Increasingly, young women are showing up at clinics complaining of irregular menstruation, one of the markers of the Polycystic Ovarian Syndrome (PCOS), which is one of the most common endocrine disorders in women of reproductive age, with prevalence estimates of around 15 to 22 per cent. The exact causes of PCOS are unknown but it is thought to be a result of hormonal disturbances (increased androgens and/or insulin) induced by a combination of genetic (X linked dominant gene) and environmental factors.
Common symptoms of PCOS are hirsutism, excess hair on chin, upper lip or lower abdomen, acne, irregular menstruation, male pattern alopecia (hair loss), dark thick pigmentation of skin, weight issues, obesity and infertility.
Consequences of PCOS include:
1. Reduced psychological and emotional well-being due to negative self-body image
2. Hyperandrogenism manifesting as hirsutism and acne
4. Infertility
5. Metabolic syndrome: Increased risk of Type 2 diabetes and cardiovascular risks.
6. Long term risk of endometrial cancer.
Diagnosis
Myth 1: Any cyst in the ovary means you have polycystic ovaries
There are several types of cysts in the ovaries. Polycystic appearance of ovaries on ultrasound may be a sign of PCOS but this may not always be seen on ultrasound. Many women have cysts but don’t have PCOS. Similarly, women may not have cysts but have signs of PCOS, like irregular periods or extra hair growth on the face or body, acne etc.
The diagnosis is straightforward using Rotterdam criteria. Two of the following three markers are needed for confirmation
1. Irregular menstruation showing anovulation
2. Ultrasound of the pelvis showing PCOS patterns
3. Clinical or biochemical hyperandrogenism
Myth 2: PCOS is only seen in obese women
There can be lean as well as obese PCOS patients although 80 per cent of PCOS patients are obese.
MYTH 3: PCOS can be cured completely
There is no cure but there are many ways to decrease or eliminate PCOS symptoms and make you feel better.
Myth 4: Patients with PCOS can never conceive
Women with PCOS do not ovulate, which causes irregular menstruation resulting in infertility. So, the best way to increase the odds of conception is to give the ovaries a push using fertility medications like ovulation induction drugs. We can help 80 per cent of women with PCOS ovulate with these drugs. Of course, there is an increased chance of miscarriage in patients of PCOS. There is also an increased risk of developing diabetes during pregnancy and other complications. But a good obstetrician will be able to guide you through these conditions.
Management
· Goals of treatment may be considered in four categories:
1. Lowering of insulin resistance levels
2. Restoration of fertility
3. Treatment of hirsutism or acne
4. Restoration of regular menstruation and prevention of endometrial hyperplasia and endometrial cancer.
The primary treatment for PCOS includes:
1.Lifestyle changes that include a calorie-restricted diet
2. Regular exercise
3. No smoking;
4. Medication
5. Emotional and psychological support
Diet
Methods that help to reduce weight or insulin resistance can be beneficial for all these symptoms. Even five to 10 per cent weight loss can improve symptoms markedly.
What diet is suggested in PCOS?
A low GI and high-fibre diet, in which a significant part of total carbohydrates is obtained from fruits, vegetables, and whole grain sources, has resulted in greater menstrual regularity
What not to eat with PCOS?
Avoid sweetened juice, canned fruit in heavy syrup, starchy
vegetables such as potatoes, corn, white flour products such as
white bread, pasta or white rice, sugary food such as cookies, cakes. Team this up with regular exercise of at least 150 minutes per week.
A diagnosis of PCOS suggests an increased risk of the following:
· Insulin resistance/Type II diabetes: Women with PCOS have an elevated prevalence of insulin resistance and type II diabetes, independent of body mass index (BMI).
· High blood pressure in those obese or pregnant
· Depression and anxiety
· Dyslipidaemia– disorders of lipid metabolism
· Cardiovascular disease: There’s a two-fold risk of arterial disease for women with PCOS relative to women without PCOS, independent of BMI.
· Stroke
· Obesity
· Miscarriage
· Sleep apnea, particularly if obesity is present
· Non-alcoholic fatty liver disease, again particularly if obesity is present
· Acanthosis nigricans (patches of darkened skin under the arms, in the groin area, on the back of the neck)
· Endometrial hyperplasia and endometrial cancer are possible due to prolonged stimulation of uterine cells by estrogen. It is not clear whether this risk is directly due to the syndrome or from the associated obesity, hyperinsulinemia and hyperandrogenism.
Key Messages
PCOS is associated with a range of metabolic abnormalities, which can lead to long-term health problems
· PCOS limits fertility but can be treated.
· Early family initiation where practicable.
· Women with PCOS have increased risk of endometrial cancer with prolonged amenorrhea.
· Increased cardiovascular risk factors.
· Increased risk of diabetes.
· Lifestyle changes are the first line of therapy.
· 5-10 per cent weight loss will greatly assist in symptom control.
· Assess mental and emotional health.
· Management has to be tailored for each patient.
