Polycystic Ovarian Syndrome (PCOS) Symptoms, Causes and Treatment
Polycystic ovarian syndrome (PCOS) is a common endocrine disorder as well one of the common causes of infertility among women characterized by an ovulation dysfunction or impedance to the normal growth and release of eggs from the ovaries. It is commonly seen in women of the child bearing age and is rare after menopause. The hormonal imbalance leads to the enlargement of ovaries, which contain numerous small cysts, filled with fluid.
PCOS affects at least 7% of adult women. Research suggests that 5% to 13% of females 18 to 44 years of age are affected by PCOS, making it the most common endocrine abnormality among women of reproductive age. This figure is even higher and reaches up to 52% in South East Asian and Mediterranean regions.
PCOS Causes
The exact cause of the polycystic ovarian syndrome is not known. However, several factors including genetics have been implicated to play a role in the development of PCOS. Women with a prior family history of polycystic ovarian syndrome are at a higher risk of developing this condition. Researchers have also found an association between excessive insulin production and the development of PCOS. The insulin hormone plays a crucial role in controlling blood sugar levels. Any dysfunction in the insulin mechanism can lead to an overproduction of insulin, subsequently causing the ovaries to release androgens. Low grade inflammation, in response to ingestion of certain foods, may lead to the release of substances that may cause insulin resistance and cholesterol accumulation in the blood vessels or atherosclerosis. Clinical studies have demonstrated the presence of low-grade inflammation in women with PCOS. Excessive exposure to the male hormone during fetal period may disrupt the function of normal gene and increase the risk of insulin resistance and low-grade inflammation.
PCOS Symptoms
The symptoms of the polycystic ovarian syndrome vary from person to person and the nature and severity of the condition. Some of the symptoms of PCOS include: –
- Infertility: PCOS is one of the most common causes of female infertility.
- Menstrual disorders: can include absent or irregular menstrual cycle. periods that occur infrequently or too frequently, heavy periods, or unpredictable periods.
- Obesity or accumulation of fat, usually around the waist. Up to 80% of women with PCOS are obese.
- Abnormal facial and body hair: Excess hair growth on the face, abdomen, chest, or upper thighs, this condition is called hirsutism and affects more than 70% of women with PCOS.
- Adult Acne usually occurs after adolescence and does not respond to usual treatments.
- Male pattern of baldness: Excessive secretion of androgens can lead to the development of male pattern baldness or thinning of hair.
- Patches of thickened skin: In some patients black or dark brown patches of darkened skin called “acanthosis nigricans” are seen around the skin of the neck, arm, breasts or thighs.
- Individuals may frequently encounter anxiety or depression, along with breathlessness during sleep (sleep apnea).
PCOS Diagnosis
There is no definitive test for PCOS. The diagnosis is primarily based on the medical history along with physical and pelvic examination. Medical history coupled with physical and pelvic examinations, MI and scoring systems for hirsutism, aids in evaluating the patient’s condition and identifying the root cause. Blood tests are conducted to determine the level of various hormones such as the male hormones and AMH(anti mullein hormone ) levels . Additional tests such as HBA1c, glucose tolerance test and evaluation of blood cholesterol may also be conducted in these patients, depending on clinical evaluations. Pelvic ultrasound is performed to evaluate the appearance of the ovaries and the uterine lining in adult women.
PCOS Treatment
Treatment for PCOS is mainly directed at the symptoms and individual concerns such as infertility, irregular menstrual cycle, acne or obesity. Both medications and surgical treatment are used for the management of PCOS. Treatment goals include correcting anovulation, inhibiting the action of androgens on target tissues, and reducing insulin resistance.
- Weight Management: Weight reduction is particularly advantageous for obese PCOS patients. It contributes to decreased androgen, luteinizing hormone (LH), and insulin levels. Weight loss aids in regulating ovulation, thereby enhancing the likelihood of pregnancy.
- Fertility Therapy: Infertility may be addressed through ovulation-inducing drugs, such as Clomiphene citrate, an oral anti-estrogen. Metformin may be added to enhance the induction of ovulation in non-responsive cases. Letrozole may be more effective in inducing ovulation in PCOS patients.
- Gonadotropins Administration: For patients unresponsive to Clomiphene and Metformin or letrozole, gonadotropins like follicle-stimulating hormone (FSH) and luteinizing hormone (LH) can be administered via injection.
- Oral Contraceptives: Prescription of oral contraceptives helps manage irregular menstrual cycles by effectively reducing male hormone levels. They also prove effective in mitigating excessive body hair growth and lowering the risks of uterine cancer.
- Lifestyle Modifications and Anti-Diabetic Medications: Lifestyle changes and anti-diabetic medications may be recommended for obesity and diabetes mellitus management or prevention.
- Surgical Options: Surgical interventions, such as laparoscopic ovarian drilling, an outpatient procedure, may be advised for patients unresponsive to medications. This procedure aims to treat the condition and induce ovulation but may cause pelvic adhesions.
Managing PCOS through Diet and Lifestyle Changes
- The initial approach to treating PCOS often involves lifestyle adjustments, emphasizing weight loss, dietary modifications, and regular exercise.
- Even a modest weight reduction of 5 to 10 percent can have a positive impact on regulating the menstrual cycle and alleviating PCOS symptoms. This weight loss can also bring about additional health benefits, including improved cholesterol levels, decreased insulin levels, and a reduced risk of heart disease and diabetes.
- While any weight-loss-promoting diet can be beneficial, certain diets show particular advantages in the context of PCOS. Research indicates that low-carbohydrate diets are effective for both weight loss and insulin level reduction.
- Adopting a low glycemic index (low GI) diet, with a focus on obtaining most carbohydrates from fruits, vegetables, and whole grains, has been shown to better regulate the menstrual cycle compared to a standard weight loss diet.
- Engaging in moderate-intensity exercise for at least 30 minutes on a minimum of 3 days per week has been found to aid weight loss in women with PCOS. Combining exercise with a healthy diet proves even more beneficial, as the synergy enhances weight loss, improves ovulation, and regulates insulin levels.
Associated Risks
PCOS extends its impact beyond the reproductive system, elevating a woman’s risk of serious conditions with potential lifelong consequences.
- Patients with PCOS may frequently develop other serious medical conditions such as diabetes mellitus, cardiovascular diseases, pregnancy induced high blood pressure, miscarriage or premature delivery.
- Women with PCOS also tend to have “endometrial hyperplasia”, in which the lining of the uterus becomes too thick. This condition increases the risk of endometrial cancer.
- These patients are also at risk of sleep apnea, anxiety or depression.
Can I still get pregnant if I have PCOS?
Yes. Having PCOS does not mean you cannot get pregnant. PCOS is one of the most common, but treatable, causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation). If you don’t ovulate, you can’t get pregnant. Your gynecologist can talk with you about ways to help you ovulate and to raise your chance of getting pregnant.
Summary
PCOS has the potential to disrupt menstrual cycles and create challenges in conceiving. Elevated levels of male hormones can result in unwanted symptoms such as facial and body hair growth.
Initially, doctors typically recommend lifestyle interventions as the primary treatments for PCOS, and they often yield positive results. Weight loss, achieved through diet and aerobic exercise, proves effective in alleviating PCOS symptoms and enhancing the chances of successful conception.
When lifestyle changes are insufficient, medications become an option. Birth control pills and metformin are among the medications that can help restore more regular menstrual cycles and alleviate PCOS symptoms. Fertility may be enhanced by ovulation inducing medication leading to pregnancy.
