What is PCOS?
PCOS means polycystic ovary syndrome. The ovaries develop many small follicles, also called cysts, of 4 to 10 mm. Poly means ‘many,’ and ‘cysts’ are small closed sacs filled with fluid. It often occurs in the general female population but is more prevalent in infertility populations. Its cause is unknown, although it is likely due to some genetic disorder.
It causes insulin resistance, a condition where the sugar-lowering hormone insulin fails in its action. This results in hormonal imbalance, causing the failure of follicles to mature and ovulate.
The immature follicles in PCOS produce more androgen (male hormone) than estrogen (female hormone). Oral contraceptive pills prevent the development of immature follicles but do not dissolve the existing follicles or cysts. The existing cysts dry up naturally over time.
In contrast, Clomiphene develops mature follicles of 17 to 18 mm or more in size. These produce more estrogen as well as ovulation. Clomiphene also does not dissolve the existing follicles or cysts.
What Causes PCOS?
The exact etiology of PCOS is unknown. However, most women portray insulin resistance. This signifies the inability of the body to use insulin and its functions well. The higher insulin levels lead to an increase in androgen levels. A high-sugar diet further causes a spike in insulin levels. Another cause to have increased insulin levels is obesity, which results in the worsening of PCOS symptoms. PCOS may also have a hereditary link. So, it is common for women of a family to have PCOS, like mothers, daughters, or sisters.
Who Can Get PCOS?
Any woman can get PCOS after attaining puberty and before menopause, that is, during the childbearing age. It is commonly diagnosed in the second or third decade of life when most women try to get pregnant.
A woman is most likely to suffer from PCOS if her mother or sister has it. Low insulin sensitivity, stress, and obesity also pose a predilection for PCOS. With adopting a sedentary lifestyle and fast life, stress is one of the leading risk factors.
What Are the Symptoms of PCOS?
The immature follicles, also called cysts, produce more androgen or testosterone, causing the following symptoms:
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Infrequent, light (dysmenorrhea), or absent periods (amenorrhea) due to hormonal imbalance.
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Infertility due to failure of ovulation.
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Acne and oily skin.
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Excess body hair (hirsutism), especially on the chest, stomach, chin, etc.
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Weight gain, particularly abdominal and obesity, due to diminished insulin action.
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Thinning of hair or male-pattern baldness.
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Skin tags (small pieces of excess skin) on the neck or armpits.
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Thick or dark skin patches at the back of the neck, under the breasts, and in the armpits.
How Is PCOS Diagnosed?
The doctor starts recording the patient’s medical history and symptoms to diagnose PCOS. A physical examination, including a pelvic examination, follows this. A pelvic examination is done to ensure the health of the reproductive organs.
To rule out other causes that may mimic the symptoms of PCOS, the following investigations are done:
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Ultrasonography of the Pelvis: This test reveals the size, appearance, and health of the ovaries and other reproductive organs, like the uterus, fallopian tube, etc.
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Blood Tests: Tests to check androgen and other hormone levels, blood glucose levels, cholesterol, and triglyceride levels are done.
How to Treat PCOS?
PCOS is not completely reversible, but several treatments can reduce its symptoms. Its treatment varies according to its contributing factors and the symptoms present in a woman. The following treatments are given for the below-mentioned symptoms:
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Irregular Periods: If the main problem is irregular periods, the usual treatment is the oral contraceptive pill.
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Infertility: Ovulation can be induced by Clomiphene and hence, treat infertility. However, it may predispose to some risks, like ovarian hyperstimulation and multiple births, causing abdominal bloating and pelvic pain.
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Excessive and Abnormal Hair Growth: Suppression of male hormone production with tablets, such as the oral contraceptive pill or with an anti-male hormone drug, Cyproterone acetate, is used for at least 9 months.
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Obesity: A change in lifestyle with a low-fat diet and exercise can reduce weight. Metformin, a drug used for diabetes, can also reduce weight and improve hormonal imbalance.
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Acne: Oral contraceptive pills help in regulating androgen levels and treat acne.
A change in lifestyle and dietary patterns, with the inclusion of a healthy diet and more physical activity, can assist in losing weight and reducing the symptoms. They can also aid the body in using insulin more efficiently, decreasing blood glucose levels, and helping in ovulation.
To alleviate the physical signs of PCOS, like weight gain, abnormal hair growth, and acne, cosmetic treatments, such as electrolysis and laser hair removal, may aid women to feel better and confident about their appearance. A discussion with the healthcare provider is the best way to deal with such symptoms.
What Are the Complications of PCOS?
The most bothering complication of PCOS is infertility. Some critical health problems like type 2 diabetes, hypertension, heart and blood vessel issues, and uterine cancer may also develop in women with PCOS.
Conclusion:
PCOS is usually seen nowadays among women of reproductive age. The patient seeks medical attention due to missed or irregular menstrual periods, abnormal and excess hair growth, acne, infertility, or obesity. Though it cannot be treated completely, however, its manifestations can be controlled. Generally, the treatment is done according to the associated problems experienced by the patient. The treatment type for PCOS also depends on the decision of the woman to bear the child in the future or not. For women planning a future pregnancy, emphasis is laid on treating infertility by inducing ovulation. PCOS patients may also likely develop type 2 diabetes, hypertension, cardiac issues, and endometrial cancer.
