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Dealing With PCOS

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Polycystic ovary syndrome is a common condition that affects the hormones in women. Read the article to know more about this condition.

Medically reviewed by

Dr. Richa Agarwal

Published At April 12, 2023
Reviewed AtApril 12, 2023

Introduction:

PCOS (polycystic ovary syndrome) is a common hormonal condition that affects one in five women globally. PCOS can strike a woman at any age after puberty. Most people get diagnosed in their 20s or 30s while trying to conceive. If a person is overweight or obese, or if other people in their family have PCOS, they are more likely to develop it. Many women have PCOS but are unaware of it.

What Is Polycystic Ovary Syndrome?

Polycystic ovary syndrome (PCOS) is a disorder in which the ovaries produce an abnormally high level of androgens; male sex hormones are typically present in small amounts in women. The term polycystic ovary syndrome refers to the ovaries' numerous small cysts (fluid-filled sacs). However, some women with the disorder do not develop cysts, whereas some women without the disorder do. Ovulation refers to the release of a mature egg from an ovary. This occurs so that it can be fertilized by male sperm. If the egg is not fertilized, it is excreted during periods.

In some cases, a woman does not produce enough of the hormones required for ovulation. When ovulation does not occur, the ovaries can develop many small cysts. These cysts produce androgens, which are hormones. Women with PCOS frequently have elevated levels of androgens. This can exacerbate a woman's menstrual cycle problems. It can also cause many of the symptoms associated with PCOS.

What Causes Polycystic Ovarian Syndrome?

PCOS's exact cause is unknown. However, there is evidence that genetics is involved. Other factors that contribute to PCOS include:

  • Increased Levels of Androgens: High androgen levels inhibit the ovaries' ability to release eggs (ovulation), resulting in irregular menstrual cycles. Irregular ovulation can also form small, fluid-filled sacs in the ovaries. Acne and excessive hair growth are also symptoms of high androgen levels in women.

  • Insulin Resistance occurs when insulin levels rise, causing the ovaries to produce and release male hormones (androgens). Increased male hormone suppresses ovulation and contributes to other PCOS symptoms. In addition, insulin aids the body's digestion and utilization of glucose (sugar). Insulin resistance happens when the body does not properly process insulin, resulting in high glucose levels in the blood. Although not all people with insulin resistance have high blood sugar or diabetes, insulin resistance can lead to diabetes. Obesity that is overweight can also contribute to insulin resistance. An elevated insulin level can indicate insulin resistance even if the blood glucose is normal.

  • Chronic Low-Grade Inflammation: People with PCOS are prone to chronic low-grade inflammation. The healthcare provider can perform blood tests to measure levels of C-reactive protein (CRP) and white blood cells, which could indicate the level of inflammation in the body.

What Are the Symptoms of Polycystic Ovary Syndrome?

PCOS symptoms can appear when a woman's first menstrual period occurs during puberty. It can also develop later in life, possibly due to significant weight gain. Symptoms could include:

  • Infertility.

  • Missed periods, irregular periods, or periods that are extremely light or heavy.

  • Ovaries enlargement with numerous small, fluid-filled cysts on the ovaries' edge.

  • Fatigue.

  • Excessive body hair on the face, chest, stomach, upper thighs, and back - approximately 70% of women suffer from this condition.

  • Weight gain, particularly in the abdomen - Being overweight is a problem for 80% of PCOS patients.

  • Cravings and binges for carbohydrates.

  • Constipation and food sensitivities.

  • Acne or oily skin that is resistant to conventional treatments.

  • Male-pattern baldness or hair thinning.

  • Skin tags (small excess skin pieces) on the neck or armpits.

  • Skin that is thick, velvety, and darkened in patches.

  • Patches of darkened, thick, velvety skin on the back of the neck, armpits, and under the breasts (acanthosis nigricans).

  • In conjunction with PCOS, endometrial hyperplasia can thicken the uterine lining, increasing the risk of endometrial cancer.

  • Women with PCOS are more susceptible to sleep disorders, sleep apnea, depression, anxiety, low self-esteem, and eating disorders.

PCOS can increase the risk of type 2 diabetes, high blood pressure, heart problems, sleep apnea, endometrial or uterine cancer, miscarriage, premature birth, depression, and anxiety because it affects many other systems in the body.

Can PCOS Be Cured Completely?

As the exact cause is unknown, it is challenging to cure this syndrome. It can only be controlled and symptoms reduced with the availability of effective drugs and lifestyle changes. There are some well-defined factors that contribute to the PCOS phenotype. Recently, the concept of secondary PCOS has been described. Although rare, this condition is completely curable because most of these factors are treatable. As a result, it is critical to seek out these conditions and provide timely treatment actively. There are currently two types of PCOS:

Primary PCOS, where the cause is unknown and is often the most common condition, and secondary PCOS, where the cause of the condition is known. It could include:

  • Obesity.

  • Hypothyroidism.

  • Prolactinoma.

  • Lipodystrophy syndromes.

  • Autoimmune thyroiditis.

  • Hyperprolactinemia.

  • Cushing's syndrome.

  • ACTH-secreting tumors.

  • Idiopathic Hirsutism.

  • Acromegaly.

  • Glucocorticoid resistance.

  • Neuroendocrine.

  • Epilepsy.

  • Androgenic drugs.

  • Severe Insulin Resistance Syndrome.

Further, the clinical categorization of both primary and secondary PCOS by HA-PODS (hyperandrogenic persistent ovulatory dysfunction syndrome) nomenclature can reduce diagnostic and therapeutic pitfalls and serve as a checklist to ensure that appropriate investigation is instructed and specific treatment is initiated as per diagnostic code.

How Is PCOS Managed?

A healthy lifestyle, a healthy diet, and regular exercise are the cornerstones of management. Losing excess weight is critical, and the goal should be to achieve a normal BMI (that is, 19 to 25), as this can reduce the risk of developing diabetes and heart disease and improve fertility. It may also reduce the risk of endometrial cancer, acne, and excessive hair growth.

Women over 40 with PCOS should have their blood sugar levels checked yearly and before age 40 if they are obese or have a family history of diabetes. In addition, blood pressure and cholesterol checks will be recommended by doctors. If menstrual bleeding becomes irregular or periods stop completely, a pelvic ultrasound analyzes the thickness of the endometrium, and a gynecological referral may be required.

Treatment options if one does not intend to become pregnant include:

  • Hormonal Birth Control: Methods include pills, patches, shots, a vaginal ring, and an intrauterine device (IUD). In addition, hormonal birth control aids in the regulation of your menstrual cycle, the treatment of acne, and the prevention of excessive hair growth.

  • Insulin-Sensitizing Drugs: Metformin is a diabetes medication. It works by assisting the body's insulin processing. Some PCOS patients report improved menstrual cycles after managing their insulin.

  • Androgen-Blocking Medications: Some medications can counteract the effects of androgens. This aids in the control of acne and hair growth caused by PCOS.

  • Changes in Lifestyle: Losing weight and eating a healthy diet can improve insulin levels.

If one is planning on getting pregnant now or in the future, PCOS treatment includes:

  • Drugs to Induce Ovulation (Releasing an Egg): A pregnancy begins with ovulation. Certain medications have been shown to induce ovulation in PCOS women. Clomiphene and letrozole are taken orally, whereas gonadotropins are administered intravenously.

  • Surgery: Ovarian drilling is a surgical procedure that can induce ovulation by removing tissues in the ovaries that produce androgen hormones. With the availability of newer medications, surgeons now rarely perform this procedure.

  • In Vitro Fertilization (IVF): In a laboratory, the egg is fertilized with the partner's sperm before being transferred to her uterus. When medication does not help with ovulation, this is an option for women with PCOS.

Conclusion

PCOS is a prevalent cause of infertility and can be associated with other conditions. If one suspects PCOS, the symptoms must be discussed with the doctor. Lifestyle changes and medical treatments can help manage the symptoms, help to get pregnant, and lower the risk of developing other health problems.

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Dr. Richa Agarwal
Dr. Richa Agarwal

Obstetrics and Gynecology

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