Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome, commonly identified by its abbreviation, ‘PCOS’ is a reproductive health issue concerning women, and occurs mainly due to hormonal imbalance and metabolic issues. Out of every ten women of reproductive age, about one is affected by PCOS. Women diagnosed with PCOS secrete androgen, the male hormone, in excess which leads to an undue buildup of follicles on the ovaries preventing them from ovulating.

Compromised ovulation could prevent women with PCOS from getting pregnant. PCOS could also play havoc with a woman’s regular menstruate periods, causing her to either have irregular periods or miss them often. Irregular periods could cause infertility as well as lead to accumulation of cysts in the ovaries, and hence the disorder is so named.

Epidemiology

All women, regardless of their race, religion, ethnicity or socioeconomic background are vulnerable to PCOS. However, women having a sister, mother or aunt suffering from PCOS or those who are overweight are at a higher risk. PCOS is prevalent in 5%-10% of women aged 15-44 (of childbearing age).

Women in their twenties and thirties, in most cases, discover they’ve PCOS when they’re unable to conceive. Nevertheless, a woman is susceptible to the syndrome the moment she crosses puberty.

Symptoms

  • Hirsutism: Abnormal hair growth on face, chest, arms, backside, and chin. Nearly 70% of women having PCOS tend to be hirsute.
  • Erratic periods: Almost all women affected by PCOS report having an irregular menstrual cycle or missing them for a long period. Many have also reported that their periods stopped altogether.
  • Acne: Outbreak on the chest, upper back, and face
  • Obesity: Overweight or obese women also face issues with losing weight
  • Hair loss: Hair loss from the scalp region leading to partial or complete baldness
  • Skin flaps: Around the neck area and armpits
  • Epidermis darkening: Observed beneath the breasts, groin, and neck folds  

Causes

PCOS continues to remain idiopathic, i.e. the exact causes remain unknown. Nevertheless, the majority of specialists are of the opinion that a combination of factors is responsible:

  • Hormonal imbalance: Women tend to produce more of the female sex hormones known as ‘estrogens’ that play a key role in the development of secondary sexual characteristics, and a minimal amount of androgens that help develop male traits. However, women with PCOS secrete androgen that is above the normal levels. Excessive secretion of androgen could interfere with their menstrual cycle and also impede ovulation. Inordinate androgen production could also cause hirsutism and acne.
  • Abnormally high blood insulin levels: Women with PCOS develop resistance against insulin, causing its level to rise in the bloodstream. Normally obese women, or the ones who lead an unhealthy lifestyle, and those who are genetically predisposed to Type 2 diabetes are prone to developing insulin resistance.

PCOS and Pregnancy

Many women suffering from PCOS have the mistaken notion that the condition comes in the way of their getting pregnant. Though PCOS is one of the biggest causative factors of infertility; the disorder is very much treatable. Gynecologists can help women (with PCOS) to remedy and restore their ovulation cycle which is crucial for pregnancy to occur.

PCOS & Other Health Issues

Medical research on PCOS has pinpointed correlations between the syndrome and a few health issues:

  • Hypertension: Women having PCOS are more susceptible to hypertension in comparison to those who do not have the problem. Hypertension is a high-risk factor for stroke and heart disease.
  • Diabetes: Almost 50% of women with PCOS are at risk of developing glucose or insulin intolerance which could eventually cause diabetes even when they’re in their thirties.
  • Sleep apnea: Many overweight women with PCOS could find it difficult to breathe while they’re sleeping which could make them snore.
  • High levels of bad cholesterol: LDL or bad cholesterol levels are higher, and HDL or good cholesterol levels are lower in women having PCOS. Both high cholesterol and sleep apnea aggravate risks of heart attack and stroke.
  • Endometrial cancer: Since women with PCOS usually have issues with ovulation, blood sugar, and weight, they’re disposed of developing endometrial cancer (cancer in the womb or uterus lining).
  • Depression: Women having PCOS also suffer from anxiety disorder and depression.

PCOS & Menopause

A significant proportion as they approach menarche (age at which menstrual periods fully stops) start experiencing regular periods. Nevertheless, the hormonal imbalance remains consistent throughout implying that PCOS symptoms might persist.

Diagnosis

Physicians make use of several procedures for diagnosing PCOS. Once you consult your doctor, he or she will ask you regarding your medical history as well as perform a few tests:

  • Physical checkup: Your doctor will check your BMI, waist size, blood pressure as well as look for signs of skin discoloration, acne, baldness or presence of unwarranted hair on your chest, face, and upper back, and so on.
  • Pelvic sonogram: Pelvic ultrasound helps establish the presence of cysts on ovaries and also examine the uterus’s endometrial lining.
  • Pelvic test: The physician may conduct a routine pelvic test to see if the ovaries are puffed-up or inflamed as well as ascertain the presence of the undue male hormone.
  • Blood assays: Blood tests can determine exact levels of androgen, thereby helping to confirm whether you’ve PCOS or other health issues.

Treatments

Though an effective cure for PCOS is yet to be found, existing treatment options could go a long way in getting relief from its symptoms. Depending on whether you want to manage the primary condition, i.e., PCOS side by side with treating related health problems like diabetes and hypertension, or get pregnant, you’ve access to following treatment plans:

  • Contraceptive (birth control) pills: Regular intake of progestin and estrogenic medications could help correct abnormal ovulation, normalize hormonal imbalance, check endometrial cancer, hirsutism, and so on.
  • Fertility medications: Fertility medicines, including clomiphene and metformin or a combination of these medications, can be taken for inducing pregnancy. Alternatively, gonadotropins like FSH (stimulating follicle hormone) or LH (luteinizing hormone) can be taken in the form of injections.
  • Diabetes management: Metformin is an effective drug that could keep type 2 diabetes at bay as well as bolster insulin levels.
  • Dealing with hirsutism: Unmanageable hair growth could be stemmed via eflornithine (Vaniqa) or spironolactone (Aldactone). However, stay away from these drugs if you’re looking forward to conceiving.
  • Fertility treatments: Artificial inseminations or IVF (in-vitro fertilization) are two time-honored methods for promoting pregnancy.

Surgery should be considered if and only if the options above prove ineffective. The surgical procedures include:

  • Oophorectomy
  • Hysterectomy
  • Cyst aspiration
  • Ovarian drilling

PCOS: Self/ Home management

  • Hair removal (excessive or unwanted hairs could be rid of via laser technique, electrolysis or hair removal facial creams)
  • Slowing and checking hair growth
  • Weight loss (Regular exercises and balanced diet will prevent you from putting on weight)

Preventing PCOS Issues during Pregnancy

You can keep PCOS symptoms under check to improve your chances of becoming pregnant if you abide by these steps:

  • Keeping weight under control
  • Improving the intake of folic acid by eating more cereals, pasta, bread, beans, oranges, green and leafy vegetables

References

  1. https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
  2. https://www.healthline.com/health/polycystic-ovary-disease
  3. https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
  4. https://www.medicalnewstoday.com/articles/265309.php
  5. https://medium.com/@englishtaylor/everything-you-need-to-know-about-polycystic-ovarian-syndrome-pcos-c98303dccf
  6. https://www.rd.com/health/conditions/all-about-pcos/
  7. https://cora.life/blogs/day-one/pcos-symptoms-causes-treatments-and-everything-else-you-need-to-know-about-polycystic-ovary-syndrome

 

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