
PCOS ( Polycystic Ovary syndrome) is a endocrine disorder. It is a common condition which affects how a woman’s ovary works.
There are 3 main features of PCOS:
Irregular periods because the ovary does not release eggs regularly, High level of male hormone ( androgen) which causes excess facial and body hair.
Polycystic ovaries: Ovaries are enlarged and contain many fluid filled sacs (follicles) that surround the eggs which gives a polycystic appearance. But there are no cysts actually. There are just large number of harmless follicles that are upto 8mm in size. These follicles are underdeveloped and unable to release eggs which means there is no ovulation.
If two of these features are present a diagnosis of PCOS is made.
Symptoms:
Not all women with PCOS will have all the symptoms of PCOS and the severity of symptoms may vary. These symptoms usually become apparent during the teens and early 20's.
Common symptoms are:
* Irregular periods or no periods at all
* Infertility because there no egg release
* Excess male type of facial and body hair ( hirsutism)
* Obesity/ weight gain
* Hair loss/ thinning hair
*Acne/ oily Skin
Girls in their teens present usually with menstrual irregularities like absent or delayed period and excess facial/ body hair and hair loss.. Women in the reproductive age discover PCOS when they have problem in getting pregnant.
Causes:
Exact cause is not known. It is thought to be genetic and environmental.
1. Genetic: PCOS runs in families and now is thought to be autosomal dominant inheritance. The specific gene has not been identified.
2. Obesity, infectious agents and toxins, poor dietary choices and physical inactivity exacerbate PCOS. Hence lifestyle modification such as exercise and weight loss can help in reversing PCOS.
3. Insulin resistance: PCOS patients have Insulin resistance where the body cannot use the insulin. The excess insulin causes obesity. It also causes excess testosterone production from the ovaries which prevents egg release.
4. Hormonal imbalance: Raised testosterone levels, raised prolactin hormone, raised luteinizing hormone( LH) and low sex hormone binding hormone ( SHBG) are some of the abnormal hormone levels in PCOS candidates. These changes are caused partly by insulin resistance.
Diagnosis:
Diagnosed with symptoms, hormone tests and ultrasound.
PCOS patients need to be screened for diabetes and high cholesterol. Irregular periods, polycystic ovaries and excess hair growth are the main symptoms and PCOS can be diagnosed is 2 of these three are present.
Treatment:
PCOS has no cure till date. But it can be kept under control and the treatment depends on the age and requirement.
Lifestyle changes: Diet and Exercise for weight loss and maintaining BMI between 18.5and 24.9 is ideal. Even a 10% weight loss helps in controlling PCOS. Eating healthy balanced diet like plenty of fruits and vegetables, whole grains and cereals, lean meat and fish.
Medication:
There are several medications which should be recommended by your gynaecologist. It may include metformin, OCPs etc., which has to be through your gynaecologist. Self medicating is dangerous.
Hirsutism or excess hair growth can be treated with medication like spironolactone, cyproterone acetate, finasteride etc., which should be through physician prescription.
For pregnancy either clomiphene or letrazole is used.
Rarely laparoscopic cyst puncture is used if medication does not result in pregnancy.
IVF is recommended if all other treatments fail.
Other medications:
1. Weight loss medication with physician opinion and advice
2. Cholesterol lowering medication like statins
3. Acne treatment
Risks in later life:
Women with PCOS are at an increased risk of developing:
* Type 2 diabetes
* Depression
* Hypertension, high cholesterol which can lead to cardiac problems and stroke
* Sleep apnoea
* Endometrial cancer: cancer of the uterine lining especially if there are less than 5 menstrual periods in a year.
PCOS is a lifetime problem. Hence regular follow up is necessary with a gynaecologist. Active lifestyle, exercising and dietary modifications go a long way in controlling PCOS. Only severe cases need medication. Over the counter medications should be avoided. Regular gynaecologist consultation and follow up as suggested can treat and prevent long term complications.
Author is Specialist Obstetrics and Gynaecologyst at YIACO Medical, Salmiya.
Dr. Revathi Ravikumar
MBBS,DNB (OBGYN)
MSc Reproductive & sexual medicine (UK) Specialist Obstetrics and Gynaecology
YIACO Medical, Salmiya.