Polycystic ovary syndrome

Polycystic Ovary SyndromeAngel Williams-KentSouth UniversityPracticum II: Family Health – Women’s HealthNSG 6430Dr. Sheri BuckleyNovember 30, 2015Introduction
Polycystic ovary syndrome (PCOS) or polycystic ovary disease (PCOD) is a set of symptoms which affects females across different age groups. It is a health concern that largely affects women after puberty. In this disease the ovaries develop small cysts that lead to impaired menstruation (oligomenorrhea) or absence of menstruation (amenorrhoea). The development of the disease is attributed to hormonal imbalance and is associated with overproduction of androgens in comparison to estrogens in females. Hence, the disease is also called hyperandrogenic anovulation. It is so called because the women who are affected with the disease does not ovulate, which is reflected by a decrease in the frequency of menstruation.
Further, individuals who are affected with the disease exhibit male secondary sexual characteristics like excess facial and axial hair (the condition is called hirsutism), develops pelvic pain and suffers from difficulties in conceiving. Presently there are no causative factors that may be linked to the genesis of the disease. However, the risk factors that are associated with PCOD include overweight, endometrial cancer, diabetes and mood disorders. Recently, PCOD has been attributed as an inherited autosomal trait. Management of PCOD is aimed to alleviate the symptoms of the disease, as the cause of the disease remains unknown.

Treatment with hormonal supplements and anti-diabetic agents may alleviate the symptoms of PCOD.
Women are concerned with the symptoms of PCOD and suffer from different apprehensions. Such apprehensions are due to the sudden cessation of menstruation, changes in the rhythm of the menstrual cycle and associated symptoms. Medical experts from the National Health Services, Mayo Clinic, the Canadian Healthcare system, Medicaid, and Medicare offer awareness programs so that such women may cope with PCOD. Pap smear tests are usually recommended to rule out other disease conditions and extent of PCOD (Diamanti-Kandarakis, 2014). The present article will provide a comprehensive review of PCOD and the nursing care of a patient for coping with such condition.
Literature Review
It is estimated that 1 out of 20 women, who have reached the stage of puberty suffers from the condition of PCOS. Approximately 5 million women in the United States are affected with the disease. PCOD is not only prevalent in women after puberty, but it may occur in females who are even 11 years old. Although the causative factors for PCOD are unknown, genetic and environmental causes are recognized as the determining factors for development of PCOD. PCOD is inherited as an autosomal dominant trait, as reflected by the pedigree analysis (Legro et al., 2013).
The identified risk factors for PCOD are obesity, type 2 diabetes mellitus, and lack of physical activity, endometrial cancer and depressive disorders. Diagnosis of PCOD is based on the number of loss of menstrual cycles, the presence of fluid-filled cysts in the ovaries that are detected through ultrasonography. The hormonal assays indicate high levels of androgens (male sex hormones). The ovaries that are filed by the fluid sacs or cysts prevent the expulsion of the matured ovum from the ovaries (Allahbadia & Agrawal, 2015). However, these cysts are benign and do not develop into cancerous form. This leads to anovulation and loss of menstrual cycle (Legro et al., 2013).
During normal conditions the ovaries produce appropriate hormones for the expulsion of ovum. This is achieved through increased pulse of estrogen released from the ovary. Increased estrogen leads to stimulation of pituitary gland which secretes Luteinizing hormone (LH). The LH surge is necessary for the release of matured ovum from the ovary. The release of matured ovum from the ovary on the 14th day of the menstrual cycle increases the probability of pregnancy. The released ovum may fuse with the matured sperm (from the male counterpart) in the fallopian tube and initiate the chances of pregnancy. Hence, prevention of release of ovum will be led to abnormalities in the menstrual cycle and decreases the chances of pregnancy. This is because the LH surge causes the ovaries to get converted to corpus luteum. Corpus luteum is formed after expulsion of the matured ovum, and they release high pulses of progesterone. Lack of corpus luteum formation will decrease the release of progesterone. Progesterone is important in maintaining the integrity of the uterine endometrium. The integrity of uterine endometrium is required for successful pregnancy (Allahbadia & Agrawal, 2015).
During PCOD the fluid-filled sacs prevent the formation of progesterone hormone which is also initiated in ovaries, before expulsion of the ovum. Progesterone pulse is also important in maintaining the normal rhythm of menstrual cycle. Estrogens and progesterone are important hormones that regulate the female reproductive cycle. These hormones are derived from the androgens (male sex hormones) by the action of an enzyme called aromatase. The decreased production of aromatase in PCOD patients leads to decreased production of estrogens and progesterone. Such changes lead to development of male secondary sexual characteristics like excess facial and axial hair (Legro et al., 2013).
The latest research by the AACE (American Association of Clinical Endocrinologists) links PCOD to an excessive production of insulin (Diamanti-Kandarakis, 2014; Allahbadia & Agrawal, 2015). Insulin levels are increased in PCOD. Increased insulin levels lead to the overproduction of the male hormones. The increased insulin levels are not associated with increased glucose transport across the cell (which is the normal function of Insulin). However such conditions lead to the development of acne, weight gain, excessive hair growth, and irregular periods.
. Harris & Carey (2014) reflected that baldness or thinning of the hair in females, results from the production of androgens. Such phenomenon also explains the development of pelvic pain in patients suffering from PCOD. When patches appear around the neck or cleavage area, it is important to seek prompt medical attention, for the removal of the cysts. PCOS patients may also suffer from sleep apnoea and depression. PCOD may decrease the chances of pregnancy or increase the complications of PCOD. Miscarriage or gestational diabetes may occur in pregnant women who suffer from PCOD. These women are also exposed to the risk of premature deliveries, which leads to critical medical crisis (Harris & Carey, 2014).
Medical experts recommend that women who are at risk of developing PCOD should undertake routine medical checkups. Medical experts mention that women with irregular periods, excessive weight gain, and uncontrollable hair growth should seek medical intervention for their risk of PCOS (Harris & Carey, 2014). Family history is another contributing factor for PCOS. Hence, individuals who have a family history of PCOD should undertake screening for PCOD.
Obesity is one of the identified causes of obesity, but 505 women who have PCOD do not suffer from obesity. However, obesity continues to remain as an independent risk factor for obesity. The feature of obesity in PCOD is quite different from truncal obesity. Truncal obesity is associated with Cushing’s syndrome. However, in case of patients with PCOD the obesity is featured as an increased hip-waist ratio. This type of obesity is referred to as android obesity. Although the cause of obesity has not been confounded in PCOD but is recognized that obesity increases the chances of diabetes mellitus.
Moreover, certain individuals with such obesity and diabetes mellitus may have an increased probability of suffering from cardiovascular diseases. 40% to 50% women who have PCOD and obesity and 10% of lean women (without obesity) with PCOD suffer from impaired glucose tolerance and diabetes mellitus.
PCOD is managed and treated conservatively. The goal of treatment involves pharmacological and non-pharmacological interventions. Such interventions are done to alleviate the symptoms of the disease. The major non-pharmacological approaches include lifestyle modifications. Since PCOD is strongly correlated to obesity and physical inactivity, patients are encouraged to undertake routine physical obesity and follow diet restriction. Patients are encouraged to develop healthy lifestyle with planned diet restriction. This would lead to a reduction of obesity, a predisposing risk factor of PCOD. Moreover, patients suffering from PCOD should consume foods with low glycemic index to reduce the probability of diabetes mellitus. These individuals should also consume whole grain based cereals, lean meat, fruits and vegetables (Legro et al., 2013). The ultimate goal of non-pharmacological interventions would be to decrease the comorbid risk factors of PCOD.
Pharmacological interventions include treatment with hormonal supplements. These supplements consist of estrogens and progesterone preparations, which are used to induce ovulation and normalize the frequency of the menstrual cycle. Anti-diabetic medications like metformin along with hormonal preparations like clomiphene are used as routine pharmacological interventions for the management of PCOD (Legro et al., 2013).
Role of Advanced Nursing Practice in the Prevention and Management of PCOS
Patients and vulnerable girls and women have access to several NHS options for the treatment and management of PCOS. Through the website, women can understand the symptoms of the disease and seek medical intervention. Further, Electronic Heath Records maintained through Obamacare, assist patients in seeking medical help. This is because the medical histories of these patients are documented, which aid physicians in screening such individuals for PCOD (Allahbadia & Agrawal, 2015).
The NHS and the WHO offer almost similar strategies, for providing awareness and guidance of the vulnerable group of individuals. This helps in early detection of signs and symptoms of PCOD. Such guidelines recommend physical examination, Pap smear test, pelvic exams, blood tests, and ultrasonography. Such interventions help in early diagnosis of PCOD, which aids in early therapeutic interventions (Allahbadia & Agrawal, 2015).
These bodies advise patients to use birth control pills, which reduces the production of androgen and occurrence of acne. Moreover, the NHS and WHO endorses lifestyle modifications as a major intervention strategy for prevention and alleviation of PCOD. Individuals are recommended to consume less sugar, tubers, and regular incorporation of physical activity in their daily lifestyle. They are also encouraged to maintain a healthy food habit (Harris & Francis-Cheung, 2015).
Implications on Nursing and Nursing Research
Individuals who are associated in the care of woman, suffering from associated PCOD, should take measures in alleviating the apprehensions and risks of PCOD. Nurses should opt for patient-centric approach in reducing the mood changes and anxiety related to apprehensions regarding symptoms of PCOD. Moreover, nursing research should be carried out to understand the exact care needs of patients with PCOD. Research should be carried out with different nursing approaches that may help to reduce the episodes of depression and anxiety associated with PCOD (Cassina et al., 2014).
Discussion and Conclusion
Polycystic ovary syndrome (PCOS) or polycystic ovary disease (PCOD) is a set of symptoms which affects females across different age groups. The prevalence of PCOD is a global concern, as because PCOD affects individuals across different individuals regardless of race, ethnicity or religion. Women are worried regarding their symptoms associated with PCOD. Often the symptoms of PCOD are neglected and under estimated by different individuals (Cassina et al., 2014). Management of PCOD imposes treatment challenges in physicians all across the world. This is because there are no treatment specifications for PCOD. Management of PCOD pivots around alleviation of symptoms of PCOD. Surgical removal of cysts may be employed in reducing the number of cysts (Cassina et al., 2014).
Such surgical interventions may increase the probability of regular menstrual cycle or increase the probability of successful pregnancy (Legro et al., 2013). However, lifestyle modifications including routine physical activity and healthy diet plan can reduce the risks of PCOD. Such interventions may bring about positive health outcome in such patients (Legro et al., 2013). This is because reduction in obesity and diabetes will not only alleviate the signs and symptoms of PCOD but may also act to reduce the chances of cardiovascular morbidity and mortality. Research should be carried out in understanding the development and alleviation of metabolic risk factors for PCOD. Proper awareness, routine screening, early interventions and improved lifestyle modifications would help in reducing the symptoms associated with PCOD.
Reference
Allahbadia, G., & Agrawal, R. R. (2015). Polycystic Ovary Syndrome. Tunbridge Wells, Kent, UK: Anshan.
Cassina M, Donà M, Di Gianantonio E, Litta P, & Clementi M (2014). “First-trimester exposure to metformin and risk of birth defects: a systematic review and meta-analysis”. Hum. Reprod. Update 20 (5): 656
Diamanti-Kandarakis, E. (2014). Insulin resistance and polycystic ovarian syndrome: Pathogenesis, evaluation, and treatment. Totowa, N.J: Humana Press.
Harris, C., & Carey, A. (2014). PCOS: A Woman’s Guide to Dealing with Polycystic Ovary Syndrome. London: Thorsons.
Legro, RS; Arslanian, SA; Ehrmann, DA; Hoeger, KM; Murad, MH; Pasquali, R; & Welt, CK; Endocrine, Society (2013). “Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.”.The Journal of clinical endocrinology and metabolism 98 (12), 4565–92
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