September is PCOS (Polycystic ovary syndrome) awareness month. PCOS affects women of reproductive age (15-49 years). Worldwide, it affects 4%–20% (8-40 crore) of women. In India, it affects 3.7% to 22.5% (1.3-7.9 crore) of women.
PCOS is not yet recognized as an important health problem. But prevention and early identification of PCOS is required to arrest, or even reverse, its increasing incidence rate.
Currently, PCOS is incurable.
What is PCOS
PCOS (polycystic ovarian syndrome) is a hormonal imbalance. In PCOS, many cysts (small sacs of fluid) may form on the outer edge of the ovary. The cysts contain follicles (immature eggs). The eggs may not mature and are not released regularly. However, PCOS can occur even when these cysts do not exist.
The exact cause of PCOS is not known. But one or more of the following factors may cause it:
- Certain genes may be linked to PCOS. Thus. women with family history of PCOS are more likely to develop it.
- Excess androgen. In some women, ovaries produce elevated levels of male hormone androgen which can cause problems with ovulation. That is, eggs may not develop, or if developed, may not be released from the follicle regularly. Excess androgen can also cause acne and hirsutism.
- Low-grade inflammation. A type of long-term, low-grade inflammation can cause ovaries to produce androgens and thus cause PCOS.
- Insulin resistance. Sugar is the main source of energy for the body. Insulin is a hormone which is used by the cells to convert sugar into energy required by the body. Sometimes the cells become resistant to insulin and the blood sugar level goes up. The body then makes more insulin to bring down the sugar level. Excess insulin causes more of male hormone androgen to be produced. Too much androgen can cause problems with ovulation, that is, with the release of eggs from the ovary.
The signs of insulin resistance are more appetite, weight gain, and dark, velvety skin-patches on the groin, armpits, under the breasts, and on lower part of the neck.
A woman has PCOS when she has at least two of these:
- Too much androgen. Indicated by too much hair on face and on the arms, chest and abdomen (hirsutism). About 70% of women with PCOS have hirsutism. Severe acne, and male-pattern baldness are the other indications.
- Irregular periods. Too short, or too long menstrual periods lasting several days, less than nine periods in a year or periods more than thirty-five days apart, irregular periods, heavy bleeding during periods, and difficulty in getting pregnant are signs of PCOS.
- Polycystic ovaries. Some women have larger ovaries which do not act properly, and this may cause PCOS.
- Skin tags are little flaps of extra skin often found in the armpits or on the neck.
But PCOS can also occur without any symptoms.
PCOS usually begins at the first menstrual period but may develop after a few periods. It is often detected in 20–30-year-old women when they are trying to get pregnant
Obese women usually have more severe signs and symptoms of PCOS.
Sometimes, but not always, hormone changes caused by menopause may make PCOS go away.
PCOS can cause one or more of these complications:
- PCOS is the most common cause of female infertility.
- Miscarriage or premature birth
- Gestational diabetes or pregnancy-induced high blood pressure
- Type 2 diabetes or prediabetes
- Metabolic syndrome — high blood sugar, unhealthy cholesterol or triglyceride and high blood pressure. These significantly increase the risk of heart and blood vessel (cardiovascular) disease.
- Non-alcoholic steatohepatitis — a severe liver inflammation caused by fat build-up in the liver
- Depression, anxiety and eating disorders
- Sleep apnea
- Cancer of the uterine lining (endometrial cancer)
In obese women, the complications are worsened
PCOS is usually diagnosed from symptoms such as weight changes, menstrual periods, insulin resistance and acne, and excess hair growth. And from these tests:
- Pelvic exam to check reproductive organs for growths, masses, or other changes.
- Blood tests to measure hormone levels, fasting cholesterol and triglyceride levels, and glucose tolerance test. These tests can exclude causes of menstrual problems that mimic PCOS.
- to check the ovaries and the thickness of the lining of the uterus.
If PCOS is diagnosed, these tests may be recommended:
- Regular checks of blood pressure, glucose tolerance, and cholesterol and triglyceride levels
- Screening for depression and anxiety
- Screening for obstructive sleep apnea
PCOS treatment is lifestyle changes and medications.
Weight loss, even just 5%, improves PCOS conditions. Weight loss also improves the effectiveness of medication. Low calorie diet rich in vegetables and fruits and low in fats, at least eight glasses of liquid including water every day, and moderate exercise is recommended for weight loss.
Medications can include combination birth control pills and progestin therapy. These can lower the risk of endometrial cancer and correct irregular bleeding, excess hair growth and acne. Eflornithine (Vaniqa) cream can slow facial hair growth. Electrolysis and laser are the two options for hair removal are two options for hair removal. Topical creams or gels, and pills, may help improve acne. Other medications may be prescribed to improve ovulation and thus the chances of pregnancy.
PCOS cannot be prevented. But the severity of the symptoms can be reduced by reducing weight, having balanced diet rich in fruits and vegetables, and regular moderate exercise. Yoga and meditation can help cope with anxiety and depression. and managing weight can help avoid or reduce the adverse effects of PCOS.
Currently, PCOS can be neither prevented nor cured. Love is the best medicine for women suffering PCOS. But they have to struggle everyday with this invisible, terrible, illness. Hope is stronger than fear. Choose to be optimistic, it feels better.