Polycystic ovary syndrome (PCOS) is a hormonal disorder with overproduction of male hormone (Androgen) and insulin resistance (Insulin resistance is a condition in which the body produces insulin but does not use it effectively which again lead to hormonal imbalance) that causes varieties of symptoms like irregular menstrual periods, overweight ,obesity, hirsutism (excessive hair growth all over body), acne etc.
Incidence – The condition occurs in about 5 to 10 percent of the female population of developed countries. A much higher incidence is reported in India 3.7 to 22.5% and In Indian adolescents, it is 9.13 to 36%.
Cause of PCOD – The cause of polycystic ovary syndrome (PCOS) is not fully understood, but genetics may be a factor. PCOS can be passed down from either your mother’s or father’s side.
How PCOS patients present –
- Menstrual irregularities are the commonest complaint. This can be in the form of scanty menses, prolonged menstrual cycles, prolonged and heavy menses or absent menses.
- Weight gain and obesity- Most of the patients presents with obesity. There are few women or adolescents who do not gain weight. They are known as Lean PCOS.
- Male-pattern hair growth (hirsutism is the excessive growth of thick, dark terminal hair in women where hair growth is normally absent) may be seen on the upper lip, chin, neck, sideburn area, chest, upper or lower abdomen, upper arm, and inner thigh.
- Pimples– ( Acne) is a skin condition that causes oily skin and blockages in hair follicles. Mostly occurs on the face, but sometimes may be seen on the back and upper chest.
- Infertility – Many women with PCOS do not ovulate regularly, and it may take these women longer to become pregnant. An infertility evaluation is often recommended after 6 to 12 months of trying to become pregnant.
- Metabolic syndrome– Many patients with polycystic ovary syndrome (PCOS) also have features of the metabolic syndrome, including insulin resistance, diabetes, obesity, and dyslipidemia (abnormal Lipid profile), suggesting an increased risk for cardiovascular disease( CVD ).
Risk Factors for PCOS –
- Early or late Menarche- age of first menses.
- Family History of PCOS, irregular periods or Diabetes.
- Sedentary and improper lifestyle.
Long term sequel of PCOS –
- They are at high risk of developing Diabetes.
- High blood pressure, high cholesterol and heart diseases.
- High risk of developing uterine cancer (endometrial cancer) due to unopposed action of Oestrogen hormone.
- Thyroid Disorders( Hypothyroidism)
- Sleep apnea — Sleep apnea is a condition that causes brief spells where breathing stops (apnea) during sleep. Patients with this problem often experience fatigue and daytime sleepiness.
- Depression and Anxiety.
PCOS DIAGNOSIS –
When a patient goes to a doctor with any of the above-mentioned symptoms then the doctor takes a full history, ask for other symptoms and examines thoroughly and then may advice certain tests to confirm the diagnosis.
There is no single test for diagnosing polycystic ovary syndrome (PCOS). One may be diagnosed with PCOS based upon symptoms, blood tests, and a physical examination. Expert groups have determined that a woman must have two out of three ( Rotterdam criteria ) of the following to be diagnosed with PCOS:
- Menstrual irregularity-Irregular menstrual periods in the form of scanty, prolonged menstrual cycles or heavy prolonged flow. It is caused by anovulation or irregular ovulation.
- Evidence of elevated male hormone (Testosterone) levels- The evidence can be based upon signs (excess hair growth, acne, or male-pattern balding) or elevated testosterone levels.
- Polycystic ovaries on pelvic ultrasound– It shows enlarged ovary with multiple cysts. This is seen in almost 30% of cases.
- TSH and Prolactin hormones should also be done as Hypothyroidism and or Hyperprolactinemia may be associated with PCOS.
- In women with moderate to severe hirsutism (excess hair growth), blood tests for testosterone and In dehydroepiandrosterone sulfate (DHEA-S) may be recommended.
- Fasting Serum Insulin.
- If PCOS is confirmed, blood glucose and cholesterol testing are usually performed.
- Fasting serum Insulin.
Adolescent PCOS –
In adolescents, presence of oligomenorrhea (scanty menses) or amenorrhea (absent menses) beyond two years of menarche should be considered an early clinical sign of PCOS, followed by all the 3 criteria as mentioned above (Rotterdam criteria ) for adults for diagnosis of PCOS and investigation.
MANAGEMENT OF PATIENTS WITH PCOS –
Both pharmacological and non-pharmacological management strategies are crucial in the overall management of PCOS. Usually, treatment depends upon the symptoms for which the patient comes. As PCOS can not be cured permanently, the long term treatment plan should be given to manage her bothering symptoms and also to prevent long term sequel.
- Treatment – usually depend upon the symptoms for which the patient has come. But lifestyle modification forms the mainstay of treatment. Regular exercise, a healthy diet, weight control, and non-smoking are all important parts of treatment for polycystic ovary syndrome (PCOS).
- Physical activity – In adults and adolescents with PCOS, daily strict physical activity sessions for at least 30 min/day or 150 min/ week are recommended.
- Weight loss – Weight loss is one of the most effective approaches for managing abnormal irregular menstrual periods, and other symptoms of PCOS. For example, many overweight women with PCOS who lose 5 to 10 percent of their body weight notice that their periods become more regular. Weight loss can often be achieved with a program of diet and exercise.
- Diet – it is recommended to follow a calorie-restricted diet (low carbohydrate and fat, high protein diet).
- Oral contraceptives – Oral contraceptives which are hormonal pills (OCs; with combined estrogen and progestin) are the most commonly used treatment for regulating menstrual periods in women with polycystic ovary syndrome (PCOS). OCs protect the woman from endometrial (uterine) hyperplasia or cancer by inducing a monthly menstrual period. OCs are also effective in treating hirsutism and acne. Oral contraceptives also decrease the body’s production of male hormone( androgens).
Other drugs used are Metformin, Myoinositol, Vitamin D, etc. all these drugs should be used only after consulting a Gynecologist.
Treatment of infertility – If tests determine that lack of ovulation is the cause of infertility, several treatment options are available.
The primary treatment for women who are unable to become pregnant and who have PCOS is weight loss. Even a modest amount of weight loss ie even 5% may allow the woman to begin ovulating normally. In addition, weight loss can improve the effectiveness of other infertility treatments.
Prevention – (PCOS) cannot be prevented. But early diagnosis and management help prevent long-term complications, such as infertility, metabolic syndrome, obesity, diabetes, and heart disease.