Discuss 2 additional symptoms associated with PCOS in terms of pathophysiological principles.

Polycystic ovary syndrome (PCOS) is a common gynecological endocrine disease in women of childbearing age, with a high risk of developing endometrial cancer (Dlugasch & Story, 2021). PCOS is characterized by excessive androgens, insulin resistance hyperinsulinemia, persistent or chronic anovulation (ovulation dysfunction), and infertility (Dlugasch & Story, 2020). Symptoms of PCOS arise during the early pubertal years and affect 6% to 20% of women of reproductive age (Witchel et al., 2019). Diagnostic features for adolescent girls with PCOS are menstrual irregularity, clinical hyperandrogenism and/or hyperandrogenemia, anovulation, hirsutism, acne, obesity, ovarian cysts and male pattern baldness. Hyperandrogenism is a persistently elevated testosterone level, which is responsible for hirsutism, and can inhibit fertility (Dlugasch & Story, 2021).

How does Metformin contribute to treatment?

Patients with PCOS have high prevalence of obtaining insulin resistance hyperinsulinemia, therefore metformin medication can effectively assist in the metabolism of organs such as the liver, muscle, and adipose tissue, by reducing the clinical symptoms of insulin resistance and excessive androgen expression (Liu et al. 2021). There are health benefits to taking metformin for PCOS, such as improving blood sugar, decreasing blood lipids lab, and improving sex hormone drive (Liu et al., 2021).

How does progesterone aid in treatment?

Progesterone hormonal treatments are given to patients with PCOS to reduce the occurrence of amenorrhea and decrease the chance of getting endometrial cancer (Shirin et al., 2020). Progesterone treatment also effectively maintains the uterine lining, preparing for possible pregnancy (Shirin et al., 2020). Unfortunately, there are adverse effects of PCOS patients taking progesterone because some progestins can mimic androgens, which can elevate blood androgen, worsening PCOS amenorrhea symptoms (Shirin et al., 2020).

How is infertility a symptom of PCOS?

Individuals with PCOS, especially women, have a high rate of infertility because of the occurrence of irregular menses that persist for two years after menarche (Aversa et al., 2020). Therefore, this incidence of irregular menses can delay sexual reproductive immaturity (Aversa et al., 2020). Finally, increased levels of androgens can inhibit the production of progesterone hormones, which helps maintain the lining of the uterine wall in preparation for pregnancy (Dlugasch & Story, 2021).