What is polycystic ovary syndrome (PCOS) or polycystic ovarian disease (PCOD)?

Polycystic ovarian syndrome or disease (PCOS/PCOD) is a hormonal disorder that affects women in their reproductive age. PCOS is a common health condition that affects teen and young women, it is seen in 1 out of o10 women in their childbearing age.  The reproductive system of women is controlled by the complex interplay of primarily five reproductive hormones namely estrogen, gonadotropin-releasing hormone, follicle stimulating hormone, progesterone and luteinizing hormone. An imbalance within these hormones leads to a hormonal disorder called the polycystic ovary syndrome (PCOS) or polycystic ovarian disease (PCOD) among women of reproductive age.

Polycystic ovarian syndrome is marked by the breakdown of reproductive hormones in women of childbearing age. Along with havoc in female hormonal control, ovaries release abnormal amounts of androgen (male hormones). This hormonal breakdown results in irregular or prolonged menstrual periods, excessive body hair, acne and hair loss. Polycystic ovaries may fail to develop follicles and regularly release eggs, causing difficulty in conceiving a pregnancy.

What are the causes of PCOS or PCOD?

There are no certain causes of PCOS, however the contributing factors include:

• Excess androgen: Overproduction of androgen by ovaries causes may lead to hirsutism and acne.
• Excess production of insulin: Insulin hormone controls the blood sugar levels in human body. When human cells become resistant to the action of insulin, the blood sugar level increases. As a result, the body produces an excess of insulin to control this increased blood sugar level. An excessive insulin production in turn increases the production of androgens which are the male hormones, otherwise very less in females. Increased androgen production causes difficulty with ovulation.
• Heredity: Certain genetic correlation may exist with PCOS in women.
• Presence of low-grade inflammation: Women with PCOS experience a low-grade inflammation that may stimulate polycystic ovaries to produce androgens.

What are the signs and symptoms of PCOS or PCOD?

Some women start experiencing symptoms around the time of their first period. Signs and symptoms of PCOS may vary; however, the symptoms are generally more severe in obese patients. Some of the commonly reported signs and symptoms of PCOS include:

• Acne
• Darkening of skin
• Hirsutism (abnormal growth of hair on face and body)
• Irregular menstrual cycle
• Polycystic ovaries, sometimes both ovaries may be involved i.e Bilateral Polycystic ovaries or ovarian cysts
• Skin tags
• Thinning hair
• Weight gain

Another gynaecological condition called endometriosis may have similar symptoms or the two may co-exist.

What are the possible complications of PCOS or PCOD?

Some of the possible complications of PCOS are:

• Abnormal uterine bleeding
• Psychological disorders like depression and eating disorders
• Endometrial cancer
• Pregnancy induced or Gestational diabetes and/or hypertension
• Infertility
• Metabolic syndrome
• Miscarriage or premature birth
• Non-alcoholic steatohepatitis
• Sleep apnoea

How is PCOS or PCOD diagnosed?

Your gynaecologist maybe able to diagnose PCOS on the basis of:

Medical history: To get detailed information about menstrual periods and weight changesPresence of at least two of the following symptoms is indicative of PCOS:

• Irregular periods
• Signs of high levels of androgens
  • – Hirsutism
  • – Acne
  • – Thinning of scalp hair
• Higher blood levels of androgens
• Polycystic ovaries

Physical examination

• Pelvic exam to assess the reproductive organs for masses, growths or other abnormalities

Tests:

• Blood, glucose tolerance, cholesterol and triglyceride levels etc
• Imaging:
  • – Ultrasound: To check the appearance of your ovaries and the thickness of the lining of your uterus.

Additional tests:

• Screening for depression and anxiety
• Screening for obstructive sleep apnoea

How is PCOS or PCOD treated?

Treatment of PCOS primarily focuses on management of underlying issues like infertility, obesity etc. Management is primarily with medications or lifestyle changes:

Medications for:

• Regulation of menstrual cycle
• Promoting ovulation
• Reduction of excessive hair growth

What lifestyle modifications could be beneficial for women with PCOS?

Some lifestyle modifications that can help in reducing the effects of PCOS include:

• Maintenance of a healthy weight: Weight loss can lower insulin and androgen levels and may restore ovulation.
• Diet management and limitation in consumption of carbohydrates: High-carbohydrate and low-fat diets may increase insulin levels.
• Exercise regularly: Exercise helps lower blood sugar levels and control body weight.

How can PCOS affect pregnancy?

Women with PCOS may face problems of:

• Increased indication for Cesarean section
• Gestational diabetes
• Miscarriage
• Preeclampsia
• Ovulation test may not be accurate

Risk of complications due to PCOS during pregnancy can be lowered by some of the following measures:

• Achieving healthy weight before pregnancy
• Achieving normal blood sugar levels before and during pregnancy
• Optimal level of iron stores

To know more about PCOS, you can request for a call back and our PCOS specialists will call you and answer all your queries.

What are the treatment options for patients with PCOS who are planning a pregnancy?

Some of the following options increase the chances of getting pregnant in women with PCOS:

• Weight management
• Medications as advised by the gynaecologist
• In vitro fertilization
• Surgery

References

• Polycystic ovary syndrome. U.S. Department of Health & Human Services. Available at: https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome. Accessed on: 10 March 2018.
• Polycystic ovary syndrome. Mayo clinic. Available at: https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443.Accessed on: 10 March 2018.
• Polycystic ovary syndrome.Eunice Kennedy Shriver National Institute of Child Health and Human Development. Available at: https://www.nichd.nih.gov/health/topics/pcos. Accessed on: 10 March 2018.

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