Polycystic Ovarian Syndrome

Polycystic Ovarian syndrome or Disease(PCOS)

Polycystic Ovarian syndrome or disease as it was previously known has become a major player in the field Gynecological disorders in recent decades. First of lets bust some myths regarding this disorder.

• Women with PCOS do not have cysts in their ovaries! The name is a
  misnomer.
• Not all women with PCOS are obese.
• Not all women with PCOS are infertile.
• Not all women with PCOS have irregular menstrual cycles.

What Causes It?

Even though the exact cause of this condition is not established or fully understood, the treatments available have proliferated and have brought relief to many women.

The causes range from genetics to a faulty lifestyle. You are more likely to suffer from PCOS if your mother or sister has the same condition. Also, the fact that this condition is predominantly seen in our generation and practically unheard of in the previous one hints at something to do with the lifestyle changes that have occurred in the meantime. Changes such as travelling by cars rather than walking or cycling, fast and processed food rather than the wholesome food made with natural ingredients made at home, sedentary working style with all the comforts at your beck and call etc have all made us ‘soft’ and prone to these disorders of the modern era!

How Does It Manifest?

So there are three hallmark signs and symptoms that earmark PCOS, namely

• Irregular menstruation (Ovulation).
• Presence of ‘cysts’ in the ovaries as seen on an ultrasound scan.
• Presence of Hyperandrogenemia (an excess of androgen (male) hormones).

The criteria for diagnosing have changed over the years but that’s something for your Gynecologist to worry about.

The symptoms that you can look out for are

• Irregular menses.
• Gain in weight, especially with a male pattern fat distribution ie, more on the abdomen rather than the hips and thighs (as is usual in women).
• Male pattern hair distribution, on the face (lips, cheek, chin), chest, inner thighs etc
• Darkening of the skin at the nape of the neck.
• Difficulty in conceiving.

What Actually Happens?

So in normal women a delicate balance or interplay between multiple hormones released from the Pituitary gland and from the ovaries ensure the normal development and release of a single oocyte every menstrual cycle. At the start of every cycle the hormones are all at their lowest level and gradually increase in concentration in the blood but each hormone starts increasing and peaking at different times during the cycle and it is this balance which is lost in women with PCOS and thus they do not ovulate regularly resulting in the build-up of immature follicles which come to the surface of the ovary every month. It is these immature follicles that appear as cysts on the ultrasound scan. Gradually the size
of the ovary increases and worsens the hormonal imbalance.

Another hallmark in women with PCOS is their resistance to the action of insulin, the hormone that plays a vital part in controlling the blood sugar values. It is the the hormone that is secreted by the pancreas when the body detects a rise in blood sugar values so that it can be decreased and brought back to normal. In PCOS patients the action of insulin is not optimal, which means that they require more
of insulin than a normal woman to reduce the sugar level by the same amount This also means that a PCOS patient will have more amount of insulin in their the blood which leads to darkening of the skin, obesity, hyperandrogenemia etc in varying degrees depending on the severity.

All women have male sex hormones in a minimal amount but PCOS women have them in excess as their ovaries’ function shifts from producing female sex hormones to the male hormones due to the factors elaborated above.

All this causes the absence of regular ovulation leading to irregular periods, male pattern hair growth and fat distribution, hair fall, acne etc, and as you can obviously see, all these symptoms are extremely distressing! And that it occurs more in women of the younger age group, adolescents and those looking to start a family make it even more of a concern. Polycystic Ovarian Syndrome patients are also more prone to develop Type 2 Diabetes Mellitus, Dyslipidemia and other complications related to obesity

What Can Be Done?

In the adolescent age group, the concern is more focused on physical appearance. Exercise and change in diet are very important first steps to the management of. The usual treatment given is Oral Contraceptive Pills because basically they are the female sex hormones that the ovary should be
producing every month. So while on the pill the body receives adequate quantities of the hormones and regular menstruation occurs albeit without ovulation!

In a woman looking to conceive, the treatment aims at restoring normal and cyclical ovulation so that she not only has regular cycles and normal hormonal milieu in the body but can also conceive. Again the first step here is lifestyle modification, which ensures weight loss and a better response to the ovulation
treatment. Ovulation can be brought about by oral tablets (mild cases) or hormonal injections (severe cases). In due course, the follicle matures and is ready for rupture and thus the woman has a chance of conceiving and at the very least she has regular menstrual cycles.

In very rare and severe cases the medicines may not ensure ovulation, in such cases the patient may require higher doses of the injections or a surgical the procedure called Laparoscopic Ovarian Drilling which involves puncturing the ovaries with heat energy (3-4 times each per ovary) so as to reduce the size and mass of the ovary which leads to a decreased production of male hormones and increased sensitivity to ovulation drugs.

Take Home Message:

• All adolescent girls having symptoms of PCOS must be evaluated by a gynaecologist and treatment initiated.
• Girls with PCOS should be made aware of the chances for infertility and the need for assisted reproduction, future health risks such as diabetes, hypercholesterolemia etc.
• All women with Polycystic Ovarian syndrome looking to conceive should have their male partner evaluated before starting the infertility treatment.
• PCOS patients should ideally not postpone their marriage or pregnancies but at the same time should not feel pressurized to marry and get pregnant just because they have a medical condition (Phew! Good luck with that).

All things considered, although it is a difficult disorder to live with and treat, support is always available. Just let go of the inhibitions and avail the support you need!