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Polycystic Ovary Syndrome

Introduction to Sharon Munroe Case Study

Polycystic ovary syndrome (PCOS) is a condition of unclear etiology that affects 6 to 10 per cent of reproductive-age women. The PCOS has been shown to affect 12 -21 per cent of Australian women of reproductive age and is common in women who are overweight and are from indigenous backgrounds (Skalecki et al., 2020). PCOS has the potential for significant metabolic implications, which include obesity, hormonal changes, cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2). PCOS has been addressed in this essay as it has severe psychological wellness impact which impairs quality of life (Cooney & Dokras, 2017). Since elevated overweight magnifies the frequency, incidence, and magnitude of PCOS, and losing weight enhances metabolic, reproductive, and psychological characteristics, so the improvements in lifestyle should always be the first-line treatment for PCOS.

In the case study, a 26-year-old woman, Sharon Munroe has a PCOS history for the past six years. Patient reports include, menstrual cessation, and have also gained weight up to 20 kg in the last five years. She has elevated hirsutism, acne, and 2 prior miscarriages and infertility. Sharon is 172 cm tall and weighs 96 kilograms, which gives her a 32 BMI. For her age, her BMI and weight are far more than the optimum.

Pathophysiology of PCOS

PCOS is a syndrome that represents a self-perpetuating vicious cycle that includes neuroendocrine, metabolic, and ovarian dysfunctions. Over the years, various theories about the indirect physiological basis for PCOS have been suggested. PCOS describes the interactions between various proteins and genes that are affected by gene expression and environmental influences. The BMI and age play an important role in the likelihood of infertility and miscarriages in PCOS patients. So it is always recommended to have an early family initiation before the age of 30–35 years coupled with the maintenance of a BMI < 31 is ideal for increasing conceivability chances (Yang et al., 2018). PCOS is characterized by an increased secretion of the ovarian and/or adrenal androgen. Intrinsic uterine factors such as altered steroidogenesis and ovarian-external factors such as hyperinsulinemia result in excess production of ovarian androgen. The increase in the levels of the hormone androgens leads to the condition of hirsutism and acne in women (Bienenfeld et al., 2019). PCOS has also shown to increase the incidence of prediabetes and DM2, in such patients, the cardiovascular risk factors also increases, and the prevalence of CVD is greater. The PCOS women also experience an elevated incidence of other problems related to atherosclerosis which is all aggravated by obesity. Because CVD and DM2 are Australian women's leading cause of death, any rise in incidence would have major public health consequences (Stephens et al., 2020).

 In Western countries, obesity or extra weight is a significant cause of other ailments. In Australia, the overweight or obese population is 56 per cent of the total adult population (Chen et al., 2018). In the given case study the woman is overweight. Obesity is now in Australian women’s primary cause of chronic illness, with poor outcomes which include CVD and DM2. Obesity has a major effect on the reproductive health of women, raising the incidence and frequency of PCOS, complications of pregnancy, infertility, gestational diabetes, and miscarriages or complications of fetal pregnancy, with severe and rising financial consequences (Kataoka et al., 2019). Nonetheless, Australia's detrimental effect of obesity on fertility, compounded by childbearing delay, results in a major social, environmental, and economic burden.

The Diagnostic Assessment

PCOS diagnosis is now primarily based on the Rotterdam guidelines, which incorporate the original standards of the National Institutes of Health (NIH) and includes two of three main characteristics which are biochemical or clinical hyperandrogenism, oligo- or anovulation, and detection of polycystic ovaries with ultrasonography (Teede et al., 2018). PCOS phenotypes, however, as mentioned, differ enormously based on the stage of life, genetic background, ethnic background, and external conditions such as the way of living and weight. Interventional trials should exclude certain factors but include tests for thyroid activity and amounts of follicle-stimulating hormone (FSH) and prolactin. The levels of androgen are also calculated for diagnosis; however, the best approach remains highly contentious. Often vaginal ultrasound is required for diagnostic tests in which both anovulation and hyperandrogenism are not present. Ultrasonography can confirm for endometrial thickness and presence of polycystic ovaries. The limitation of the Vaginal ultrasound is that it will only be reserved for sexually active women (Panchal, 2019). The function of ultrasonography remains uncertain for teenagers, amongst which there is a very popular polycystic occurrence of ovaries which could lead to overdiagnosis.

Evaluation is also important to diagnose risks of PCOS, and to guide prevention and management. Including family background, ethnicity, body mass index ( BMI), smoking habits, waist size, glycaemic status, cholesterol levels, and lipid profiles, extensive cardiovascular risk monitoring is essential for evaluation and should be performed at a frequency guided by metabolic risk ( e.g age, body weight, family history, ethnic background) (Pfieffer, 2019). Optimal routine screening technique for DM2 and prediabetes are problematic in PCOS, but because behavioral modification and metformin enhance IR in PCOS, even in other at-risk groups, such interventions have been shown to significantly reduce diabetes advancement and the early assessment helps in prediabetes detection (Akgül et al., 2018).

Pharmacological Management

Information, safe lifestyle interventions, and medical treatments treating their signs provide treatment of women at risk for PCOS and others who have reported PCOS diagnosis. Intervention strategies may include metformin, a mixture of hormonal contraceptive tablets, spironolactone, and local hirsutism and acne remedies (Witchel et al., 2019). The therapy should focus on the psychological, metabolic, and reproductive features of the short and long term. It is essential to tackle psychological factors initially to maximize self-efficacy, durability of lifestyle changes, and readiness to change as well as enhance QoL. Besides, multidisciplinary lifestyle counseling aimed at helping weight control for those women are already overweight is known as first-line therapy. Short-term diets never induce a lasting weight loss, so changes in lifestyle are required. The concepts of health coaching can be applied to improve preparation for change and provide awareness and correct assessment of risk, which can help the patients in gaining motivation through awareness and tailoring the information applicable to the person (Escobar-Morreale, 2018). The management of the PCOS gives importance to identifying mood disorders and mental well-being. Interventions to the check on the hormones help in the care of hirsutism.

 Infertility remains a subject of considerable concern in PCOS so pharmacological interventions have to be taken in this regard. Optimal care for miscarriages and infertility is among the most contentious fields of PCOS management and involves induction of surgical and medical ovulation, nutritional therapy, consideration of bariatric surgery for weight reduction of preconception, and in-vitro fertilization (IVF) (Martin et al., 2018). The risk assessment of DM2 and CVD is included; however, therapies for these conditions are protected by certain relevant national evidence-based recommendations. There is already a high risk of metabolic complications among Aboriginal women, independent of PCOS; thus, in these women, PCOS will increase metabolic risk more. Certain considerations for women include the unclear role of ultrasonography in rural settings due to disparities in care and accessibility to ultrasound resources offered provision in rural areas; and socioeconomic influences and possible issues regarding social acceptance of bariatric surgery can exist (Legro, 2017).

Conclusion on Sharon Munroe Case Study

All-female in their puberty, adulthood, and PCOS are distinguished by their menstrual periods, anovulatory, and acne abnormalities. It is difficult to distinguish the triggering factors because of the complex intertwined pathophysiology. Because elevated overweight magnifies PCOS frequency, occurrence and severity, and weight reduction improves reproductive, metabolic, and psychological characteristics, lifestyle changes should often be the first-line PCOS care. Evaluation is also important to diagnose risks of PCOS, and to guide prevention and management. Comprehensive information about PCOS pathogenesis would help in the detection of girls with high risk for developing PCOS. The timely interventions and implementation of personalized treatment modalities will help improve adolescent monitoring of PCOS, avoid related comorbidities, and improve the quality of life.

References for Sharon Munroe Case Study

Akgül, S., Düzçeker, Y., Kanbur, N., & Derman, O. (2018). Do different diagnostic criteria impact polycystic ovary syndrome diagnosis for adolescents?. Journal of Pediatric and Adolescent Gynecology31(3), 258-262.

Bienenfeld, A., Azarchi, S., Sicco, K. L., Marchbein, S., Shapiro, J., & Nagler, A. R. (2019). Androgens in women: Androgen-mediated skin disease and patient evaluation. Journal of the American Academy of Dermatology80(6), 1497-1506.

Chen, C., Xu, X., & Yan, Y. (2018). Estimated global overweight and obesity burden in pregnant women based on panel data model. PLoS One13(8), e0202183.

Cooney, L. G., & Dokras, A. (2017). Depression and anxiety in polycystic ovary syndrome: Etiology and treatment. Current Psychiatry Reports19(11), 83.

Escobar-Morreale, H. F. (2018). Polycystic ovary syndrome: Definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology14(5), 270.

Kataoka, J., Larsson, I., Björkman, S., Eliasson, B., Schmidt, J., & Stener‐Victorin, E. (2019). Prevalence of polycystic ovary syndrome in women with severe obesity–Effects of a structured weight loss programme. Clinical Endocrinology91(6), 750-758.

Legro, R. S. (2017). Evaluation and treatment of polycystic ovary syndrome. In Endotext [Internet]. MDText. com, Inc..

Martin, K. A., Anderson, R. R., Chang, R. J., Ehrmann, D. A., Lobo, R. A., Murad, M. H., ... & Rosenfield, R. L. (2018). Evaluation and treatment of hirsutism in premenopausal women: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism103(4), 1233-1257.

Panchal, S. (2019). Three-dimensional ultrasound in infertility and ectopic pregnancy. Donald School Textbook Current Status of Clinical Use of 3D/4D Ultrasound in Obstetrics and Gynecology, 225.

Pfieffer, M. L. (2019). Polycystic ovary syndrome: Diagnosis and management. The Nurse Practitioner44(3), 30-35.

Skalecki, S., & Robson, S. J. (2020). Trends in metabolic surgery in reproductive‐age women in Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology.

Stephens, C. R., Easton, J. F., Robles-Cabrera, A., Fossion, R. Y. M., De La Cruz, L., Martinez-Tapia, R., ... & Rivera, A. L. (2020). The impact of education and age on metabolic disorders. Frontiers in Public Health8, 180.

Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., ... & Norman, R. J. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction33(9), 1602-1618.

Witchel, S. F., Oberfield, S. E., & Peña, A. S. (2019). Polycystic ovary syndrome: Pathophysiology, presentation, and treatment with emphasis on adolescent girls. Journal of the Endocrine Society3(8), 1545-1573.

Yang, W., Yang, R., Lin, M., Yang, Y., Song, X., Zhang, J., ... & Deng, F. (2018). Body mass index and basal androstenedione are independent risk factors for miscarriage in polycystic ovary syndrome. Reproductive Biology and Endocrinology16(1), 119.

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