Polycystic ovary syndrome (PCOS) is a common disorder in women of reproductive age with a prevalence range of 20–30 %. It is a condition of hormonal imbalance leading to various reproductive and metabolic repercussions. Owing to the trend of urban lifestyles, it now happens to be one of the leading causes of female infertility.
WHAT CAUSES PCOS?
• Excess Insulin: Insulin is the hormone produced in the pancreas that allows cells to use glucose. Insulin resistance as in PCOS leads to glucose intolerance and excess androgen production, interfering with the ovarian ability to form mature eggs and further ovulate. This hormonal imbalance of excess androgens and oestrogen and deficient progesterone produces the symptoms of PCOS.
• Heredity: The condition appears to run in families and sisters of those with the disorder are twice as likely to have it.
HOW TO DIAGNOSE PCOS?
Symptoms:
PCOS is a syndrome disease defined by a collection of signs and symptoms. The symptom profile ranges over the following features:
• Irregular, infrequent or prolonged menstrual periods
• Infertility
• Excess or unwanted body or facial hair growth
• Thinning hair on the scalp
• Weight problems, often weight gain, increased waist size
• Skin problems, including skin tags, darkening skin and acne
Clinical Workup:
There is no single test to diagnose PCOS. A proper medical history, medical examination including weight, BMI, waist circumference, blood pressure, skin signs should be followed by
• Blood tests – for glucose and androgen hormone measurement
• Pelvic ultrasound – to examine ovaries and uterine lining
In PCOS, the ovaries appear polycystic meaning ‘many cysts’ signifying the clusters of small, pearl-sized cysts which are actually fluid-filled follicles of arrested growth containing immature eggs.
DOES PCOS PUT WOMEN AT RISK FOR OTHER HEALTH PROBLEMS?
PCOS has evolved from a gynaecological curiosity to a multisystem endocrinopathy. Women with PCOS have greater chances of developing the following health consequences: infertility, diabetes or pre-diabetes (impaired glucose tolerance), high blood pressure, cholesterol and lipid abnormalities posing a risk of heart attack, sleep apnea, anxiety and depression, endometrial hyperplasia and rarely endometrial cancer.
Hence, the need to watch out and screen regularly for the above disorders while adopting preventive measures is highly recommended.
HOW IS PCOS TREATED?
There being no cure for PCOS, the treatment generally focuses on the management of the individual’s main concerns, such as infertility, hirsutism, acne or obesity. Many women require a combination of treatments to meet these goals. Some treatments for PCOS include:
Lifestyle changes
Prime attention to physical exercise, weight loss, healthy diet and improving psychological attitudes are the mainstay in overcoming the endocrine, reproductive and metabolic abnormalities at all ages. Their importance cannot be over-emphasised. For overweight infertile women with PCOS, these activities can not only resume spontaneous ovulation, but may also improve the outcome of pregnancies conceived.
Keeping the weight in check:
Obesity makes insulin resistance worse. So for overweight infertile women with PCOS weight loss may not only resume natural ovulation, but also improve the outcome of pregnancies conceived. Maintaining the BMI (Body mass index) [Weight in kg divided by square of height in metres] in the normal range of 18.5 – 24.9 is vital.
Diet Modifications:
• Reducing portion sizes, resisting the urge for the seconds
• Preferring low-carbohydrate, high-fibre complex carbohydrates like whole-grain breads and cereals, wheat, barley, brown rice, and beans
• Restricting simple carbohydrates like soda, excess refined foods like cake, candy, ice cream, pies, cookies, doughnuts, burgers, pasta, pizza, etc. will bring about the desired effects
Being Active:
Increasing daily activity and participating in regular exercise corrects the metabolic abnormality.
Support:
The journey of PCO women from adolescence to menopause includes considerable dilemma and emotional turmoil. So, adequate counselling and having consistent medical, social and familial support for maintaining treatment and lifestyle goals for as long as possible is crucial.
Medications that may be used
1. For regulation of menstrual cycle: hormonal pills of oestrogen and progestin which also decrease androgen production. Nowadays, very low hormonal content pills are available. Hence, users need not be wary of any side-effects.
2. Metformin, which is an insulin-sensitizer.
3. For those trying to conceive, medications to help follicular development and induce ovulation are required. Consulting a reproductive specialist for monitoring the response is essential to walk the right path. In certain cases, in vitro fertilization (IVF) may be required to achieve a pregnancy.
Surgery can be attempted in cases resistant to medical ovulation induction
Cosmetic Treatments for hair and acne problems are also available
With a proper diagnosis, lifestyle preventive changes and appropriate treatment, women with PCOS can get relief from its disturbing symptoms and the overwhelming health problems it causes.
Authored by
Dr. Nameeta Sagar Mokashi-Bhalerao
MBBS, MS (Obs-Gynaec), DNB, FNB (Reproductive Medicine), PGDMLE
Fertility Consultant at Nova IVI Fertility, Pune
