Polycysticovarian syndrome, widely known as PCOS, is a hormonal disorder affecting women in the reproductive age group. The incidence of PCOS in Indian women is increasing every year. It is estimated that about 1 in5 Indian women in the reproductive age group suffer from PCOS. More and more young women are now becoming aware about PCOS.
The number of women visiting a Gynaecologist’s office to know if their symptoms are consistent with PCOS is also increasing. In this article, we shall attempt to demystify PCOS and empower women to make better treatment choices.
While the terms PCOD and PCOS are often used interchangeably, there is a difference between the two conditions. PCOD is a disorder in which the ovaries appear enlarged and polycystic. PCOS on the other hand is a more serious metabolic condition.
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a. ) Anovulatory menstrual cycles - An anovulatory menstrual cycle is the one in which the process of ovulation (release of a mature egg) does not happen. This may manifest as irregular periods or difficulty in conceiving.
b.) Hyperandrogenism – High levels of "male" hormones in your body may cause physical signs such as excessive facial hair growth, thinning of scalp hair or breakout of acne.
c.) Ultrasound findings of polycystic ovaries – The ovaries appear enlarged in size with a volume greater than 10 cc and show more than 20 small follicles of about 2-8 mm diameter arranged peripherally in each ovary giving it a ‘String of Pearls’ appearance.
A diagnosis of PCOS is made if at least 2 of these 3 features are present.
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The exact cause for PCOS is still not known. However it appears to be strongly linked with genes associated with diabetes and insulin resistance. PCOS is usually triggered by a sudden weight gain attributable to a stressful or sedentary lifestyle. It has also been associated with chronic low grade inflammation. .
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In most cases the signs and symptoms of PCOS start after an episode of sudden weight gain. In few women, symptoms may be apparent from teenage years. Few women may discover the problem only when they find it difficult to conceive. Following are the common signs and symptoms of PCOS –
1) Irregular periods – Most women with PCOS experience delayed periods with scanty bleeding due to lack of ovulation. Some women experience only blackish brownish discharge during periods. Some women may not get periods at all and need medication to induce periods. Some women experience very frequent periods. However, some women with PCOS might have regular periods with normal bleeding. Some women with PCOS experience very heavy or prolonged bleeding, especially if the periods are substantially delayed. .
2) Hair growth – Hirsutismor excessive growth of coarse dark hair on the face, chest, belly, back, thighs or upper arms, is a visible and bothersome symptom of PCOS. It is caused by the high levels of androgens present in the body.
3) Acne – Skin becomes oily due to the effect of male hormones leading to clogged pores and development of nodulocystic acne , especially in the beard area and jawline.
4) Weight gain – Women who have PCOS are prone to insulin resistance. As a result women with PCOS tend to put on weight rapidly. Losing weight can be quite a challenge and women with PCOS often find themselves struggling to shed the extra kilos. Overweight or obese women with PCOS are at an increased risk of developing diabetes, hypertension, high cholesterol and heart diseases.
5) Skin darkening – Dark velvety discoloration of skin folds and body creases like on the neck, in the groin, armpits or under the breasts is a sign of insulin resistance usually observed in overweight or obese patients with PCOS
6) Hair Fall – Hair fall and thinning of scalp hair is also a sign of high androgen levels.
7) Mood Disorders - Studies have shown that women with PCOS have a higher risk of suffering from mood disorders like depression or anxiety.
8) Headaches – Women with PCOS may suffer from headaches which are triggered due to hormonal changes.
Unfortunately there is no permanent cure for PCOS at present. The treatment is aimed at alleviating the symptoms. It may involve regularization of periods in women with irregular cycles, or reduction of acne and excessive facial hair growth or treatment for fertility. The recommended treatment options include –
1. Lifestyle changes - lifestyle interventions can really make a difference and relieve symptoms. Eat a balanced diet, include plenty of fruits and vegetables. Avoid fried items, junk food and sugary or calorie dense foods. Limit the intake of caffeine. Exercise regularly and be physically active. Get enough sleep. Try to maintain your weight in the normal range for your height. Say absolute no to smoking, as this increases the risk of hypertension, cholesterol and heart disease.
2. Birth control pills - These are usually prescribed to regularize periods. Birth control pills suppress excessive androgens and also help reduce acne, excessive hair growth and thinning of hair.
3. Metformin - Metformin is a medicine commonly used in the treatment of type 2 diabetes but can also be used to break insulin resistance in PCOS patients, in whom glucose tolerant test are abnormal. Anti-androgenic medicines - Medicines like Spironolactone have anti-androgenic action and may be prescribed to reduce acne and facial hair growth, if high level of androgens are detected.
4. Fertility Treatments :
If pregnancy is desired then treatment is aimed at bringing about ovulation with the help of medication. Sometimes, Metformin may also be added to improve the outcome. Rarely, a surgical procedure called laparoscopic ovarian drilling may be performed for fertility problems associated with PCOS that do not respond to medicine. Some women may need a more aggressive approach like IVF.
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Dermatological treatments for acne, excessive facial hair growth and thinning of scalp hair may be warranted in some cases. A combination of laser treatments, birth control pills and eflornithine cream is seen to be more effective for reducing the facial hair growth.
