Skip to content

Content

Home
Patient case
Patient case: Polycystic ovarian syndrome in sub-Saharan Africa.

Patient case: Polycystic ovarian syndrome in sub-Saharan Africa.

Patient details
Patient details.
Ms. N.W Age: 27 years Location: Nairobi, Kenya Chief Complaint: Ms. N.W presents to the clinic with complaints of irregular menstrual cycles and difficulty in conceiving over the past two years.
Patient case fields
Medical History

Ms. N.W reports that her menstrual cycles have always been irregular, often occurring every two to three months since her teenage years. She also experiences occasional acne and excessive hair growth on her face and abdomen. There is no history of significant medical conditions or surgeries. Her family history reveals that her mother and sister both had irregular periods but no known diagnosis.

Social History

Ms. N.W works as a teacher and lives in an urban area of Nairobi. She reports a relatively healthy diet but admits to a sedentary lifestyle with minimal exercise. She is not a smoker and consumes alcohol occasionally. The couple has been trying to conceive for two years, leading to increased stress.

Examination Findings

On examination, Ms. N.W has a BMI of 30, indicating obesity. There are signs of hirsutism (excess hair growth) on her face and abdomen. No abnormalities are detected in her pelvic exam.

Investigations

An ultrasound of the pelvis reveals multiple small cysts on both ovaries, consistent with polycystic ovarian syndrome (PCOS). Blood tests show elevated levels of androgens and slightly elevated insulin levels, with normal thyroid and prolactin levels.

Management

1. Lifestyle Modifications:
- Encourage weight loss through a balanced diet and regular exercise to improve menstrual regularity and reduce insulin resistance.
- Stress management techniques, including mindfulness and relaxation exercises.
2. Medical Treatment:
- Prescribe metformin to address insulin resistance.
- Consider hormonal contraceptives to regulate menstrual cycles and manage hirsutism.
- Recommend ovulation induction agents like clomiphene citrate if conception does not occur naturally after lifestyle changes.
3. Follow-Up:
- Monitor menstrual cycle regularity and symptoms over the next six months.
- Regular check-ups to assess weight, blood sugar levels, and response to treatment.
- Referral to a fertility specialist if pregnancy does not occur within a year.

Outcome:

With appropriate lifestyle changes and medical management, Ms. N.W has a good chance of improving her symptoms and achieving pregnancy. However, ongoing monitoring and management of PCOS are essential for long-term health.

Discussion
No data was found
Questions
1. What are the primary symptoms that led Ms. N.W to seek medical help? 

   (A). Weight gain and high blood pressure  

   (B). Irregular menstrual cycles and difficulty conceiving  

   (C). Severe abdominal pain and bloating  

   (D). Frequent headaches and dizziness  

2. What finding on the ultrasound confirmed the diagnosis of polycystic ovarian syndrome (PCOS) in Ms. N.W?  

   (A). A single large ovarian cyst  

   (B). Multiple small cysts on both ovaries  

   (C). Enlarged uterus  

   (D). Presence of fibroids

3. Which lifestyle change was recommended to Ms. N.W to help manage her PCOS?

   (A). Increased caloric intake  

   (B). Regular exercise and weight loss  

   (C). Increased sugar consumption  

   (D). Avoidance of all carbohydrates

4. If Ms. N.W does not conceive naturally after lifestyle changes, what treatment was recommended next? 

   (A). In vitro fertilisation (IVF)  

   (B). Ovulation induction with clomiphene citrate  

   (C). Hormone replacement therapy  

   (D). Surgical removal of ovarian cysts

Reveal answers

Answers

  1. (B). Irregular menstrual cycles and difficulty conceiving
  2. (B). Multiple small cysts on both ovaries
  3. (B). Regular exercise and weight loss
  4. (B). Ovulation induction with clomiphene citrate