Understanding PCOS

menstrual health

The incidence of polycystic ovarian syndrome (PCOS) appears to on the rise, or perhaps it is now being diagnosed more often. When a recently concluded health survey disclosed that it is one of the leading causes of infertility among women, it brought to the forefront some alarming facts.

PCOS is a health problem that is seen in as many as 25 to 30% of young women and affects their menstrual cycle, fertility, hormones, heart, blood vessels and appearance as well.

Recent studies have found that more than 50 % of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40. The risk of heart attack is four to seven times higher in these women and they are at a greater risk of having high blood pressure and high levels of LDL (bad) cholesterol. PCOS women are also at risk for endometrial cancer.

What causes it?

The cause of PCOS is unknown. But most experts think that several factors including genetics, could play a role. The underlying problem is hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.

Researchers also think insulin may be linked to PCOS. Excess insulin appears to increase production of androgen and in turn high androgen levels leads to acne, excessive hair growth, weight gain and problems with ovulation.

Symptoms

They can vary from woman to woman. Some symptoms include infertility, infrequent or absent menstrual periods, hirsutism (increased hair growth on the face, chest, stomach, back, thumbs, or toes), cysts on the ovaries, acne, oily skin, dandruff, weight gain and male-pattern baldness.

The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released and the egg travels through the fallopian tube to the uterus (womb) for fertilisation. This is called ovulation.

In women with PCOS, the ovary doesn’t make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent. Plus, the ovaries produce male hormones, which also prevent ovulation.
Treating PCOS

Because there is no cure for PCOS, it needs to be managed. Treatment goals are based on symptoms and whether or not you want to become pregnant. Here are some ways to manage PCOS:

Healthy diet and exercise lowers blood glucose levels, improves use of insulin and normalises hormone levels.

Birth control pills can control menstrual cycles, reduce male hormone levels and help to clear acne.

Diabetes medication achieves better insulin levels and lowers testosterone production. It also helps reduce body weight and improves cholesterol levels.

Medications that stimulate ovulation can help women with PCOS get pregnant. Even so, other reasons for infertility should be ruled out beforehand. Another option is in-vitro fertilization (IVF).

Ovarian drilling is a laparoscopic surgery that may increase the chance of ovulation by lowering male hormone levels.

Anti-androgens may reduce hair growth and clear acne.

(The author is director, Reproductive Medicine, Manipal Fertility)