POLYCYSTIC OVARIAN SYNDROME

“Polycystic Ovarian Syndrome”, might be a new word for you, but have you ever heard of hormonal imbalance? Ever wondered why some women skip periods, despite not being pregnant? Well, here’s a leading cause of hormonal imbalance- PCOS.

What is PCOS?

Polycystic ovary syndrome (PCOS), also known as Polycystic Ovarian Syndrome, is a common health problem caused by an imbalance of reproductive hormones. “Poly” means “many”, and “Cysts”, are fluid-filled sacs. Literally, this means many fluid-filled sacs in the ovaries.

PCOS affects the ovaries in women. The ovaries are responsible for producing the hormones (oestrogen, progesterone, and androgen in small amounts) that regulate a woman’s menstrual cycle. The ovaries release eggs to be fertilized by sperm cells. The release of an egg each month is called ovulation.

When the ovaries are affected, the menstrual cycle is disturbed and this could lead to irregularities in ovulation and subsequently menstruation.

Many women have PCOS but don’t know it. In one study, up to 70 percent of women with PCOS hadn’t been diagnosed.

PCOS affects 1 in 10 women of childbearing age. Women with PCOS have a hormonal imbalance and metabolism problems that may affect their overall health and appearance.

What causes PCOS?

The exact etiopathophysiology of this condition remains unclear. However some several factors play a part. 

• PCOS can result from abnormal function of the hypothalamic-pituitary-ovarian (HPO) axis. This affects the production of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), which are responsible for ovulation control. FSH stimulates the ovary to produce a follicle — a sac that contains an egg — and then LH triggers the ovary to release a mature egg.

• High levels of androgens. A major characteristic of PCOS is inappropriate gonadotropin secretion. Androgens are sometimes called “male hormones,” although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness. Women with PCOS have more androgens than normal. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne, which are two key symptoms of PCOS. One of the most consistent biochemical features of PCOS is a raised plasma testosterone level.

• An elevated level of insulin: Many women with PCOS have insulin resistance. Insulin resistance is when the body’s cells do not respond normally to insulin. Excess insulin might increase androgen production, causing difficulty with ovulation. 

What are the risks factors of PCOS?

• It’s seen typically in women in reproductive age. Most diagnosis are made as at when women are trying to getting pregnant. However, it can occur at any stage of puberty. 
• Being overweight or obese. 
• Have unhealthy eating habits, do not get enough physical activity.
• Family history of PCOS.
• Family history of Diabetes. 

Other possible causes include excessive prenatal exposure to androgen/testosterone. 

What are the signs and symptoms of PCOS?

PCOS is a “syndrome,” or group of symptoms that affects the ovaries and ovulation. Its three main features are:

• cysts in the ovaries (Seen via ultrasound scan)
• high levels of male hormones
• irregular or skipped periods (menstruation)

Others include:

• Hirsutism. It involves having too much hair on the face, chin, or parts of the body where men usually have hair.
• Acne on the face, chest, and upper back
• Thinning hair or hair loss on the scalp; male-pattern baldness
• Weight gain or difficulty losing weight
• Darkening of skin, particularly along neck creases, in the groin, and underneath breasts.
• Skin tags, which are small excess flaps of skin in the armpits or neck area.
• Infertility.

How is PCOS diagnosed? 

No single test can suffice to make a diagnose of PCOS, rather a combination of test are done. 

• Detailed history, to rule out other causes of your symptoms. 
• Physical examination.
• Pelvic exam.
• Blood tests (for cholesterol, glucose, and the level of androgens and testosterone).
• Ultrasound (to assess the ovaries appearance. A woman is diagnosed with PCOS if she has 20 or more follicles in at least 1 ovary).

How can PCOS be treated? 

There is no cure for PCOS, however the symptoms can be managed. 

Treatment plans are usually individualized based on symptoms, plans for having children, and risk of long-term health problems such as diabetes and heart disease. A combination of treatment plans is used. 

• Lifestyle changes, such as diet and exercise, are considered first-line treatment for adolescent girls and women with PCOS. 
• Pharmacologic treatments are reserved for metabolic derangements associated with PCOS such as anovulation, hirsutism, and menstrual irregularities. 
• Surgical management of PCOS is aimed mainly at restoring ovulation. 

Can I still get pregnant with PCOS?

The answer is Yes. Having PCOS does not mean you can’t get pregnant. Although PCOS is one of the most common causes of infertility in women, it is treatable. Since PCOS affects the ability to ovulate, treatment plans are usually targeted at aiding ovulation and chances of getting pregnant. 

PCOS is a disease with many long-term complications. Patients need regular follow-up with their physicians for early detection and management of any untoward sequelae associated with the syndrome. 

However, judicious consistent lifestyle modifications such as maintaining healthy diet with fruits and high fiber meals, exercise, controlled blood glucose level, avoid alcohol and smoking have been found to reduce the severity of PCOS. 

Still, have questions on PCOS? Leave a comment and remember to share with someone.