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Overview of Polycystic Ovary Syndrome

Team AckoMay 24, 2024

Polycystic Ovary Syndrome (PCOS/PCOD) affects women of reproductive age, from puberty to menopause, presenting with irregular periods and infertility. Its incidence is on the rise, becoming a prevalent concern in gynaecological clinics. PCOS/PCOD is characterised by hormonal imbalances, leading to ovarian cysts, irregular ovulation, and metabolic disturbances. Symptoms include menstrual irregularities, excess hair growth, acne, and weight gain. 

While its exact cause remains unclear, factors like genetics, insulin resistance, and lifestyle play significant roles. Management involves lifestyle changes, medication to regulate hormones and insulin levels, and fertility treatments when needed. Early detection and tailored interventions are crucial for managing PCOS/PCOD and its associated complications.  Here’s an overview of this medical condition.

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What is Polycystic Ovary Syndrome?

Polycystic Ovary Syndrome is a condition of hormonal imbalance. It is characterised by an increase in the male sex hormones, also called androgens, in women. There is usually a small amount of androgens present inherently in the female system. In PCOS, there is an excess of these hormones and a decrease in the amount of female sex hormones (estrogens). This condition involves the presence of multiple, small, fluid-filled sacs, also called cysts, present in the ovaries of the affected women. 

What is the cause of Polycystic Ovary Syndrome?

The exact cause of PCOS is still unknown. However, there are certain other abnormalities present in people with PCOS, which are attributed to be significant causative factors.

  • Insulin resistance: Insulin is a hormone that is produced by the pancreas. The function of insulin is to act on tissues and cells in order to make them use up sugar/glucose in the blood. 

Insulin resistance is a phenomenon wherein these cells & tissues cannot use insulin appropriately, leading to both an excess blood sugar level as well as an increased level of insulin in the bloodstream. This is thought to contribute to an increase in androgen levels. A classical manifestation of insulin resistance is Acanthosis nigricans, a condition where there are velvety patches of dark skin over the neck, groyne, armpits, etc.

  • Obesity: People with increased body mass index are more susceptible to insulin resistance, and have an increased propensity for PCOS.

  • Hereditary: A family history of PCOS is a strong indicator of it possibly occurring in an individual. Studies have shown that there are multiple genes involved in PCOS, which can be passed from parent to offspring. 

Complications of PCOS

Polycystic ovary syndrome (PCOS) poses significant health risks for women, increasing the likelihood of developing type 2 diabetes, high blood pressure, cardiovascular issues, and uterine cancer. PCOS also impacts fertility, with women often encountering difficulties conceiving due to irregular ovulation or absence of menstruation. These reproductive challenges can lead to emotional distress and require medical interventions such as fertility treatments. 

The hormonal imbalances characteristic of PCOS can further exacerbate these risks, requiring comprehensive management strategies to mitigate potential complications. Early diagnosis and proactive management are crucial in addressing the multifaceted health concerns associated with PCOS, empowering women to navigate their reproductive health and overall well-being effectively.

Living with PCOS

Many women grapple with the physical manifestations of PCOS, including weight gain, excessive hair growth, and acne, which can significantly impact self-esteem and quality of life. Cosmetic interventions like electrolysis and laser hair removal offer relief by addressing unwanted hair growth while also boosting confidence and improving body image. Consulting with a healthcare provider is crucial to devise personalised treatment plans tailored to individual needs and concerns. 

By discussing symptoms openly, women can explore a range of therapeutic options, including lifestyle modifications, medication, and cosmetic procedures, to manage PCOS-related symptoms effectively. 

Empowering women to address both the physical and emotional aspects of PCOS fosters a holistic approach to health and well-being, promoting greater self-confidence and overall satisfaction with appearance and quality of life.

Scope of PCOS

PCOS stands as a significant public health concern, representing one of the most prevalent hormonal imbalances among women of reproductive age. Estimates indicate that 8–13% of women within this demographic are affected, with a troublingly high rate of up to 70% of cases remaining undiagnosed. Certain ethnic groups face a heightened prevalence of PCOS, predisposing them to increased metabolic complications. 

Moreover, the multifaceted impact of PCOS extends beyond physical health, encompassing profound biological and psychological repercussions. Issues such as obesity and infertility often culminate in mental health challenges, increasing the burden of this condition. Additionally, the societal stigma surrounding PCOS exacerbates the psychological distress experienced by affected individuals, increasing the already complex array of challenges they confront. 

Addressing PCOS comprehensively requires a combined effort from healthcare professionals, policymakers, and society as a whole to promote awareness, early detection, and equitable access to treatment and support services, thereby alleviating the substantial burden it imposes on women's health and well-being.

What are the clinical features Of Polycystic Ovary Syndrome?

The main features of PCOS are due to hormonal imbalances. They include the following. 

  • Anovulation: Anovulation is the absence of ovulation (the process where an egg or ovum is released from the ovaries during the menstrual cycle). Female sex hormones, particularly oestrogen, are required for the release of ova from the ovaries. When no ovum is released, fertilisation and hence conception cannot happen. This is the reason women with PCOS can have infertility. 

  • Irregular menstrual cycles: The menstrual cycle is a delicate, structured system that depends on many hormones to work seamlessly and occur regularly and properly. Irregular cycles can present as less frequent periods, varying periods of time between cycles, and reduced flow. 

  • Features of increased androgen levels (hyperandrogenism): These include:

  • Increased hair growth & male pattern distribution over the body, which is also called hirsutism. Women with hirsutism commonly have increased hair growth over the lip, chin, abdomen, etc. 

  • Male pattern hair loss

  • Acne 

  • Obesity

  • Diabetes Mellitus: Diabetes, a disorder of insulin dysfunction, is closely related to PCOS.

  • Sleep apnea: OSA, or obstructive sleep apnea, is commonly associated with PCOS. Sleep apnea is a condition affecting your breathing when you are asleep. 

The ovaries in PCOS may be enlarged and filled with small cysts. Unlike what the name suggests, not all women with PCOS actually have cysts on their ovaries. 

Risks Of Complications In Pregnancy

PCOS significantly diminishes the chances of conception while elevating the risks of miscarriage and pregnancy-related medical complications, including diabetes. Preconception preparation plays a pivotal role in mitigating these risks, with maintaining a healthy weight emerging as a critical factor. Prioritising weight management by achieving and sustaining a normal weight before pregnancy is paramount, particularly for overweight individuals. 

Stopping smoking is imperative, given its detrimental impact on both fertility and pregnancy outcomes. Embracing a diverse and nutritious diet fosters optimal health for conception and pregnancy, while regular exercise promotes physical fitness and overall well-being. These proactive measures not only enhance the likelihood of a successful pregnancy but also mitigate the risk of complications associated with PCOS. 

By adopting a holistic approach to preconception care, women with PCOS can optimise their reproductive health and improve the prospects of a healthy pregnancy and childbirth.

PCOS types

Scientists propose categorising PCOS into Non-hyperandrogenic (type D), Ovulatory (type C), Non-PCO (type B), and Full-blown (type A) based on symptoms and hormone levels. Informally, PCOS is categorised as Insulin-resistant, Inflammatory, Hidden-cause, and Pill-induced. Insulin resistance heightens the risk of type 2 diabetes, while inflammation exacerbates symptoms. 

Genetics and environmental factors likely contribute to PCOS. Pill-induced PCOS occurs when birth control masks symptoms. Understanding these classifications aids in tailored management approaches, emphasising lifestyle modifications and appropriate medical interventions.

Hormones and PCOS

PCOS disrupts reproductive hormone balance, including insulin, androgens, follicle-stimulating hormone, luteinising hormone, progesterone, and oestrogen. Insulin resistance, prevalent in 30%-80% of cases, leads to excess insulin and androgen production. Elevated androgens affect ovulation and menstruation, causing irregular cycles and symptoms like acne and unwanted hair growth. 

Follicle-stimulating and luteinising hormones regulate ovulation, while insufficient progesterone leads to missed periods. PCOS may also disrupt the balance of ovarian hormones, exacerbating hormonal imbalances and associated symptoms.

How is Polycystic Ovary Syndrome diagnosed?

PCOS is diagnosed based on your clinical presentations, and associated blood and scan abnormalities. Your doctor will elicit a detailed menstrual history, which can provide details of dysfunction. They will perform a physical examination, which may also include a pelvic and per-vaginal examination if required, to look for any obvious signs of the disease as well as to check for any other masses/diseases causing similar symptoms. They may also look for signs of insulin resistance and other evidence of hormone imbalances. 

Blood investigations are done, including:

  • Androgen hormone levels

  • Lipid profile (to evaluate blood cholesterol levels)

  • Blood sugar levels & Glucose tolerance test (to look for insulin dysfunction) 

  • Thyroid levels (a decrease in thyroid levels can contribute to hormonal dysfunctions & menstrual abnormalities as well)

  • Prolactin levels (a hormone produced by the pituitary gland in the brain that can be increased in a proportion of patients)

The most commonly done radiological investigation to aid a diagnosis of PCOS is an ultrasound scan of your pelvis. The reproductive organs are visualised here, and any abnormality of the ovary can be seen. However, not all women with PCOS need to show some obvious change in the ovary on this scan.

This scan can be done abdominally, or a specialised way called transvaginal ultrasound may be done as the visualisation is better on this modality. The ultrasound probe is inserted through the patient’s vagina; it is a relatively painless and quick procedure.

If you have other symptoms of this disease, specialised tests for their evaluation may also be done (for example, sleep study in patients with symptoms of sleep apnea).

What is the treatment for Polycystic Ovary Syndrome?

The treatment for PCOS involves the use of specific medications along with significant lifestyle modifications. Treatment options include the following.

  • Medications to normalise hormonal cycles are used to manage the abnormal menstrual cycles that occur in PCOS. These medications are typically drugs that affect different hormones or are synthetic forms of hormones. The commonly used medicines include Oral Contraceptive Pills (OCPs) or Birth control pills and Progestins. Both of these medicines work to decrease androgen levels and promote the levels of the female sex hormones. 

  • Metformin is a regularly used diabetes medication that is also used in PCOS. It is used to combat insulin resistance, promote weight loss, and also delay the onset of diabetes in patients with PCOS. 

One of the major concerns in women with PCOS is infertility or difficulty in getting pregnant. Hormonal therapy is also used to induce the release of the egg to aid in this process.

The good news is that a lot of the symptoms of PCOS can be controlled by making lifestyle changes such as those shared below. 

  • Avoiding processed food. Pick fresh, whole foods instead.

  • Increasing the intake of antioxidant-rich foods such as broccoli, spinach, carrots, etc.

  • Reducing caffeine consumption.

  • Eating healthy probiotics found in fermented food and curd.

  • Including low-impact exercises such as yoga or walking in your daily routine.

  • Improving sleep hygiene by getting seven to eight hours of uninterrupted sleep every night.

  • Reducing stress and including self-care activities such as long walks or meditation

  • Limiting the use of chemical substances such as dioxins, phthalates, or pesticides that may be found in certain foods or household products. These substances are known to interfere with hormone levels.

  • Exploring alternative options such as acupuncture or the use of Ayurvedic products such as ashwagandha have been shown to be effective. However, these should only be tried after consulting a specialist.

Frequently Asked Questions

Here’s a list of common questions and answers related to PCOS.

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Is PCOS on the rise?

The incidence of PCOS is on the rise with studies showing that up to one in five women now suffer from this condition.

Is PCOS linked with other medical conditions?

PCOS is also linked with an increase in the incidence of depression and anxiety.

What are the basic changes one needs to do to manage this condition?

Healthy lifestyle changes and stress reduction have been strongly advocated in controlling the long term effects of this medical condition.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions. 

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