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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 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