Polycystic ovarian syndrome, or PCOS, is a hormonal disorder that affects women of reproductive age. Every year, the prevalence of PCOS in Indian women rises. PCOS affects approximately one in every five Indian women of reproductive age. PCOS is becoming more well-known among young women.
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.
Is PCOD the same as PCOS?
While the terms PCOD and PCOS are frequently used interchangeably, there is a distinction between the two. PCOD is a condition in which the ovaries become enlarged and polycystic. PCOS, on the other hand, is a more severe metabolic disorder.
The 3 main features of PCOS are:
a. ) Anovulatory menstrual cycles – An anovulatory menstrual cycle is one in which the ovulatory process (the release of a mature egg) does not occur. This can manifest as irregular menstrual cycles or difficulty conceiving.
b.) Hyperandrogenism – Excessive levels of “male” hormones in your body can cause physical symptoms such as excessive facial hair growth, scalp hair thinning, or acne breakouts.
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 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.
Causes
The precise cause of PCOS is still unknown. It does, however, appear to be strongly linked with genes linked to diabetes and insulin resistance. PCOS is usually brought on by a sudden weight gain caused by a stressful or sedentary lifestyle. It’s also been linked to chronic low-grade inflammation.
Signs and symptoms of PCOS
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 – Due to a lack of ovulation, most women with PCOS have delayed periods with scanty bleeding. During their periods, some women only have blackish brownish discharge. Some women may not have periods at all and may require medication to induce them. Some women have very frequent periods. However, some PCOS women may have regular periods with normal bleeding. Some PCOS women experience very heavy or prolonged bleeding, especially if their periods are significantly delayed.
2) Hair growth – Hirsutismor is a visible and bothersome symptom of PCOS that causes excessive growth of coarse dark hair on the face, chest, belly, back, thighs, or upper arms. It is caused by the presence of high levels of androgens in the body.
3) Acne – As a result of the effect of male hormones, the skin becomes oily, resulting in clogged pores and the development of nodulocystic acne, particularly in the beard area and jawline.
4) Weight gain – Women with PCOS are predisposed to insulin resistance. As a result, women with PCOS gain weight quickly. Losing weight can be difficult, and women with PCOS frequently struggle to shed the extra pounds. Women who are overweight or obese and have PCOS are more likely to develop diabetes, hypertension, high cholesterol, and heart disease.
5) Skin darkening – Dark velvety discoloration of skin folds and body creases such as on the neck, groyne, armpits, or under the breasts is a sign of insulin resistance that is commonly seen in overweight or obese PCOS patients.
6) Hair Loss – Hair loss and thinning of scalp hair are also symptoms of high androgen levels.
7) Mood Disorders – Research has shown that women with PCOS are more likely to suffer from mood disorders such as depression or anxiety.
8) Headaches – Women with PCOS may experience headaches as a result of hormonal changes.
Treatment
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 make a significant difference in symptom relief. Consume a well-balanced diet that includes plenty of fruits and vegetables. Avoid fried foods, junk food, and foods that are high in sugar or calories. Caffeine should be consumed in moderation. Be physically active and exercise on a regular basis. Get enough rest. Keep your weight within the normal range for your height. Smoking significantly increases the risk of hypertension, cholesterol, and heart disease.
2. Birth control pills – These are typically prescribed to regulate menstruation. Birth control pills help reduce acne, excessive hair growth, and hair thinning by suppressing androgens.
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 a pregnancy is desired, treatment aims to induce ovulation with the help of medication. Metformin is sometimes added to improve the outcome. In rare cases, a surgical procedure known as laparoscopic ovarian drilling may be used to treat fertility issues associated with PCOS that do not respond to medication. Some women may require a more aggressive approach, such as IVF.
Dermatological treatments for acne, excessive facial hair growth, and scalp hair thinning may be necessary in some cases. For reducing facial hair growth, a combination of laser treatments, birth control pills, and eflornithine cream appears to be more effective.
