By Dr. Poonguzhali Liston
Polycystic Ovarian Syndrome or PCOS is a hormonal disorder common among women of reproductive age group. One in ten women of childbearing age suffers from PCOS. It affects women between the ages of 15 and 44 or mostly those women who are at the age of bearing children. Most women discover they have PCOS in their 20s and 30s when they face difficulties getting pregnant. However, PCOS can develop at any age following puberty. PCOS can affect any women within the reproductive age group. Women with a family history of PCOS are more susceptible. Women who are overweight or have an unhealthy lifestyle are also prone to develop PCOS.
The most common causes of PCOS are:
The exact cause of PCOS is unknown. Several factors including genetics play a role in development of PCOS.
- Insulin Resistance – Insulin resistance means the body cannot process insulin properly, which increases blood sugar (as insulin controls blood sugar levels). Increased blood sugar in turn increases the production of insulin. Increased insulin levels increase the production of androgens (male hormones from the ovaries which supresses ovulation). Insulin resistance and being overweight both increase the chances of diabetes in future.
- High androgen levels – High androgen levels supress ovulation and hence causes menstrual irregularities. Due to supressed ovulation, the growth arrested eggs (follicles) are seen as multiple fluid filled sacs (cysts) on scan or ultrasound (hence the name poly cystic ovaries). Ovulation or high androgen levels also contributes to symptoms like acne, increased body hair, obesity .
- Low grade inflammation
What are the symptoms of PCOS?
Symptoms due to irregular ovulation – Irregular cycles, infertility, polycystic ovaries on scan
Symptoms due to androgen excess – Acne, hirsutism (excessive hair growth), hair fall
Symptoms due to Insulin resistance: Weight gain or difficulty to lose weight, skin darkening, skin tags
Presence of 2 or more symptoms is a diagnostic criteria for PCOS:
Irregular or missed periods- Women with PCOS may experience missed or fewer periods (fewer than eight in a year). Alternately, they may also experience periods every 21 days or more frequently. While some women with PCOS may stop having menstrual periods altogether. These complaints should be present over a prolonged period of time.
Signs of excess androgen such as acne or excessive hair growth or a blood test confirming higher androgen levels.
Polycystic ovaries- one or both ovaries. Many females suffering with PCOS don’t develop cysts.
Not all women with PCOS experience similar symptoms and are subjective from patient to patient.
How is PCOS diagnosed?
- Diagnosis involves detailed history including family history of PCOS
- Physical examination (weight, Blood pressure, signs of excess androgen)
- Blood tests
- Pelvic ultrasound
Myth: Women who have PCOS won’t be able to get pregnant.
Fact: PCOS can interfere with a woman’s menstrual cycles and make it more challenging to conceive. However, it is commonly assumed that there are no chances of pregnancy because PCOS adversely impacts the ovaries and follicles. Many women with PCOS do become pregnant naturally or with the aid of their gynaecologist and/or fertility treatments. PCOS is definitely not a reason to forgo using contraception or safe sex.
Myth: PCOS is just a menstrual issue and can be self-diagnosed/treated.
Fact: If PCOS is not addressed or treated, it may lead to complications affecting general health. Insulin resistance seen in PCOS increases a woman’s chances of developing diabetes. In fact 50% of women diagnosed with PCOS and insulin resistance develop diabetes before the age of 40. It increases the chances of metabolic syndrome (high blood pressure, central obesity and increased cholesterol) which in turn increases the chances of heart diseases. PCOS raise the chances of developing endometrial cancer as well. Therefore, rather than delaying medical treatment, patients are advised to seek it out early in life.
Myth: PCOS can be treated with contraceptive pills.
Fact: Unfortunately, there is no cure for PCOS. Treatment is aimed at the management of symptoms.
Lifestyle changes, such as healthy eating and regular exercise, intake of supplements like Vitamin D, Omega 3 fatty acid, Myo-inositol improve the way the body uses insulin and, therefore, reduces insulin resistance which in turn regulates the hormone levels better.
Birth control pills regulate the menstrual cycle and reduce androgen levels. It also reduces the increased risk of endometrial cancer by decreasing the amount of time the uterus is exposed to unopposed estrogen. This treatment modality is useful in women with predominantly menstrual complaints.
Fertility medications also can help stimulate ovulation if the aim is fertility.
Hence a comprehensive and individualised plan and approach should be considered depending on the patient’s symptoms and complaints.
Myth: You have PCOS if your menstrual cycle is irregular.
Fact: An irregular cycle may be caused by a number of different reasons, PCOS being only one of them. Other potential causes for an inconsistent cycle include breastfeeding, excessive dieting or exercise, pelvic inflammatory disease, uterine fibroids, thyroid conditions, and the most common – stress.
Myth: PCOS affects only obese females
Fact: Although many PCOS-diagnosed women have spoken about their struggles with weight, PCOS does not discriminate and can affect women of all shape and sizes. It is true that obesity or weight gain can make the symptoms worse.
With an increase in weight – there is an increase in insulin resistance and hence this can worsen PCOS. Thus, the need to include a healthy lifestyle (exercise and eating habits) as part of the management plan for PCOS is vital.
(The author is MS OB/GYN, Advanced Diploma in ART and RM, Kindly. Views expressed are personal and do not reflect the official position or policy of FinancialExpress.com.)