Herald Café: What
is Polycystic Ovarian Syndrome (PCOS)?
Dr Gauri Gauns: The ovaries are responsible for producing eggs (oocytes) and the
female hormones (estrogen, progesterone and androgens). In a normal ovary, ovulation
(release of a mature egg) is a regular feature which takes place in a cyclical
manner.
Polycystic ovarian
syndrome is an endocrine disorder with heterogeneous features, wherein there is
absence or infrequent ovulation associated with various hormonal imbalance.
Polycystic ovaries are larger than normal ovaries with increased stroma and
multiple small follicles filled with fluid, which fail to ovulate.
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HC: Why is PCOS so
commonly heard of lately?
Dr GG: Approximately 10-20%
of women in the age group of 15 to 45 years have PCOS. Its incidence is on a
rise due to change in lifestyle, food habits, increasing obesity and
environmental factors.
HC: What are the symptoms
of PCOS?
Dr GG: The following are the
various symptoms that a woman can present with:
Menstrual
irregularities such as no menstrual periods; frequently missed periods and very
heavy periods or prolonged periods
Increase in body hair
especially on face, chest, belly and upper thigh (hirsutism)
Loss of hair on scalp
Being overweight,
experiencing a rapid increase in weight or having difficulty losing weight
Oily skin, pimples
(acne)
Difficulty becoming
pregnant
Patches of thickened,
dark skin over neck, axilla, groin (acanthosis nigricans)
Depression and
psychological problems
Symptoms vary from
woman to woman. Some women may have very few mild symptoms, while others are
affected severely.
HC: What causes
polycystic ovaries?
Dr GG: The cause is
multifactorial:
Androgen excess seen
in almost 60-80% of women
Insulin resistance or
elevated insulin levels
Family history in
mother, sister, aunt
‘Epigenetics’ –
Environmental factors like obesity, unhealthy lifestyle, low birth weight etc,
can interact with genes to lead to PCOS
HC: How do I know if I
have PCOS?
Dr GG: There is no single
test to diagnose PCOS.
A diagnosis is made
when you have any two of the following:
Irregular, infrequent
periods or no periods at all
An increase in facial
or body hair and/or blood tests that show higher testosterone levels than
normal
An ultrasound scan
that shows polycystic ovaries
It is important to
note that ONLY polycystic ovaries on ultrasound, in the absence of any of the
above-mentioned signs or symptoms, it is NOT PCOS.
Also, certain
conditions like thyroid dysfunction, high prolactin level, Cushing syndrome,
stress, excessive exercise can also present as irregular periods and have to be
ruled out.
HC: If I have PCOS, will
I have difficulty getting pregnant?
Dr GG: PCOS is one of the
most common but treatable causes of infertility. The hormonal imbalance
interferes with the growth and release of eggs from ovaries, thus making it
difficult to conceive.
HC: What are the
treatment options to get pregnant if I have PCOS?
Dr GG: If a patient is
overweight, losing weight through healthy eating and regular physical activity
can help to regularise periods in majority of women. Even 10% weight loss helps
to restore ovulation. Medicines to induce ovulation like clomiphene citrate and
letrozole may also be prescribed.
Some women may need
intra uterine insemination (IUI) or in vitro fertilisation (IVF), if the
infertility is of long duration, or if any other factors of infertility are
associated.
HC: Can PCOS cause
complications in pregnancy?
Dr GG: Yes. Women with PCOS
can have miscarriage (especially in first trimester), gestational diabetes,
preeclampsia (high blood pressure), macrosomia (large weight babies) and
increased incidence of cesarean section.
Babies can also have
increased risk of developing hypoglycemia (low blood glucose) and hypocalcemia
(low calcium) in the immediate post natal period and can have long term risk of
developing obesity and metabolic syndrome.
HC: What are the various
treatment options available?
Dr GG: PCOS treatment is
tailored to each woman according to symptoms, existing health problems and
whether she wants to become pregnant.
Exercise: At
least 150 min/week of moderate intensity exercises like brisk walking, playing
light sports etc OR at least 75 min/week of vigorous intensity activities like
running, field sports, swimming, jumping rope ,etc OR weight training, which
helps to strengthen the muscle and increase bone density
Medications: Combination
birth control pills, Progestins, Metformin, Myoinositols.
Healthy food: Balance carbohydrates with protein and healthy fats; choose
nutritious or high fibre carbohydrates instead of sugary or refined
carbohydrates; eat small frequent meals instead of large meals; do not skip
breakfast.
HC: Why have I been
prescribed Metformin although my blood sugar is normal?
Dr GG: Hyper insulinemia or
insulin resistance is seen in almost 80% patients of PCOS. In hyper
insulinemia, the cells can’t utilise insulin properly, thus the pancreas makes
more insulin to compensate. High levels of insulin trigger the production of
androgens by the ovaries and cause the arrest of normal follicle development.
Metformin is an insulin sensitiser, which helps to increase uptake of insulin.
It also helps to reduce weight, especially in obese patients.
HC: Would PCOS cause any
long-term health complications?
Dr GG: Women with PCOS are
at greater risk of developing long term health problems, such as diabetes,
metabolic syndrome (obesity+ hypertension+ diabetes+ high cholesterol), sleep
apnea (snoring) and day-time drowsiness, depression and mood swings,
endometrial cancer.
Since women with PCOS
do not ovulate, the lining of the womb (endometrium) may thicken, leading to
increased risk of developing cancer of endometrium in few women.
HC: Is there a cure for
PCOS?
Dr GG: There is currently no cure for PCOS.
Medical treatments aim to manage and reduce the symptoms or consequences of
having PCOS. Medication alone has not been shown to be any better than healthy
lifestyle changes.
