PCOS: No More Silent Struggle!

Image by jcompFreepik

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) means the development of fluid-filled follicles or small cysts) in the ovary. It is a common health condition that affects women during their childbearing age. In this condition, the ovaries secrete excessive male sex hormones (androgens). This hormonal imbalance disrupts the functioning of the ovaries and may cause irregular ovulation affecting the entire menstrual cycle. An absence of ovulation or delayed ovulation can lead to the formation of cysts in the ovary. These cysts are likely to produce androgens. Therefore, most women with PCOS have high levels of the male sex hormone, one of the symptoms of polycystic ovary syndrome. Other symptoms include - irregular menstrual periods, excessive hair growth, pimples and acne, weight gain, male-like baldness, and infertility.

What are the common symptoms of PCOS?

Irregular Periods

Irregular or prolonged menstrual periods are common in women with PCOS. For example, they may have less than nine periods each year or a gap of more than 35 days between their menstrual cycles.

Excess Androgen

Excessive levels of androgens in the body are likely to present physical symptoms, including hirsutism (excess body and facial hair), in women with PCOS.

Hair Growth in Unwanted Areas

Unwanted and excessive hair growth on the chest, face, armpits, and buttocks is a common sign of PCOS. It affects as many as 70% of women with this condition.

Polycystic Ovaries

Ovaries can enlarge due to polycystic ovary syndrome and develop multiple sacs filled with fluid (cysts). These might hinder the proper functioning of the ovaries.

Acne or Oily Skin

The production of more male sex hormones can make the skin oily and cause acne on the face and other parts of the body.

Heavy Periods

In many cases, women with PCOS experience heavy bleeding, sometimes for more than seven days. It is mainly because of PCOS-induced low levels of progesterone.

Trouble Getting Pregnant

If women do not ovulate (release the egg), they cannot conceive. Infertility and trouble getting pregnant are also related to PCOS as the condition disturbs the ovulation cycle.

Weight Gain

About 40-80% of women with PCOS are either obese or overweight. It is due to the surge of male hormones in their bodies.

What Causes PCOS?

Excess Insulin

Insulin is the hormone secreted by the pancreas and is responsible for cells to utilise the sugar content in the blood, producing energy. In PCOS, cells can become resistant to insulin, raising blood sugar levels that, in turn, increase insulin production and affect ovulation.

Heredity

Some studies have claimed that PCOS is hereditary. If the mother has symptoms of PCOS, the daughter is most likely to have it too.

Excess Androgen

Excessive androgen (male sex hormone) production by the ovaries can lead to acne and undesirable hair growth.

Weight

PCOS is also known as an obesity-related health condition. Obesity and severe weight gain can also lead to the development of polycystic ovary syndrome symptoms, including acne and menstrual abnormalities.

What are the Complications of PCOS?

Infertility

Although PCOS may cause infertility in women, having the condition does not necessarily mean a woman cannot conceive. As PCOS causes hormonal imbalance, it affects the development and release of eggs from the ovaries. Lack of ovulation may cause infertility in some women.

Gestational Diabetes or Pregnancy-induced High Blood Pressure

PCOS can cause high glucose levels in the blood during pregnancy and also cause high blood pressure.

Miscarriage or Premature Birth

PCOS can increase the risk of miscarriage by three times in the early months of pregnancy. It may also lead to pre-eclampsia (pregnancy-induced high blood pressure). The condition, if left untreated, can be fatal for the mother and the child.

Nonalcoholic Steatohepatitis or Nonalcoholic Fatty Liver Disease (NAFLD)

It is a severe liver inflammation caused by fat accumulation in the liver. NAFLD is common in women with PCOS, with insulin resistance and obesity being the main contributing factors.

Metabolic Syndrome

Around 33% of women with polycystic ovary syndrome develop metabolic syndrome. It is a cluster of symptoms, including high blood sugar, high blood pressure, abnormal cholesterol levels, and cardiovascular diseases.

Type 2 Diabetes or Prediabetes

More than 50% of women with PCOS are likely to get type 2 diabetes by the time they turn 40.

Sleep Apnea

According to the latest reports, the prevalence of sleep apnea (OSA - obstructive sleep apnea) in women with PCOS is unexpectedly high.

Depression, Stress, Anxiety and Eating Disorders

As PCOS is a hormonal disorder, it can cause depression, stress, anxiety, and eating disorders in many women.

Abnormal Uterine Bleeding

The absence of ovulation often leads to abnormal or infrequent menstrual bleeding in women with polycystic ovary syndrome.

Endometrial Cancer

Anovulation (lack of ovulation) causes prolonged exposure of the endometrium to sex hormones (estrogen). It can further lead to endometrial hyperplasia (a reproductive condition), causing endometrial cancer.

Interconnection of PCOS and Pregnancy

Polycystic ovary syndrome is related to an increased risk of many pregnancy-associated complications, including miscarriage and preterm delivery. Moreover, PCOS and pregnancy are interconnected. PCOS directly affects the ovaries and disrupts the ovulation patterns. Therefore, it has an immediate impact on the menstrual cycle. Thus, women with PCOS may have difficulty conceiving children. PCOS may also lead to infertility. However, some PCOS treatment options and healthcare technologies like IVF (in-vitro fertilisation) can help one deal with PCOS and the difficulties faced during pregnancy.

How is PCOS Diagnosed?

Doctors generally look for the common symptoms while diagnosing PCOS – cysts, irregular cycles, or high androgen levels. Diagnosis of PCOS can be performed in the following ways:

Pelvic exam

This exam checks for any abnormalities in the female genitalia.

Blood tests

Blood tests look for the level of various hormones in the body. Any abnormal increase could be a direct indication of the condition.

Ultrasound

Ultrasound detects abnormalities (if any) in the ovaries and uterus. After PCOS is diagnosed, the doctors monitor the following parameters.

1. 1. Blood pressure, cholesterol, glucose tolerance and triglyceride levels
2. 2. Anxiety and depression
3. 3. Obstructive sleep apnea

What is the treatment of PCOS?

While complete healing of PCOS can be difficult, PCOS treatments help manage symptoms and thereby prevent them.

Diet and lifestyle changes

• Women with PCOS should keep a check on their carbohydrate and sugar intake
• Weight management and exercising are also integral to polycystic ovary syndrome treatment

Medications

• Progestin therapy in combination with contraceptive (birth control) pills to regulate the menstrual cycle
• Medicines such as Clomiphene, Letrozole (Femara), Metformin, and Gonadotropins to normalise ovulation
• Other medications include Spironolactone (Aldactone), Eflornithine (Vaniqa), and Electrolysis

Diet for PCOS

Diet plays a crucial role in PCOS management. Since insulin resistance is a possible cause of PCOS, the PCOS diet should contain low amounts of sugar and carbohydrates. High-fibre foods, such as nuts and berries, green vegetables, pumpkins, and sweet potatoes, are also effective in reducing insulin resistance. Lean meats and protein sources, such as fish and tofu, are also nutritious and good options for women with PCOS. Other food items, such as spinach, kale, salmon, olive oil and tomatoes help reduce inflammation in the body.

Frequently Asked Questions (FAQs):

Q.1 Who can get PCOS?

PCOS can happen to any woman who has started menstruating or reached puberty. However, it usually happens to women during their childbearing or reproductive age.

Q.2 Can IVF or ICSI help a woman with PCOS get pregnant?

Yes, IVF or ICSI can help women with PCOS get pregnant. It is better to consult a medical professional who can help analyse and plan a proper PCOS treatment for the same.

Q.3 Does PCOS put women at risk of developing other severe conditions and can PCOScause cancer?

PCOS increases the risk of type 2 diabetes, heart problems and high blood pressure. It can also affect fertility and can cause uterine cancer. Additionally, women with PCOS may have a slightly increased risk of developing endometrial cancer, which is cancer of the lining of the uterus. However, there is no evidence to suggest that PCOS directly causes cancer.

Q.4How prevalent is ovarian cancer in PCOS?

The prevalence of PCOS ovarian cancer in women is estimated to be around 1-3%, which is slightly higher than the general population but still considered to be low.