PCOS is a common hormonal disorder in women of reproductive age group and Adolescents. In India, one and five women or adolescent girls suffer from PCOD. It is due to an increase in male hormone testosterone or androgens and usually manifests as irregular menstrual cycles. This can be in the form of scanty menses, prolonged menstrual cycles, prolonged and heavy menses or absent menses, obesity, hirsuitsm(male-patterned hair growth), pimples, infertility, stress, anxiety, and depression. it is a disease of the reproductive age group but its long-term consequences can be seen beyond Menopause in the form of metabolic syndrome manifested as heart disease, diabetes, high blood pressure, obesity, uterine and breast cancers, etc.
The exact cause of PCOS is not known but there is evidence that genetics play a role. Several other factors also play a role in causing PCOS: Higher levels of male hormones called androgens and high levels of Insulin prevent the ovaries from releasing eggs (ovulation), which causes irregular menstrual cycles and other features of PCOS.
Risk Factors of PCOS
- Early or late Menarche- age of first menses.
- Obesity.
- Family History of PCOS, irregular periods or Diabetes.
- Sedentary lifestyle.
PCOS is of Two Types
- lean PCOS 20 to 30 %
- Obese PCOS 70 to 80 %
Tests to be done in PCOS
Usually one can make diagnosis by symptoms and clinical examination.
- All women with suspected PCOS should be screened for thyroid disease with TSH and hyperprolactinemia with serum prolactin.
- Pelvic ultrasound – May show PCO ovaries in 25% cases.
- Testosterone level
- Fasting blood sugar
- Lipid profile
Management of PCOS – Management depends upon the symptoms with which patient has come.
Lifestyle modification is the main stay of treatment for all. It includes
Weight loss – In obese PCOS weight reduction by 10 % can normalize periods and show improvement in many symptoms. Weight loss can often be achieved with programmed diet and exercise.
Diet – It is recommended to follow calorie restricted diet (low carbohydrate, fat, and high protein and fibre rich diet) Weight loss surgery may be an option for severely obese women with PCOS.
Oral contraceptives — Oral contraceptives (combined estrogen and progestin) are the most commonly used treatment for regulating menstrual periods in women with polycystic ovary syndrome (PCOS). OCs protects the woman from endometrial (uterine) hyperplasia or cancer by inducing a monthly menstrual period. OCs is also effective for treating hirsuitsm and pimples.
Anti-androgen drugs (such as spironolactone) decrease the effect of androgens. These treatments can be used in combination to reduce and slow hair growth. Oral contraceptives and anti-androgens can also reduce acne.
Other Medicines – sometimes we do use Metformin and inositols in the form of myoinositol and chiroinositol which increases Insulin sensitivity thereby improvement in symptoms of PCOS.
Treatment of infertility – It is usually due to anovulation. Normally every month an egg is released from the ovary but in PCOS due to hormonal imbalance this does not happen.
The primary treatment for women who are unable to become pregnant and who have PCOS is lifestyle modification and weight loss. Even a modest amount of weight loss may allow the woman to begin ovulating normally. In addition, weight loss can improve the effectiveness of other infertility treatments. Ovulation inducing drugs (like clomiphene etc.) are also used in conjunction with Metformin. Your gyncologist in Indore will discuss with you about it.
Ovarian drilling – Ovarian drilling, also known as multiperforation or laparoscopic ovarian diathermy, is a surgical technique of puncturing the ovary with a laser beam or a surgical needle using minimally invasive laparoscopic procedures.
Prevention- (PCOS) cannot be prevented. But early diagnosis and treatment helps prevent long-term complications, such as infertility, metabolic syndrome, obesity, diabetes, and heart disease. Consult a Gynecologist for PCOS treatment in Indore.