What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a common hormonal condition that’s becoming increasingly prevalent in teenage girls and young women. Unfortunately, almost 50% of women with PCOS are unaware of the condition and remain undiagnosed. Around one in every ten women in India is affected by PCOS leading to

  • Irregular periods
  • Unwanted body and facial hair and acne 
  • Difficulty getting pregnant
  • Increases the possibility of developing additional health issues such as diabetes and high blood pressure

While some women with PCOS have small cysts in ovaries, this is not always the case. Also, not all women suffering from PCOS show the same symptoms.  

Being aware of the causes and symptoms of PCOS helps early diagnosis and treatment and prevents long-term health complications like obesity, diabetes, heart disease, infertility, etc.

What are polycystic ovaries?

Polycystic ovaries are a little bigger than usual and have twice the number of follicles (fluid-filled spaces in the ovary that release eggs). However, having polycystic ovaries does not always mean you have PCOS. PCOS is characterized by the presence of symptoms along with polycystic ovaries. 

What role do hormones play in PCOS?

Hormones play a significant role in PCOS. Women with PCOS have higher levels of androgens (male hormones) than normal, which can interfere with egg development and release. Instead of eggs maturing and being released during ovulation, as in a normal period, cysts are formed in the ovaries. This can lead to polycystic ovaries. Women with PCOS may not ovulate or release an egg each month, resulting in irregular or missed periods. 

In addition, women with PCOS may have insulin resistance, leading to high insulin levels and increased androgen production. These hormonal imbalances can interfere with the normal functioning of the ovaries, leading to fertility problems and the development of ovarian cysts.

What are the symptoms of PCOS?

The symptoms differ from woman to woman. Some may experience mild symptoms, while others may be affected more severely by a broader range of symptoms. The most common symptoms include: 

  • Irregular or missed periods or a long-time gap between periods
  • Oily skin and appearance of acne
  • Difficulty getting pregnant (reduced fertility)
  • Excess facial or body hair (hirsutism)
  • Thinning and loss of hair on the head
  • The rapid increase in weight and difficulty reducing weight

Some psychological problems like mood swings and depression can also result from having PCOS. 

What are the causes and risk factors for PCOS?

The causes of PCOS are not fully understood, but researchers believe genetics, environmental factors, and lifestyle habits may play a role. Some of the factors that contribute to PCOS include:

Excessive insulin or insulin resistance:  Excess of insulin can stimulate the ovaries to produce more androgen, which interferes with ovulation and contributes to symptoms of PCOS. Insulin hormone helps your body to process glucose and use it for energy, thereby controlling blood sugar levels. Insulin resistance means the body does not respond to insulin leading to high blood sugar levels.

Low-grade inflammation: Women with PCOS often have chronic low-grade inflammation. Your healthcare provider will get blood tests that measure C-reactive protein and white blood cells, which can indicate the level of inflammation in your body.

Genetic: Specific genes may be linked to PCOS and often run in families. Women with any of their relatives (mother, aunt, sisters) with a history of PCOS are more likely to develop PCOS themselves.

Excessive androgen:  High levels of androgens are thought to disrupt normal hormone production and egg development in the ovaries as well as physical symptoms such as excessive hair growth and acne.

How is PCOS diagnosed?

PCOS symptoms can be unpredictable and vary, particularly with weight increasing and making it difficult to diagnose.

It is diagnosed with a combination of history & physical examination, pelvic examination, ultrasound, and blood tests.

To get a diagnosis of PCOS, you must have at least two of the following symptoms:

  • Irregular, infrequent, or absent menstrual periods
  • Elevated levels of testosterone or increase in facial or body hair
  • Ultrasound scan showing enlarged ovaries with multiple cysts

In addition, blood tests are performed to look for sugar and cholesterol levels.

After diagnosis, you may be referred to a gynecologist or endocrinologist (a doctor who specializes in the hormonal system)

What risks do women have with PCOS?

Women with PCOS are at risk for various health complications.

  • One of the risks is related to irregular ovulation, which can lead to abnormal bleeding and thickening of the uterus lining. This can eventually lead to pre-cancerous changes or uterine cancer.
  • Difficulty getting pregnant:  Irregular ovulation can make it difficult to conceive.
  • Women with PCOS are also at risk for metabolic syndrome, which includes symptoms such as extra weight around the abdomen, high cholesterol, high blood pressure, and diabetes. Each of these symptoms increases the risk of heart disease.
  • Obesity is common in women with PCOS and can further increase the risk of metabolic syndrome.
  • Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat build-up in the liver
  • Snoring and daytime sleepiness
  • Depression and mood swings
  • Miscarriage and premature birth of baby

How are women with PCOS treated?

Polycystic ovary syndrome (PCOS) treatment is personalized to cure concerning symptoms such as irregular bleeding, infertility, excess hair growth, and acne. 

The specific treatment of PCOS might include lifestyle changes and appropriate medication.   

Lifestyle changes:  Your healthcare provider may recommend weight loss with a low-calorie diet and regular physical exercise. Even losing 5% of body weight may improve your condition. Weight loss will also improve the effectiveness of medications.

Medications: A combination of birth control pills and progestin therapy may be used to regulate menstrual cycles.

For excessive hair growth, the healthcare provider may prescribe birth control pills, creams, or electrolysis to help reduce hair growth.

For acne:  Topical creams, gels, or oral medication may help improve acne.

In general, leading a healthy lifestyle that includes a well-balanced diet, regular exercise, abstinence from tobacco use, reduced stress, and treatment of diabetes and other medical disorder decrease the chances of developing long-term health complications.

How infertility in PCOS women is treated?

Infertility can be treated by using medicine to cause ovulation. The first medicine usually tried is clomiphene citrate, taken by mouth. Another oral medication called letrozole can also be used. If these oral medicines do not work, injected fertility medicines called gonadotropins may be given to stimulate egg growth. However, women with PCOS must be monitored closely to avoid the risk of multiple births.

Losing weight can also improve ovulation and fertility, especially for women who are overweight.

Medicines like metformin can help make the body use insulin better, improving ovulation in some women with PCOS. This can also reduce the risk of diabetes or metabolic syndrome.

If other treatments do not work, in vitro fertilization (IVF) may be an option for women with PCOS to get pregnant.

How can a woman reduce the risk of long-term health problems associated with PCOS?

Have a healthy lifestyle

  • Eat a healthy balanced diet
  • Regular exercise
  • Maintain a healthy weight

Regular health check-ups:  Once the diagnosis of PCOS is confirmed, you should monitor yourself for any early signs of health problems 

  • Diabetes: For women with PCOS who are 40 years or older, it is recommended to have a blood sugar test every year to check for diabetes. If you have a BMI of 30 or higher or a family history of diabetes, you may need to be tested earlier than 40.
  • Uterine Cancer:  If you have irregular bleeding or do not have periods for over four months, your healthcare provider may get your uterus ultrasound to look for any abnormality.
  • High blood pressure:  Discuss with your healthcare provider how often you should check your blood pressure and get your cholesterol levels checked as well. 
  • Depression or psychological symptom:  If you experience any talk to your healthcare provider and get consulted with a counsellor.

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