What is Polycystic Ovary Syndrome PCOS?

Polycystic Ovary Syndrome PCOS is a hormonal disorder common amongst women in child bearing age. Women with PCOs have infrequent or prolonged periods or excess male hormone androgen (testosterone). Ovaries develop numerous small fluid-filled sacs and fail to release eggs regularly. Almost 1 in 5 women in childbearing age have PCOS. Incidence has been increasingly high mainly due to lifestyle and diet changes in last couple of decades.

What are the symptoms of PCOS?

All women with PCOS do not have symptoms and those who have, it is in varying degrees. Symptoms keep changing especially with weight. The signs and symptoms get worse with increasing weight. Following are some of the prevalent signs and symptoms of PCOS:

• Irregular Menstrual Cycles – Delayed periods are common, sometimes can even go up to 6 months or more
• Hirsutism is undesired growth of hair, especially on the upper lip, chin, back, chest, stomach. As many as 70% of women with PCOS have hirsutism.
• Acne – Acne on the face, chest, and upper back
• Hair Loss – Thinning of hair accompanied by hair loss from the scalp and male-pattern baldness
• Weight gain – Obesity and difficulty in shedding the extra weight
• Darkening of the Skin –Skin around the neck crease, groin, and underneath breasts tends to get darker (Acanthosis Nigricans)
• Skin Tags – Small excess tags of skin in the armpits and on the neck. They look like warts, but they are not.
• Infertility – In women where ovulation is hindered, they do not get pregnant.

What are the causes of PCOS?

Reason behind is still unknown However, there are four factors that are known to increase the risk of PCOS in women:

1. Excess Insulin – The hormone “Insulin” controls how the food that we eat is converted into energy. Insulin also controls the level of glucose in our blood. Insulin resistance is caused when the cells in the body do not respond to insulin as expected. The body has higher glucose levels and it thus raises the insulin levels above the normal. This is the leading cause of type 2 diabetes in women with PCOS, especially those who are overweight or obese, have unhealthy eating habits, do not exercise often, and have a family history of diabetes.
2. Heredity – Research studies have pointed towards the presence of certain genes that may be linked to PCOS.
3. Excess Androgen – All women have small amounts of Androgen. Androgen hormones are responsible for male traits such as male-pattern baldness, facial hair growth, etc. Women with PCOS have higher than normal levels of Androgen which is responsible for anovulation, hirsutism and acne.

Are there any other health concerns related to PCOS?

Yes, there are health concerns even in long term too. The increased insulin resistance leads to Type 2 diabetes. There is increased risk of high blood pressure, increased levels of cholesterol and heart disease. 40% of women PCO who are obese are likely to het heart attack. In women who do not have at least 3 periods in one year, have higher risk of cancer of the uterus.

How is PCOS diagnosed?

• A good medical history and physical examination confirms period problems, acne, hirsutism, obesity and acanthosis nigricans.
• Ultrasound Scan of the pelvis confirms polycystic ovary
• Blood Tests confirm raised androgens, fasting insulin and Luteinising Hormone (LH)

What treatments are available for PCOS?

All women with PCOS do not need treatment. Only those with symptoms do. PCOS cannot be removed, it can only be kept under control. Main focus is on lifestyle.

1. Weight Loss – Very essential step. Losing weight reduces insulin levels and improve hormone balance. Eating a healthy diet and having an exercise routine helps regularise the menstrual cycle and improve fertility. BMI under 2t5 should be aimed for.
2. Diet – recommended foods in women with PCOs are high fibre food, vegetables, fish. Timely eating is recommended. Foods to be avoided include milk and milk products, red meat, sweets, ice creams and refined foods.
3. For hirsutism – Topical and cosmetic treatment Eflornithine HCl Cream (Vaniqa), waxing, shaving, threading or laser treatment treatments can be tried.
4. For Acne – Certain Oral contraceptive pills OCP help in treatment of acne. Avoiding oily foods and frequent cleansing with non-fragranced wet wipes offers additional benefit.
5. Metformin – Metformin increases the sensitivity of the tissues to insulin. Therefore, it helps reduce the insulin levels in the bloodstream thereby reducing the levels of male hormones. Metformin can also restore ovulation and regulate periods. Again, this should be taken once It is only prescribed by the doctor.
6. For periods – Oral contraceptive pills OCP help regulate periods. These also help treat acne. There are certain risks associated with these medicines and thus OCP must be taken only once prescribed by the doctor.
7. For infertility – Ovulation can be induced by Letrozole or Clomid tablets. Hormone injections can also be combined with these tablets. Again, these medication should be taken only under strict supervision of the doctor. In case of no ovulation with these tablets and injections (Ovulation induction) other ART Assisted Reproductive Technology ART treatments such as IVF, IUI, ICSI are used to improve chances of achieving pregnancy

Additional reading materials

https://www.rcog.org.uk/en/patients/patient-leaflets/polycystic-ovary-syndrome-pcos-what-it-means-for-your-long-term-health/