Polycystic Ovary Syndrome (PCOS)

Usually, the signs and symptoms of polycystic ovaries differ from patient to patient. Some of the common symptoms a woman with polycystic ovary syndrome experiences are:

• Irregular Menstruation (heavy, light, or lack of periods): Women with PCOS lack ovulation which prevents the monthly shedding of the uterine lining. This results in irregular menstrual cycle.
• Heavy bleeding: As the regular period is absent, the uterine lining builds up for a long time. When it finally begins to shed, a woman gets a heavy period as compared to normal bleeding.
• Acne: Due to excess production of androgen, the skin becomes oilier than usual. This causes acne on various body parts including the face, upper back, and chest.
• Weight Gain (especially around the abdomen): More than 70 % of women with PCOS suffer from obesity.
• Darkening of Skin: Patches of dark or thickened skin – are called acanthosis nigricans. In some cases, dark patches may develop on the skin in areas like the neck, groin, and under the breasts.
• Headache: The hormonal disbalance can trigger headaches as well.
• Hair Growth: Polycystic ovaries also lead to excessive hair growth on the face and body. This condition is also known as hirsutism.
• Baldness: Some women with PCOS can also expect male pattern baldness.
• Emotional disturbances due to hormonal changes

Though the main causes of PCOS are not known, there are certain factors that are usually associated with the excess production of androgen. Some of the factors that may play a role in PCOS are as follows:

• Excess Insulin: Insulin is a hormone that helps the cells in using sugar from the food and converts it into energy or stores it in the form of glucose for future use. Insulin resistance happens when the cells in the body stop responding normally to it, resulting in high levels of insulin and sugar in the body. This condition of excess insulin may increase the production of androgen, causing disturbances in ovulation.
• Genes: Genes are related in causing polycystic ovaries. Family without diabetes mellitus is a strong contributing factor.
• Inflammation: Patients with polycystic ovaries usually have high levels of inflammation in the body, and this is also linked to the excess production of androgen hormone in the body.
• Environmental triggers
• Abnormal hormone levels

Polycystic ovaries syndrome is not just responsible for causing the symptoms mentioned above but can also lead to several health issues. A few of them are mentioned below:

• Infertility: Due to PCOS, women cannot ovulate regularly, and this irregular ovulation prevents the production of eggs for fertilization. This leads to trouble in pregnancy and in many cases infertility as well.
• Sleep Apnea: In this condition, obesity may cause repeated pauses in breathing to occur during the night which interrupts sleep.
• Metabolic Syndrome: Most of the women suffering from PCOS are obese or overweight. This increases the risk of high blood pressure, blood sugar, LDL cholesterol, and low HDL cholesterol. All these factors are together called metabolic syndrome which can increase the risk of stroke, diabetes, and heart disease.
• Endometrial Cancer: The thickened lining in the uterus due to irregular ovulation can increase the risk of endometrial cancer.
• Depression: Due to various hormonal changes and unwanted hair growth, many women with polycystic ovaries tend to experience depression.
• Endometrial hyperplasia
• Abnormal uterine bleeding
• Gestational diabetes
• Anxiety

Once the symptoms and complications related to PCOS are detected in a woman, doctors recommend various diagnostic tests to ensure the presence of the hormonal disorder. The doctor first asks the patient about the symptoms and then moves forward for the pelvic exam. During the pelvic exam, the doctor checks for the issues related to the ovaries or any other part of the reproductive system.

The diagnostic process also involves blood tests and an ultrasound. Blood tests are performed to check the presence of high levels of male hormones. Moreover, an ultrasound test is performed to identify abnormal follicles and other complications in the uterus and ovaries.

Treatment is generally a mix of these:

• Lifestyle changes - Making dietary changes and implementing a regular exercise routine can help with ovulation, make medications more effective, lower blood glucose levels, and reduce other symptoms.
• Hormonal birth control - Hormonal birth control helps decrease the production of androgens, regulate oestrogen levels, and helps manage symptoms like acne, excessive hair growth, and irregular cycles.
• Insulin-sensitising medications
• Androgen-blocking medications - PCOS is characterised by high levels of testosterone, which is why androgen-blocking medications can help decrease the levels of testosterone and manage other symptoms.
• Surgery - Certain surgical procedures are an option for severe PCOS, so levels of hormones can be managed. It is usually implemented after a range of medications and therapies that have been shown to be ineffective. It can affect a person's fertility.

Though there is no cure for polycystic ovaries syndrome, doctors prescribe treatments that can control the symptoms. Primary polycystic ovaries treatment involves healthy alterations in lifestyle and medications. Mostly the treatment is tailored as per the condition of the patient.

The main aim of a PCOS treatment includes-

• Weight control
• Lowering the blood glucose level
• Preventing fertility issues
• Hindering the growth of acne
• Restoration of regular periods

During the treatment, the patient is required to attend regular appointments to check the progress.

The symptoms of PCOS can be managed but cannot be cured. Staying active and eating a healthy diet can be very beneficial.

Factors that put you at risk of developing PCOS are:

• Obesity & environmental issues
• Genetic predisposition

Reviewed by Dr. Anuradha Kapur, Senior Director & Head of Unit (Institute of Obs & Gynae), Obstetrics And Gynaecology on 12-Jan-2023.

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