Introduction
Polycystic ovarian syndrome (PCOS) is the most prevalent endocrine condition in women of reproductive age. In addition to irregular or heavy periods, extra hair, acne, pelvic pain, trouble getting pregnant, and patches of thick, darker, velvety skin, women with polycystic ovarian syndrome may also experience excess hair and acne. Some of the main features of polycystic ovarian syndrome are hyperandrogenism (a condition when there is an overproduction of male hormones), anovulation (a condition when the ovary does not release an egg), insulin resistance (it is a condition when muscle cells do not respond to insulin), and neuroendocrine disturbance. The majority of women with polycystic ovarian syndrome have central obesity, although there is inconsistent evidence regarding whether visceral and subcutaneous abdominal fat is higher, unchanged, or lower in polycystic ovarian syndrome-positive women compared to reproductively healthy women with the same body mass index. Even when body mass index is considered, type 2 diabetes and insulin resistance are more common in women with the polycystic ovarian syndrome (BMI). An increased risk of diabetes is also linked to polycystic ovarian syndrome.
What Is Polycystic Ovarian Syndrome?
Polycystic ovarian syndrome affects 6 percent to 12 percent (up to 5 million) of American women of reproductive age, making it one of the most prevalent reasons for female infertility. This chronic health issue persists even past the childbearing years.
Women with polycystic ovarian syndrome frequently have insulin resistance, a factor in type 2 diabetes risk, even if their bodies can produce insulin. They also have higher levels of androgens, which are female hormones that can inhibit ovulation and lead to irregular periods, acne, thinning hair on the scalp, and excessive hair growth on the face and body.
Women With PCOS Are More Likely to Become Overweight and Experience Major Health Issues:
1. Type 2 Diabetes - Type 2 diabetes is a condition that more than half of polycystic ovarian syndrome-afflicted women develop by age 40.
2. Gestational Diabetes (Diabetes During Pregnancy) - Diabetes during pregnancy puts the unborn child and mother at risk and can result in type 2 diabetes in later life.
3. High Blood Pressure - High blood pressure can harm the kidneys, brain, and heart. Heart disease risk is increased by low HDL ("good") cholesterol and high LDL ("bad") cholesterol.
4. Sleep Apnea - This condition raises the risk of heart disease and type 2 diabetes by preventing breathing while a patient sleeps.
What Are the Symptoms of Polycystic Ovarian Syndrome?
The Following Are Typical PCOS Symptoms and Signs:
1. Menstrual Disorders: Polycystic ovarian syndrome typically causes oligomenorrhea (fewer than nine menstrual cycles in a year) or amenorrhea (no menstruation for three or more consecutive months), while other menstrual diseases may also occur.
2. Infertility: Chronic anovulation is typically the direct cause of polycystic ovarian syndrome (lack of ovulation).
3. High Levels of Masculinizing Hormones: Hyperandrogenism can cause hypermenorrhea (heavy, protracted menstrual periods) and significant hair loss or widespread thinning of the hair (androgenic alopecia), among other symptoms. The most common symptoms are acne and hirsutism (male pattern hair growth, such as on the chin or chest).
4. Metabolic Syndrome: This is characterized by a propensity for central obesity and other indications of insulin resistance, such as fatigue and food cravings. Women with polycystic ovarian syndrome have elevated serum levels of homocysteine, insulin, and insulin resistance.
How Does PCOS Relate to Diabetes?
When hormones like testosterone are extremely high, they promote the synthesis of insulin, resulting in insulin resistance and hyperinsulinemia, both of which can lead to the possible onset of type 2 diabetes and prediabetes. High insulin levels appear not just as a side consequence of polycystic ovarian syndrome but also likely play a role in generating and maintaining polycystic ovarian syndrome. This suggests that there is a bidirectional relationship between polycystic ovarian syndrome and prediabetes. The ovaries are thus stimulated to create additional hormones, including testosterone, as a result of the high insulin levels. This causes problems like weight gain, irregular menstruation periods, and hair growth.
Theca cells, specialized cells in the ovary that create androgens, are directly impacted by insulin, making polycystic ovarian syndrome worse. Insulin may also increase the number of theca cells within the ovary, boosting the ovaries' ability to create androgens. In addition to causing high amounts of male hormones, high insulin levels can also reduce the formation of a substance called the sex hormone-binding globulin (commonly known as SHBG).
What Are the Treatment Modalities to Treat PCOS?
Polycystic ovarian syndrome is primarily treated with medication and lifestyle modifications.
Treatment objectives can be categorized into the following four groups:
-
Reduction in insulin resistance.
-
Restoration of fertility.
-
Acne or hirsutism treatment.
-
Regularization of menstruation, protection against endometrial cancer and hyperplasia, and restoration of a regular period.
1. Diet
Weight loss is the most efficient way to return to normal ovulation and menstruation because the polycystic ovarian syndrome is linked to being overweight or obese. To reduce insulin resistance and all hormonal abnormalities, the American Association of Clinical Endocrinologists advises aiming for a weight loss of at least 5 to 15 percent.
2. Medication
Metformin and oral contraceptives are two polycystic ovarian syndrome medications. The production of sex hormone-binding globulin is increased by oral contraceptives, which increases the binding of free testosterone. This controls the return to regular menstrual cycles and lessens the signs of hirsutism from elevated testosterone. Metformin is a drug frequently used to treat type 2 diabetes mellitus to lower insulin resistance. Metformin frequently promotes ovarian health and a return to regular ovulation. For its antiandrogenic properties, Spironolactone can be utilized, and the topical lotion Eflornithine can be used to lessen facial hair. Metformin has a better side effect profile. However, a newer class of insulin-resistance drugs called thiazolidinediones (glitazones) has demonstrated comparable efficacy.
3. Infertility
Pregnancy is challenging for polycystic ovarian syndrome sufferers. However, because their bodies do not produce the hormones required for regular ovulation, some women with polycystic ovarian syndrome may experience difficulties getting pregnant. The chance of miscarriage or early delivery may also rise with polycystic ovarian syndrome. medications The main ovulation-inducing medications are Letrozole and Clomiphene citrate. Previously, Metformin, an anti-diabetes drug, was suggested as a treatment for anovulation, but it now seems to be less effective than Letrozole or Clomiphene. There are solutions available for women who are not receptive to Letrozole, Clomiphene, diet, or lifestyle changes, such as assisted reproductive technology procedures, including injections of follicle-stimulating hormone (FSH), followed by in vitro fertilization, resulting in regulated ovarian hyperstimulation. Ovarian drilling, a laparoscopic operation, can be used to treat polycystic ovaries even though surgery is not frequently performed.
4. Mental Health
Women with polycystic ovarian syndrome are much more likely than those without to experience depression; there is still debate over whether or not these women should take antidepressants. Nevertheless, the pathophysiology of depression and psychological stress during polycystic ovarian syndrome is connected to a variety of alterations, including psychological changes like an elevated proinflammatory marker and immune system activity under stress. Aside from depression, polycystic ovarian syndrome is linked to other mental health issues such as anxiety, bipolar disorder, and obsessive-compulsive disorder.
Conclusion
When the body's cells develop insulin resistance, an excessive amount of insulin is produced, and type 2 diabetes can develop. According to the Centers for Disease Control and Prevention, more than 30 million Americans have diabetes (CDC). Research indicates that polycystic ovarian syndrome is a significant independent risk factor for developing diabetes, even though type 2 diabetes is often prevented or controllable with physical activity and a healthy diet. In general, women with PCOS in their twenties are more likely to develop diabetes and possibly deadly heart issues later in life. In addition to lowering the risk of diabetes and managing weight, a balanced diet is essential. Birth control medications are also used to treat polycystic ovarian syndrome in female patients.
In some circumstances, birth control tablets might assist in controlling menstruation and clearing acne. Individuals who are at risk for diabetes, several birth control tablets may also raise blood glucose levels. Nevertheless, Metformin, the first-line treatment for type 2 diabetes, is also employed to combat insulin resistance in polycystic ovarian syndrome.
