Polycystic ovarian syndrome commonly affects women in their reproductive years. We provide answers to frequently asked questions about PCOS.

What is PCOS?

PCOS is a common condition among women in their childbearing years. It is characterized by an imbalance in female/ male sex hormones and large ovaries with many cysts or folli       cles that do not produce egg. It affects approximately one out of ten women.

These women have problems in hormone production from their ovaries.

Normally, ovaries are stimulated by two hormones FSH and LH from pituitary gland. In response to FSH, a number of follicles containing eggs are formed in the ovaries. One of these matures and LH causes this mature follicle to rupture and release egg for fertilization. Ovaries also produce hormones like estrogen, progesterone (female sex hormones) and androgens (male sex hormones).

In PCOS, follicles do not mature. The ovaries have a number of follicles (fluid filled sacs called cysts), each containing an immature egg. So, on ultrasound we see multiple cysts in the ovaries (hence the name polycystic ovarian syndrome). Also, there is an imbalance in hormone production and relatively increased androgens (male hormones) are formed. Extra androgens disturb normal menstrual cycle and these women have irregular menses (generally delayed), excess hair growth or acne over the body.

PCOS is also associated with many long term health risks. Early diagnosis and treatment can help in reducing these risks.

 

What is the cause of PCOS?

Exact cause of PCOS is not known. The factors that have been implicated are-

1. Heredity- Scientific research has reported some genes that might be playing role in PCOS. PCOS has been seen to occur more frequently among first degree relatives of PCOS patients.
2. Excess insulin- Insulin is a hormone produced by pancreas in our body. Its main function is to transport sugar to the cell to supply energy. Insulin resistance develops (due to obesity) resulting in excess insulin production by the body. This excess insulin is responsible for increased production of androgens.
3. Excess androgen production by the ovary leads to PCOS
4. Low grade inflammation- Some studies have suggested that low grade inflammation stimulates ovaries to form more androgens.

 

What are the symptoms of PCOS?

Symptoms usually begin in adolescence. Sometimes, they may begin late when a girl has gained weight. These symptoms are-

 

1. Menstrual irregularities- Periods may come early or late and may be too light or heavy. Generally they are delayed (occur infrequently) by more than 35 days.
2. Excess hair growth or acne may occur on chin, face, chest, abdomen or back due to excess male hormones.
3. Male pattern baldness- Due to excess androgens, these women may have increased hair fall specially on the front and temporal sides..
4. Features of insulin resistance- acanthosis ( dark, thick skin markings on neck, armpits etc) or skin tags.
5. Symptoms may specially become worse if you gain weight.

 

What are the long term health risks in PCOS?

Other health problems associated with PCOS are-

1. Infertility- Due to absence of egg maturation, these women are likely to be infertile and need treatment for infertility.
2. Gestational diabetes, that is, you may have high blood sugar during pregnancy or pregnancy induced hypertension (high blood pressure).
3. High likelihood of getting a miscarriage or premature birth.
4. Metabolic complications like Diabetes mellitus, High blood pressure, weight gain and obesity, high cholesterol and heart disease.
5. Cancer of endometrium (Uterine lining) is more likely in these women.

 

What will happen to PCOS at menopause?

PCOS hormonal imbalance does not change with age. Some women may have regular menses as they get closer to menopause, others may continue to experience same symptoms. These women are more likely to get an early menopause.

Other health risks like metabolic complications- diabetes, high blood pressure, heart disease, stroke etc are more likely to occur with increasing age.

When should you see a doctor?

You should see a doctor if-

1. You have missed your periods and pregnancy test is negative.
2. You have other symptoms like increased hair growth or acne over body or increased hair fall from scalp.
3. You are not able to conceive even after one year of trying.

How is PCOS diagnosed?

No single test can diagnose PCOS. Infact, PCOS is a diagnosis of exclusion. You need to rule out other diseases to diagnose PCOS.

1. Your doctor will ask your detailed history and examine you.
2. You will need some blood tests for hormones, thyroid test and tests for blood sugar, cholesterol etc.
3. Ultrasound pelvis will be done for the presence of multiple cysts in the ovaries.

What is the treatment of PCOS?

Treatment of PCOS depends upon your individual concern like obesity, menstrual irregularity or hirsutism and also depends on whether you are planning pregnancy or not. Treatment includes lifestyle management and some medicines.

 

1. Lifestyle modification includes a healthy balanced diet and at least 45 minutes of moderate intensity physical activity daily.
2. Weight loss ( even 5-10% of your initial weight) can help treating these hormonal changes as well as associated complications.
3. Your doctor may prescribe you some medicines depending on your symptoms. Most commonly prescribed medicines are- hormonal pills, metformin and anti an
4. drogenic medicines.
5. If you are planning pregnancy, then you will need ovulation induction drugs or procedures like intrauterine insemination or invitro fertilization. Remember, before getting pregnant, you should try to reduce your weight to a healthy weight, try controlling your blood sugar level and start taking folic acid supplementation to reduce the problems that may occur during pregnancy.
6. You may need laser/ electrolysis for permanent hair removal.

Your doctor can advise you what treatment suits you best.

 

ALL THE BEST!!