Polycystic ovary syndrome (PCOS) is a complex disorder that affects 5 to10% of women of reproductive age. It derives its name from the presence of multiple fluid filled cysts found in the ovary in this condition. This is usually evident on an ultrasound scan of the ovary. In addition, the syndrome is characterized by excessive hair growth in face and other body parts, pimples, darkening of skin which altogether is suggestive of hyperandrogenism, obesity, and chronic anovulation which is evident by irregular menses.
Though a woman may be genetically predisposed to developing PCOS, it is only the interaction of environmental factors with the genetic factors that results in the characteristic hormonal and menstrual disturbances associated with PCOS. Obesity, sedentary lifestyle and poor eating habits are important contributors to the development of PCOS.
If you have PCOS, you may have normal reproductive organs (uterus and fallopian tubes). However, you may have one or more of the following signs and symptoms:
• Menstrual disturbances in 70% (Irregular or absent periods, No bleeding to excessive spotting, Cycle lengths more than thirty-five days)
• Obesity( 65- 75%)
• Infertility and miscarriage
• Hair and skin problems ( 60-70%)(acne, hair loss, excessive facial hair, oily skin etc)
• Adolescent girls with hair and skin problems with associated irregular menses.
• Excessive weight gain with irregular menses
• Infertile couples
A careful examination by your physician or a gynecologist is the most important step in the diagnosis of PCOS. If PCOS is suspected, further blood tests, hormonal assays and an ultrasound scan may be required to confirm the diagnosis.
The figures show the ultrasound picture of a polycystic ovary (right) in comparison to a normal ovary (left). The polycystic ovary gives an appearance of multiple black coloured cysts in an ultrasound scan.
Apart from gynecological problems like irregular menses and infertility, PCOS is associated with several long-term health consequences that affect the overall health in 30-40% of women. This includes pre-diabetes, metabolic syndrome, heart disease, and type 2 diabetes. About 1 in 3 women with PCOS have pre-diabetes and other symptoms associated with metabolic syndrome. These conditions may pave the way for diabetes and other serious illnesses if left untreated.
Living with PCOS and getting pregnant is challenging because your body doesn't produce the hormones necessary for regular ovulation. Without these hormones, the egg inside the ovary does not fully mature. The follicle that holds the egg still grows and fills with fluid. However, there is no mature egg to rupture it, so it remains as a cyst. The cysts with PCOS produce higher than normal amounts of androgens (male sex hormones), which block ovulation. Because no mature egg is released, ovulation fails to occur and the hormone progesterone is not made. This results in an irregular or absent menstrual cycle. PCOS is a leading cause of infertility. Life with PCOS can be complex without some medical guidance.
• Weight reduction :
The recommended first line of treatment is weight loss. Among women with PCOS, 65% to 75% are obese. Obesity has a significant impact on reproductive outcome. When a woman's body mass index (BMI) is greater than 35, the time to conception is increased 2-fold to 4-fold. Obesity not only influences time to conception but also adversely affects the response to fertility treatment. In addition, it negatively influences pregnancy and may give rise to pregnancy related complications. Our dietitian will prescribe a diet chart designed to reduce weight without making you starve or otherwise affecting the nutritional status of the body. We also stress on an exercise program that will help with weight reduction as well improve your overall stamina and well-being. Some may additionally require weight reduction medicines to achieve the target body weight.
• Hormonal therapy :
Women with complaints of menstrual irregularity, abnormal hair growth, pimples from PCOS are treated with low dose hormonal medicines to correct these symptoms.
• Fertility treatment :
PCOS is a leading cause of infertility and women with PCOS usually require medical help for conception. There are several treatment options available for such patients.
• Medicines that restore ovulation : Medicines such as clomiphene and several injectable hormonal medicines have the ability to interrupt the pathology in PCOS and boost the development of follicles. This permits an ovum to develop and be released for fertilization. As anovulation or inability to form and release an ovum is an important cause of infertility in PCOS, such medicines, through their effect on ovulation can address infertility and result in a successful pregnancy.
• Metformin : Resistance to insulin and a pre-diabetic state accompany PCOS. Metformin is a medicine that increases the sensitivity of the tissues to insulin. Metformin helps to lower insulin levels, and to prevent development of diabetes. Fertility drugs for PCOS are often taken in combination with metformin.
• IVF : With repeated failure with basic fertility drugs, In vitro fertilization (IVF) is another great option for getting pregnant with PCOS. While IVF can be an expensive and time-consuming process, many women with PCOS have had great success with IVF, getting pregnant and bringing home healthy babies.