Team AckoSept 21, 2023
Polycystic Ovary Syndrome, commonly abbreviated to PCOS/PCOD (Polycystic Ovarian Disease), is seen in women in the reproductive age group (between the onset of puberty and menopause). It is a commonly encountered cause of abnormal periods, as well as infertility. The incidence of Polycystic Ovary Disease is steadily increasing and is a commonly encountered issue in a gynaecology clinic. Here’s an overview of this medical condition.
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.
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.
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
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.
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).
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.
The incidence of PCOS is on the rise with studies showing that up to one in five women now suffer from this condition.
PCOS is also linked with an increase in the incidence of depression and anxiety.
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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