Polycystic ovarian syndrome (PCOS) is a multifactorial disorder that is considered as the most common reproductive disorder for females in their childbearing age. This condition is characterized by increased androgen levels, menstruation cycle abnormality, and the presence of cysts in one or both ovaries.
What happens in your body with PCOS?
The female body have two ovaries right and left, where eggs are formed. One or multiple eggs are matured and then released from one of two ovaries toward uterus via fallopian tubes. In PCOS person’s, numerous fluid-filled cysts are formed in ovaries that retards the maturation and release of an egg from the ovary. These cysts may be present in single or both ovaries.
This abnormality halts the normal functioning of hormones that help egg maturation and its release in the ovary. In PCOS, Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), estrogen, and progesterone are not enough to release an egg. This is called anovulation and it disturbs menstruation cycle.
Causes of PCOS
Researchers and health professionals not exactly know why and how polycystic ovarian syndrome arises in women. It is assumed that the excess of male hormone androgen stops the ovaries from the release of egg normally. Some of the causes that seem to be repeated in most of PCOS patients are:
- Genes. According Johns Hopkins Medicine, PCOS is a genetic syndrome that runs in families. But it is also considered that only one gene is not responsible for the cause.
- Insulin resistance and excess androgen. According to US National Institute of Health about 65-70% of women suffering from PCOS are resistant to insulin. It means that insulin receptors are not working and are not capable of utilizing insulin. That’s why due to improper insulin functioning their body tend to be obese and have a high risk of diabetes.
- Inflammation. In a study at US National Institute of Health, it is observed that PCOS patients have a high level of inflammation in their bodies. Polycystic ovarian syndrome elevates the level of inflammatory markers like CPR, MCP-1 LI-18, and white blood cells count.
- Stress. Stress is an important factor that worsens the PCOS because of hormonal imbalance in the body.
Symptoms of PCOS
Due to a wide range of signs and symptoms, it becomes difficult to set grading criteria for the diagnosis. Following are some most common symptoms found in women:
- Irregular periods or no periods. Because of anovulation, uterus lining gets thicker and does not shed. PCOS patients see fewer periods a year.
- Heavy bleeding. Thicker uterus lining when sheds, it doesn’t follow a normal pattern. Periods get heavy and prolonged with blood clots.
- Hirsutism (hair growth on face and body). Due to the overstimulation of male hormone, growth of hair gets prominent on the areas of face, chest, and upper back. It is named as hirsutism.
- Alopecia (loss of hair) or thin, scanty hair. It is also termed as male pattern baldness where the hair on scalp gets thinner and then fall out. It is more prominent on front area of scalp.
- Acne. Excess of male hormone makes skin oily and cause breakouts on the face, back and chest.
- Darkening of skin complexion. Dark patches start to appear on body specific areas of body like on the neck, in the groin, and under the breast.
- Weigh gain at pelvic area (pear-shaped body). Insulin resistance and usual carbohydrate intake aggravate the fat deposition which increases weight. This fat deposition usually occurs around the hips giving a pear-shaped look to the body.
- Infertility. Due to hormone imbalance the probability of egg release drops and causes infertility.
- Headache. Hormonal changes that cause polycystic ovarian syndrome also gives you headache.
The diagnosis of polycystic ovarian syndrome depends on two types of symptoms – endocrine symptoms and metabolic symptoms. PCOS being a complex disorder have numerous symptoms and they differ from woman to woman, not all the symptoms are present in every woman. Symptoms get change with the phases of life.
In short, what to notice in PCOS patients are:
- Fertility and reproductive health
- Metabolic health
- Psychological health
Diagnostic criteria of PCOS is set as if any of two symptoms from the following three symptoms present, the person will become the suspect of PCOS:
- Irregular periods or no periods
- A higher level of androgen
- Polycystic ovaries visibility on a scan
How will this diagnosis be made?
When a woman come to a healthcare provider regarding their reproductive or menstrual cycle, following observations will be considered.
- Medical history of signs and symptoms. Menstrual cycle history, and unusual signs and symptoms patient having in this duration like acne, hirsutism, weight gain, body mass index (BMI), amenorrhea, dysmenorrhea etc.
- Pelvic examination. In pelvic examination your healthcare provider physically checks your ovaries, fallopian tubes, vagina, and uterus. Pelvic examination is used to check whether patients have any masses, growths, swelling or other abnormalities in the pelvic area. It determines the presence of inflammation.
- Blood test. Blood laboratory tests are the most important and authentic way to show whether insulin level, androgen or other hormone levels are in the normal range or not. In blood test the levels of hormones like estrogen, TSH, FSH, LH and prolactin are noticed.
In case when a patient is gaining weight because of PCOS, the following tests will be done to check insulin resistance:
- Blood cholesterol level
- Sugar metabolism/ Glucose tolerance test
There is another test to confirm the formation of cysts in the ovaries:
- An ultrasound examination. Ultrasound examination is done to have a clear image of the uterus, ovaries, and the pelvis. This examination shows the presence of cysts in ovaries and health of endometrium lining (it thickens due to irregular periods).
This scan may be abdominal or transvaginal. Your ovary will enlarge from 1.5 tp 3 times if you have polycystic ovarian syndrome.
Treatment of PCOS
As there is no cure for PCOS but it can be managed and controlled by modifying lifestyle and habits. You should change your eating habits (what to eat, when to eat, quantity or portions of food) and do regular physical exercise (walking, jogging, yoga, etc) to manage PCOS.
Weight loss through a low-calorie diet combined with moderate exercise is recommended to cope up insulin resistance. According to Center of Disease Control and Prevention, losing weight increases the effectiveness of PCOS medication and fertility chances.
Pharmacological treatment is based upon a patient’s history and current profile. If the patient wants to conceive then ovulatory medication will be suggested. If the patient does not want conception then hormonal contraceptives will be suggested. Symptomatic treatment for hair growth, acne will suggest to the patient of polycystic ovarian syndrome.
Medicines to induce ovulation (if you want to get pregnant)
Following medicines are used to induce ovulation (egg production in ovaries and its release from ovaries):
- Clomiphene. It is used in the first week of the menstrual cycle with the consent of your healthcare professional. After a specific passage of time, scan is necessary to see the status of egg formation. The further dose is adjusted according to the scan.
- Letrozole. The main role of this medicine is in breast cancer treatment because it regulates certain hormones. These hormones are also effective in the stimulation of ovaries for proper ovulation.
- Gonadotrophin. These hormones are used in the form of an injection to promote the ovaries to release an egg and proceed further toward fertilization.
Medicines for irregular menstrual cycle (if you don’t want to get pregnant)
You also have irregular menstruation cycle due to cyst in your ovaries. Following medicines help you in regulating menstruation cycle:
- Combination of birth control pills. These birth control pills contain estrogen and progestin that decreases androgen production and regulates estrogen. It regulates your hormone, menstrual cycle, hair growth and acne.
- Progestin therapy. It includes taking 10-14 days progestin every month to regulate the menstrual cycle and reduces the risk of endometrial cancer. It does not prevent pregnancy.
Medicines for insulin resistance
You will also face insulin resistance and risk of type 2 diabetes to cope-up with this condition following drug is effective:
- Metformin. This oral medication is used to decrease carbohydrate uptake into the blood. Hence lower the blood sugar level and helps with polycystic ovarian syndrome.
Medicines for hirsutism
To decrease the hairs and other effects of hirsutism following medicines will work for you:
- Spironolactone. This is used to block the effects of excess androgen on the skin. It is not recommended for pregnant ladies or ones who are planning to get pregnant
- Eflornithine. This is a topical medication used to reduce facial hair growth
- Electrolysis. Electrolysis is a hair removal treatment where a thin needle inserted into each follicle. An impulse of electricity is used to damage and destroy the follicle.
Laparoscopic ovarian drilling is a minor surgical process used to destroy certain part of ovaries to stimulate ovulation. This procedure is done in those PCOS patients who does not respond to medication therapy.
Complications of PCOS can include:
- Gestational diabetes or pregnancy-induced high blood pressure
- Miscarriage or premature birth
- According to US National Institute of Health (PubMD), metabolic syndrome including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease.
- Type 2 diabetes or prediabetes
- Sleep apnea
- Depression, anxiety and eating disorders
- Stroke according to Center of Disease Control and Management
- Abnormal uterine bleeding
- Cancer of the uterine lining (endometrial cancer)
Pregnancy and PCOS
The women with PCOS have to face many complications before, during, and after pregnancy. First, it becomes difficult for PCOS patients to get pregnant. Sometimes IVF becomes the sole procedure toward pregnancy. When they get pregnant there are higher chances of having a miscarriage. By taking proper medication and following the guidelines of healthcare providers the risk of these complications can be minimized. Following complications occur in pregnant women with PCOS:
- High blood pressure
- Premature birth
- Gestational diabetes
Women with PCOS have to mostly deliver their babies through the cesarean section because their babies are larger than normal. There is a greater risk of death of a baby during delivery in a woman with PCOS. The risk of these complications can be reduced by taking more care during pregnancy and strictly observing the symptoms of polycystic ovarian syndrome.
Living with PCOS
Many women are striving hard with the health and skin effects of PCOS. Most of the women are worried about their facial hair and acne that makes them look ugly. These women can seek medical treatment like laser hair removal to make themselves satisfied with their looks.
Moreover, weight gain is another hectic issue related to this syndrome, obesity totally changes one’s lifestyle. An overweight person can’t enjoy life fully but one can get rid of it by proper exercise and medications related to high cholesterol levels. Talk to your medical healthcare provider for all the issues that distress you.
In PCOS patient it is necessary to observe what kind of body metabolism they have. Rich fiber diets and low carbohydrate intake will increase the fertility rate and will keep the duration of menstrual cycle normal. Light but frequent meals help patients to remain their BMI in the normal range.
Physical activity like stretching, walking and yoga is good for maintaining a healthy life. Studies at Harvard Medical School suggest that yoga decreases testosterone level, symptoms of anxiety and depression in women. These exercises increase insulin sensitivity in the patient’s body.
Common myths about PCOS
You can’t be pregnant with PCOS
This is the most stereotype myth regarding PCOS. Polycystic ovarian syndrome can’t stop pregnancy but the probability of getting pregnant decreases due to anovulation. Many medicines used these days for PCOS to get pregnant by naturally enhancing the probability of ovulation. If in-vivo pregnancy fails to start then IVF is the most effective method to correct the conceiving issue.
No treatment of PCOS
No one can treat PCOS by100% but it can be managed and symptoms can be treated by modifying lifestyle, taking appropriate medication, exercise, diet control and routine checkups.
IVF does not work for PCOS patients
This is a false argument. PCOS patients feel difficulty in having periods regularly. It does not mean they have no egg production. It depends upon medical condition of patient – whether the medication is affecting the ovulation or not. If a female egg is not getting fertilized or not able to fertilize naturally then IVF is the most recommended option. In IVF, the egg is fertilized outside the body and implant in the woman’s womb. Rest of pregnancy continues as in normal woman
PCOS is the most common, poorly identified and badly managed disorder. It has various causes either hereditary or environmental factors. There must be no shame to accept if someone is diagnosed with PCOS. The stressful environment may potentiate and worsen the symptoms. With a proper diagnosis, medication and lifestyle patients can enjoy all the perks of life. PCOS patient must focus on her health and design it in a way to manage it maximally so that she may prevent herself from the risk of metabolic and cardiovascular problems. Women who are well aware of the PCOS and its management are living a far better than others.
STAY AWARE, STAY HEALTHY