiness (Matheson & Bain, 2019). It presents with excess growth of terminal hair in a male pattern in women. The hairiness symptoms occur due to abnormal androgen action. Idiopathic hirsutism usually begins at puberty and has a slow progression over many years (Matheson & Bain, 2019). PCOS should be differentiated from Idiopathic Hirsutism when there are no features of menstrual dysfunction, anovulation, infertility, and obesity.

Hyperprolactinemia: Hyperprolactinemia is a condition characterized by elevated levels of serum prolactin (Glezer & Bronstein, 2018). The primary function of Prolactin is to stimulate breast development during pregnancy and induce lactation. Patients with hyperprolactinemia present with a history of menstrual dysfunction such as amenorrhea and oligomenorrhea and infertility (Glezer & Bronstein, 2018). The symptoms occur due to the suppression of gonadotropin-releasing hormone by prolactin.

Diagnostic Studies and Laboratory Tests

Imaging studies and biochemical tests are conducted to rule out other possible conditions that result in hyperandrogenism and menstrual irregularity and to ascertain the diagnosis of PCOS.

Diagnostic studies: Imaging studies used in the diagnosis of PCOS include ovarian ultrasonography using a transvaginal approach,

which aids in the assessment of ovarian morphology. A polycystic ovary is diagnosed when an ovary with 12 or more follicles having a diameter of 2-9 mm is visualized with ultrasound or an ovary with a volume higher than 10 ml on ultrasonography (Williams, Mortada & Porter, 2016). Pelvic CT scan or MRI to help in the visualization of the adrenal glands and the ovaries if a tumor suspected. MRI is an effective method of visualizing the ovaries in very obese patients in whom the ovaries may not be visualized through transvaginal ultrasonography.

Laboratory tests: The recommended baseline laboratory tests for patients suspected of having PCOS include, serum prolactin levels, Thyroid function tests, and free androgen index (Williams, Mortada & Porter, 2016).

A free androgen index or Total and free testosterone levels should be measured to evaluate for androgen excess. A high free testosterone level is a sensitive marker of androgen excess.

Free cortisol levels and creatinine levels in the urine should be done using a 24-hour urine sample to rule out the possibility of Cushing syndrome.

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The goals of treatment for patients with PCOS include managing infertility, regulating menses to protect the endometrium, and to control hyperandrogenic symptoms such as hirsutism and acne.

Non-pharmacological Approaches: Lifestyle modification such as diet and exercise is considered the first-line treatment for adolescents and women with PCOS. Lifestyle interventions aim to promote weight loss and include increasing physical activity along with a diet modification to lower the risk of diabetes (Sirmans & Pate, 2014). Besides, weight reduction helps to reduce insulin resistance and can improve ovulation.

Non-pharmacological management of hirsutism includes shaving excess body hair and using chemical depilatories.

Pharmacological Treatment: Treatment should be patient-centered based on a woman’s presentation and desire for pregnancy.  Treatment options for the various PCOS presentations include:

Anovulation or Infertility: First-line drugs include Clomiphene or Letrozole to induce ovulation in women who desire pregnancy. For women who do not wish to get pregnant, the first-line treatment is Hormonal contraception, such as Levonorgestrel-releasing intrauterine contraceptive (Williams, Mortada & Porter, 2016). The second-line drug is Metformin.

Insulin resistance: the First-line drug is Metformin, which is a hypoglycemic agent that improves insulin resistance and lowers hyperinsulinemia in PCOS patients. Metformin also has a minimal but beneficial impact on metabolic syndrome and causes a modest decrease in androgen levels (Williams, Mortada & Porter, 2016). Besides, it promotes weight loss, but patients with a BMI greater than 37 may not have a good prognosis with Metformin.

Hirsutism: Electrolysis and light-based therapies are useful for mild cases in cases where contraception is desired. Eflornithine can be used as an adjunct to laser therapy since it slows hair growth (Sirmans & Pate, 2014). In women who do not desire contraception, the first-line treatment is Hormonal contraception with or without antiandrogen therapy. Second-line therapy entails Spironolactone monotherapy after six months of oral contraceptives if the desired outcome is not achieved (Williams, Mortada & Porter, 2016). Other second-line treatments include electrolysis, and Eflornithine while the third-line agent is Metformin.

Acne: Treatment of acne entails the use of topical creams such as benzoyl peroxide, antibiotic creams tretinoin, and differin (Williams, Mortada & Porter, 2016). Hormonal contraception is often prescribed in patients who do not desire pregnancy.

Education

Health education to a patient diagnosed with PCOS should be directed at helping the patient modify her lifestyle to promote weight loss, which reduces insulin resistance and improve ovulation and fertility. Besides, weight loss suppresses androgen production in obese women; hence it is an effective approach to slow hair growth (Pfieffer, 2019). A calorie-restricted diet should be recommended for all patients with PCOS who are overweight and those having glucose intolerance to lower their risk of developing diabetes. Patients should be recommended a diet patterned for type 2 diabetes, which consists of increased fiber, omega-3ncl and omega-9 fatty acids intake, and a decreased intake of trans fats, refined carbohydrates, and saturated fats (Sirmans & Pate, 2014). Women with a high lipid profile should be recommended to take a diet low in saturated fats and cholesterol and increase physical activity to manage dyslipidemia.

Furthermore, patients should be discouraged from cigarette smoking as it increases their risk of diabetes and cardiovascular diseases. Patients with hirsutism should be advised against plucking or waxing unwanted body hair as it may result in ingrown hairs and folliculitis and be recommended to shave instead (Williams, Mortada & Porter, 2016). Families should be educated on the disease process, who is at risk, and how it is managed to empower them and relieve anxiety (Pfieffer, 2019). Lastly, patients should be encouraged to participate in peer support groups to help in alleviating stress and to improve self-management skills.

Optimal Outcomes

The optimal outcomes with the recommended treatment will include the induction of ovulation and the achievement of a regular menstrual cycle. Besides, excessive hair growth should slow down, and acne should resolve. With lifestyle modification, a patient will be expected to lose weight and have reduced insulin resistance; hence hyperinsulinemia will resolve.

Follow-up care: PCOS is associated with many long-term complications, and patients require regular follow-up with their healthcare provider to enable early detection and treatment of any complication (Williams, Mortada & Porter, 2016). Besides, pregnant women with a history of PCOS need constant follow-up during delivery as they ate at an increased risk of preeclampsia, gestational diabetes, preterm, and post-term delivery.

Open-Ended Questions

1. What are the common comorbidities associated with PCOS?

PCOS is associated with hyperinsulinemia and insulin resistance which result in Type 2 Diabetes mellitus. Patients with PCOS have a four-fold risk of developing type 2 diabetes (Williams, Mortada & Porter, 2016). PCOS has also been associated with multiple metabolic defects such as metabolic syndrome which contribute to obesity in half of the women (Williams, Mortada & Porter, 2016). Other comorbidities associated with PCOS include non-alcoholic fatty liver, dyslipidemia, sleep apnea, mood disorders, and cardiovascular diseases (Williams, Mortada & Porter, 2016).

2. What are the essential diagnostic tests for PCOS patients during their follow-up visits?

Based on the comorbidities associated with PCOS, it is recommended that PCOS patients have their blood pressure monitored at every follow-up visit (Williams, Mortada & Porter, 2016). The Lipid profile should be done every three months, and a two-hour oral glucose test despite the patient’s body mass index (Williams, Mortada & Porter, 2016). Depression screening is also recommended due to mood disorders.

3. A 17-year old girl comes to the consultation office with features of hirsutism. She reports that her classmates are making fun of her due to excessive hair growth, and this has affected her self-esteem. How would you manage and educate this patient?

I would manage this patient with Hormonal therapy using Ethinyl estradiol. Ethinyl estradiol is an oral contraceptive that lowers the secretion of luteinizing and follicle-stimulating hormone from the pituitary gland, decreasing the amount of circulating gonadotropin-releasing hormone. It also reduces the levels of free testosterone and androgen production. I would then educate the patient that the excessive hair growth is a result of high androgen levels due to increased production of androgen, which is a male hormone, by the adrenal glands and the ovary (Matheson & Bain, 2019). Using oral contraceptives would help to lower the level of androgen and slows the growth of excess hair (Matheson & Bain, 2019). I will also recommend her to shave but not to pluck or wax the hairs. Besides, I will educate her on taking a healthy diet and engaging in physical activity to promote weight loss which also helps slow hair growth. I will advise her if there is no improvement despite using the oral contraceptives she should come for follow-up.

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Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource