PCOS – Polycystic Ovary Syndrome – What is it?

‘Polycystic’ means, having multiple cysts.  This is quite a misnomer because; many women suffering from PCOS problem do not have any cysts at all.  PCOS is a hormonal condition that some women get during their fertile age.  This condition can affect the fertility of the person.  When the reproductive hormones are out of balance, ovaries do not release egg on time and the menstrual cycle gets disturbed. Sometimes it may be short and sometimes it may be long and predicting the ovulation time will become a difficult task.

The imbalance of hormones can also cause acne, facial hair and increase the risk of diabetes and high blood pressure.  The hormones that play a role in this problem are:

1. Androgens – These are men’s hormones. They are also present in women’s bodies in a very small quantity. Women with PCOS problem have higher levels of androgens.
2. Insulin – You should have heard this when you come across diabetes. They manage the sugar level in blood. In women with PCOS problem, their body doesn’t work like the way it should when insulin is released by the pancreas.
3. Progesterone – Progesterone regulates the menstrual cycle in a woman. When this hormone is not produced in required quantity, women usually miss their period and may not have periods for a very long time. As said, it becomes difficult to tell when such women will have their periods.

Symptoms of PCOS

1. “Missed or irregular periods” – Most common symptom in women suffering from PCOS.
2. Hair growth in unwanted areas of your body, such as face, breasts, stomach, thumbs and toes. This is sometimes called “hirsutism”.
3. Hair loss on the head.
4. Oily skin and acne. Similar to the teenage, hormonal changes can cause oily skin and pimples. This is not a tell tale sign of PCOS problem but women with this problem can notice this change.
5. Darkening of skin – Thick, dark patches of skin under arms or breasts, on the back of the neck and in the groin area can be noticed. This condition is called ‘Acanthosis Nigricans’.
6. Fatigued all the time and problems with sleeping – You may have trouble having a good night sleep or may suffer from ‘Sleep apnea’ (where you forget to breath when sleeping, it’s not actually forgetting but the rythm will be lost).
7. Headches
8. Heavy periods when they happen.
9. Inability to conceive – This again circles back to release of progesterone and regulation of menstrual cycle. Women with disturbed or irregular cycles don’t release the egg at regular intervals.
10. Weight gain – Many women with PCOS will gain weight and find it hard to lose. Being overweight compounds the problems of PCOS.

Causes of PCOS

PCOS belongs to the category of medical conditions for which the exact reason is not known to the experts. In some cases, excessive production of insulin can affect the ovaries and their ability to make and release eggs.

How do you know if you are suffering from PCOS?

Irregular periods should be your first sign followed by inability to conceive, if you are planning to get pregnant. Darkening of skin and weight gain should tell you that you must see a good gynaecologist immediately to diagnose your problem.  PCOS can put women at risk of type 2 diabetes and high blood pressure.

Diagnosis of PCOS

Your gynaecologist will start with physical examination (looking for patches on the skin, hair on face and hair on your scalp) and question about your menstrual cycle and other symptoms. Make sure you mention about your family’s medical history because, if your mother or sister has/had PCOS, most likely, you will also have it.   Doctor may ask for blood tests to measure the level of androgen.   Pelvic ultrasound exam may also be done to check if the ovaries are fine or have any cysts on them.  The thickness of the uterus lining will also be examined along with the size of the ovaries. Typically ovaries become 1.5 to 3 times larger when a woman is suffering from PCOS.

The physical exam may also include examining  the pelvis region to see if there is anything unusual with the vagina, cervix, uterus, fallopian tubes, ovaries, rectum etc. (covering most of the organs in the pelvis region).

Tests your doctor may ask for when you have PCOS problem

1. Blood Tests – To check the levels of different hormones viz. Follicle Stimulating Hormone (affects the ability to become pregnant)., Luteinizing Hormone that helps in ovulation, Testosterone, a male sex hormone which is present in high levels in women with PCOS, Estrogen that regulates a woman’s periods and SHBG – Sex Hormone Binding Globulin.
2. hCG – Human Chorionic Gonadotropin, if you are missing your period, presence of this hormone may indicate that you are pregnant. hCG levels can be obtained from urine sample.
3. Anti-Mullerian Hormone (AMH) – This test reveals the functioning of the ovaries. Higher levels of this hormone indicate the possibility of PCOS problem.
4. Some other tests may be advised to rule out certain conditions like thyroid, tumors, hyperplasia whose symptoms resemble the symptoms of PCOS.

Certain post diagnosis tests may also be performed to check cholesterol levels, triglycerides, blood glucose levels etc.

Treatment of PCOS

There is no standard treatment for PCOS problem. Once your doctor diagnoses the problem and obtains the reports, treatment will target the root cause of the problem.  Medications along with some lifestyle changes may also be advised.

Lifestyle chances

Maintaining healthy weight is very important. Your gynaecologist may recommend some weight loss programs including nutritious diet plan. For the medicines to be more effective, it is important that the person should reach optimal weight and BMI.

Medications

1. Estrogen and Progestin pills – They reduce the production of androgen and regulate estrogen. Controlling androgen stops growth of facial hair, skin patches etc. A skin patch or a vaginal ring may be prescribed instead of oral medicines.
2. Progestin therapy – Consuming progestin for about 2 weeks once every month or two months can regulate the menstrual cycle.

Medicines include Clomiphene,  Letrozole, Metformin, Gonadotropins etc depending on the problem identified during diagnosis and test reports.