Mary Julie is a 35-year-old woman from North Carolina who presents at the clinic with symptoms that relate to the polycystic ovarian syndrome. Mary has been married for five years but does not have any children, although she states that she has been trying to get pregnant for a while. She is the second-born daughter of Mr. and Mrs. Oliver Martin. Earlier this year, Mary’s elder sister was diagnosed with PCOS, while her mother was diagnosed with the same at the age of 38, and she is afraid that their reproduction system problems could be genetic.
Description of the Polycystic Ovarian Syndrome (PCOS)
Symptoms
Mary presents with several symptoms that are indicative of the polycystic ovarian syndrome. Mary reports that for the last four months, she has been receiving very light periods, and she observed a rare occurrence the previous month when she missed her period. At first, she admits that she thought that she was pregnant, only for the pregnancy test to turn negative. She reports having added 15kgs over the last two months, which she considers strange because she has not changed her lifestyle or eating habits. Notably, she has gained weight around the belly. Moreover, Mary states that she has noted the growth of excess body hair at the back, stomach, and chest. She has also developed skin tags on the armpits and dark skin patches under the breasts, armpits, and around the neck.
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These symptoms are indicative of PCOS, whereby according to Kabel (2016), the significant signs of the condition include an oily skin or acne, presence of many cysts or large ovaries, weight gain, particularly around the belly, extra body hair, infertility, thinning of hair or male pattern baldness, skin tags, and the presence of dark skin patches in such areas as under the breast, the armpits, and the neck. Further investigations of the patient’s condition indicate that she has high blood pressure, fasting glucose levels, low high-density lipoprotein (HDL), the good cholesterol, and high levels of triglycerides (LDL).
Etiology and Body Systems Affected
Mary's PCOS seems to be a genetic condition, mainly because her mother and her sister have previously suffered from the disease. According to Sirmans and Pate (2014), PCOS can be inherited, indicating that a previous study illustrated that approximately 32% of women with the condition had a sister with PCOS, while 24% of women with PCOS had a mother with the condition. Kabel (2016) notes that individuals in families where women have a history of PCOS are also at a high risk of similar metabolic abnormalities. Although PCOS does not have a single gene, the broad range of symptoms associated with PCOS can be attributed to the fact that a wide variety of mechanisms and genes influence PCOS. Particularly, Kabel (2016) highlights that many genetic studies focusing on PCOS indicate that genes that affect insulin resistance and hormone levels extensively influence the development of PCOS.
As illustrated by Mary, who reports an abnormal weight gain around the belly, most women are suffering from PCOS experience excessive weight gain. As a result, they become overweight or obese, conditions that lead to insulin resistance. However, although insulin resistance is mainly observed in obese individuals, lean women with PCOS also portray insulin resistance. The problem of insulin resistance affects critical other body systems, including hormones, whereby it contributes to high testosterone levels. Moreover, insulin resistance may indicate a risk for diabetes or the presence or pre-diabetes. Escobar-Morreale (2018) further postulates that insulin resistance suggests that the body's capacity to send adequate glucose to the cell is reduced. As a result, the pancreas responds by producing more insulin to maintain even glucose levels. However, excessive insulin presents several adverse effects, including increasing the levels of androgens, the male hormones, which include testosterone, and shutting down the ovaries.
The high levels of androgens in women with PCOS bring about such risks as halting or interfering with the normal ovulation process, therefore causing infertility, irregular periods, and the formation of the ovarian cysts ( Escobar-Morreale, 2018) . Additionally, women with PCOS and with excessive androgens often suffer from acne and excessive growth of hair, a condition known as hirsutism, on such areas as the legs, arms, chest, neck, and the face. Further, insulin resistance creates other changes, including darkened areas and skin tags, as well as undesirable weight gain.
Diagnostic/Detection Technologies
There is no definitive test that has been recommended for the detection or diagnosis of PCOS. However, doctors begin the diagnosis process by discussing with the patient regarding their medical history, incorporating such elements as weight changes and menstrual periods. Further, the doctor conducts a physical examination to check such features as acne, insulin resistance, and signs of excessive hair growth. After conducting a physical exam, the doctor may recommend an ultrasound to check the appearance of the ovaries as well as the thickness of the uterus lining. A blood test is also often conducted to measure the patient’s hormone levels, triglyceride levels, fasting cholesterol levels, and glucose tolerance levels ( Sirmans & Pate, 2014) . Finally, a pelvic examination, which involves the doctor manually and visually inspecting the patient’s reproductive system for growths, masses, and other abnormalities. If the doctor arrives at a PCOS diagnosis, he or she may recommend additional tests to determine complications. The tests may include periodic checks of triglyceride, cholesterol, glucose tolerance, and blood pressure levels; screening for anxiety and depression; and screening for obstructive sleep apnea.
Treatment/Therapies
The treatment of PCOS mainly focuses on the management of the client's concerns. For Mary, the fundamental interests include hirsutism, infertility, and excessive weight gain. In this context, the doctor would recommend lifestyle changes, including adopting a low-calorie diet in combination with moderate physical exercises to facilitate weight loss. Losing weight is particularly vital in enhancing the effectiveness of the medications administered by the doctor to address other issues as well as infertility ( Barry, Azizia & Hardiman, 2014) . Regulating Mary’s menstrual cycle would require administration of medications, including a combination of birth control pills that contain progestin and estrogen. These pills work by lowering the production of androgens and regulating estrogen, therefore correcting abnormal bleeding patterns, acne, and abnormal hair growth, as well as reducing the risk of endometrial cancer. In place of pills, the doctor may recommend a vaginal ring or skin patch that comprises of a combination of progestin and estrogen. In addition to the birth control therapy, doctors recommend progestin therapy that aims at regulating periods by taking progestin for a period of 10 to 14 days. To help facilitate ovulation, the doctor may recommend a broad range of medications, including clomiphene, letrozole, which stimulates ovaries, metformin, which lowers insulin levels and improves insulin resistance, and gonadotropin.
Prognosis
Mary will achieve a high quality of life if she follows the doctor’s advice on lifestyle changes and adheres to the provided medication. Given that the problem has been recognized early, hence it is possible to eliminate potential complications that Mary would have otherwise suffered. Women with PCOS demonstrate an increased risk of developing a wide range of serious complications, whereby some may be life-threatening. Some of the difficulties associated with PCOS include pre-diabetes and diabetes, cardiovascular disease, endometrial cancer, hypertension, heart attack, low levels of (HDL) and high levels of LDL ( Barry, Azizia & Hardiman, 2014) .
Reflection
Learning about PCOS has given me key insights into one of the most prevalent causes of infertility in women. Mainly, I have learned that it is essential to educate patients on the need to go for a check-up, especially women with close family members who have suffered from PCOS. Moreover, the case study has informed me of the need to conduct further research on new viable diagnosis techniques since presently; there is no positive approach that medical professionals use in the diagnosis of PCOS.
References
Barry, J. A., Azizia, M. M., & Hardiman, P. J. (2014). Risk of endometrial, ovarian, and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Human reproduction update , 20 (5), 748-758.
Escobar-Morreale, H. F. (2018). Polycystic ovary syndrome: definition, etiology, diagnosis, and treatment. Nature Reviews Endocrinology , 14 (5), 270.
Kabel, A. M. (2016). Polycystic ovarian syndrome: insights into pathogenesis, diagnosis, prognosis, pharmacological, and non-pharmacological treatment. J Pharma Reports , 1 (103), 2.
Sirmans, S. M., & Pate, K. A. (2014). Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical epidemiology , 6 , 1.
