WHAT IS POLYCYSTIC OVARIAN SYNDROME (PCOS)
Polycystic ovarian syndrome (PCOS) is a hormonal disorder affecting around 15-25% of Indian women. It is called a ‘syndrome because it encompasses a number of symptoms experienced at the same time. As the name suggests, most women with PCOS have multiple small cysts in their ovaries. This need not necessarily be present in all women and a diagnosis of PCOS can be made by other symptoms which are detailed below.
WHAT CAUSES PCOS?
Doctors are not exactly certain what causes PCOS. Genetics may play a role, in other words- it runs in the family. If any relatives, such as your mother, sister or aunt have PCOS, the risk of you developing the disease is often increased.
Levels of insulin are found to be raised in women with PCOS. Insulin helps to regulate blood sugar levels. It is secreted by the pancreas following a meal and moves glucose from the blood into cells, where it is further broken down to produce energy. Women with PCOS are resistant to the actions of insulin (their tissues don’t respond to insulin), hence, more and more insulin is produced as compensation. These high levels of insulin cause the ovaries to produce excess testosterone. Moreover, insulin resistance and hyperinsulinemia can lead to weight gain, worsening the symptoms of PCOS, as having excess fat can further increase insulin resistance leading to more hyperinsulinemia. Thus, it is a vicious cycle of events.
The following hormones are found to be deranged in women with PCOS:
DO I HAVE PCOS?
Women with PCOS may exhibit the following symptoms: Irregular periods or no periods at all. Difficulty getting pregnant (because of irregular production or failure to produce an egg).
Not all women with PCOS have all of these symptoms. Some women experience menstrual problems or difficulty in conception or both, and are subsequently found to have PCOS.
HOW DOES IT AFFECT MY ABILITY TO CONCEIVE?
Polycystic ovaries have multiple tiny cysts (follicles). A follicle is a fluid-filled sac in the ovary which contains an egg. You may wonder women with PCOS have many follicles and if each contains an egg, aren’t the chances of natural conception higher? Well, more is not always better as is evidenced by this scenario. To understand why, let us look at the normal menstrual cycle. Every month or so, after your period, a few follicles start developing in your ovary under the influence of a hormone called follicle-stimulating hormone (FSH). Out of these follicles, only one undergoes complete maturation while the others regress. When that single follicle is ready, there is a surge of another hormone called luteinizing hormone (LH), which causes rupture of the follicle and release of the egg- the process called ovulation. In women with PCOS, due to the underlying hormonal imbalance, these follicles stop growing around halfway to maturity and ovulation does not happen. Therefore, an egg is not produced and conception is affected.
WHAT TESTS WILL I HAVE TO UNDERGO?
Your doctor will consider your symptoms and perform a physical examination, a few blood tests and a scan to look at your ovaries.
DIAGNOSTIC CRITERIA FOR PCOS: A diagnosis of PCOS is made after all other causes have been ruled out and you have 2 of the following 3 criteria: 1. Irregular/ no periods- indicate infrequent/ no ovulation. 2. Blood tests or symptoms suggestive of high levels of “male hormones” (11 rerandroienism . 3. Scans showing you have polycystic ovaries.
WHAT IS THE TREATMENT OF PCOS?
Polycystic ovarian syndrome cannot be cured but the symptoms can be alleviated with appropriate treatment. Treatment options may vary from person to person depending on the particular symptoms. These are discussed in more detail below.
In overweight women, weight loss is the key factor to regularize periods and reduce the risk of developing long-term health problems from PCOS. Weight loss of just 5-10% of your body weight can lead to a significant improvement in PCOS. You can find out if you’re a healthy weight by calculating your body mass index (BMI) which is a measurement of your weight in relation to your height. A normal BMI is from 18.5 to 24.9.
If you do not respond to medications, you may be advised to undergo a procedure called laparoscopic ovarian drilling. This procedure helps to reduce male hormone levels and may aid ovulation.
WHAT ARE THE LONG-TERM RISKS OF PCOS?
HOW DO I REDUCE THESE RISKS?
Weight loss and physical activity as detailed above form the cornerstone of risk reduction strategies. They lower the risk of developing diabetes and cardiovascular disease in later life. It is advisable to make sure you have a period at least once every two months. This will ensure your uterine lining does not thicken too much thereby reducing your risk of developing endometrial cancer.
EVERY CLOUD HAS A SILVER LINING
The good news about PCOS is that your ovarian reserve (the number of eggs you have) is good. Therefore, your chances of getting pregnant with treatment (stimulation) are also good.