Understanding Polycystic Ovary Syndrome (PCOS)

By Dr. Anuradha Kapur in Obstetrics And Gynaecology

Apr 30 , 2019 | 2 min read

What is PCOS?

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women in reproductive age, with prevalence estimates of around 15 % reported. The exact causes of PCOS are unknown, but it is thought to be a result of hormonal disturbances (increased androgens and/or insulin) induced by a combination of genetic (X linked dominant gene) and environmental factors.

Common Symptoms of PCOS

Hirsutism, Excess hair on the chin, upper lip or lower abdomen
Acne
Irregular menstruation
Male pattern alopecia (hair loss)
Acanthosis nigricans .. dark thick pigmentation of the skin
Weight issues - Obesity
Infertility

Consequences of PCOS

Reduced psychological and emotional well- being due to negative self-body image
Impaired physical, sexual, social and cognitive functioning, anxiety and depression
Hyperandrogenismmanifesting as Hirsutism and acne
Ovulatory and menstrual dysfunction
High blood pressure Infertility & miscarriages
Increased type 2 diabetes and cardiovascular risks
Liver diseases & sleep apnea if the patient is obese
Long term risk of endometrial cancer

Treatment and Management of PCOD

There is no cure, but there are many ways to decrease or eliminate PCOS/PCOD (Polycystic Ovarian Disease) symptoms and feel better.

We may achieve this by the following:

Lowering of insulin resistance levels
Restoration of fertility
Treatment of hirsutism or acne
Restoration of regular menstruation

The primary treatment for PCOS includes:

Lifestyle changes that is diet
Regular exercise
No smoking
Medication
Emotional and psychological support

Diet

Methods that help to reduce weight or insulin resistance can be beneficial for all these symptoms. Even 5 to 10% of weight loss can improve symptoms markedly.

What Diet is Suggested in PCOS?

A low GI diet and high fibre diet in which a significant part of total carbohydrates is obtained from fruits, vegetables, and whole grain sources has resulted in greater menstrual regularity.

Avoid - sweetened juice, canned fruit in heavy syrup, starchy vegetables such as potatoes, corn and peas. white flour products such as white bread ,pasta, or white rice, Sugary food such as cookies, cakes.

Regular Exercise: recommendation of 150 mts of exercise per week

Medication: The easiest way to treat PCOS is with birth control pills. In Indian conditions, pills with antiandrogenic effect like cyproterone acetate with ethinyl estradiol work best for patients with hirsuitism, acne and menstrual irregularity. However, for patients trying to conceive, birth control pills are not an option. Women with PCOS do not ovulate, which causes irregular menses, so the best way to increase the odds of conception is to give the ovaries a push using a fertility medication called clomid. We can help 80-85 percent of women with PCOS ovulate with clomid. The other 15-20 percent will require a stronger treatment.

Another way we can address PCOS is to lower the insulin level with a medicine called metformin which is recommended if blood sugars are impaired.

Can a PCOS Patient Get Pregnant?

Women with PCOS usually will have difficulty getting pregnant - and require PCOS treatment to improve chances for pregnancy. Some women with polycystic ovary syndrome will ovulate - others do not ever ovulate without treatment and need an infertility specialist.

Key Messages

PCOS is associated with a range of metabolic abnormalities which can lead to long term health problems:

PCOS limits fertility but can be treated
Advice early family initiation where practicable
Women with PCOS have increased risk of endometrial cancer with prolonged amenorrhea
Increased cardiovascular risk factors
Increased risk of diabetes
Lifestyle changes are the first line of therapy
5-10% weight loss will greatly assist in symptom control
Assess mental and emotional health
Management has to be individually tailored for each patient