Polycystic Ovary Syndrome- often neglected or hushed up.

                                                                                           written by Dr Arun Kumar

A routine ultrasound scan says polycystic ovaries and the panic begins... is it a reasonable reaction? what is PCOS? is it a health condition of the ovaries exclusively?

PCOS is not an ultrasound finding alone!

USG image of PCOS/PCOD

PCOS (Polycystic Ovary Syndrome) or PCOD is a common endocrine disorder predominantly affecting women of reproductive age group. Prevalence of PCOS in India ranges from 3.7% to 22.5%, depending upon the population studied and criteria used for diagnosis.

The incidence of PCOS has increased in recent times and the hypothesis is that its due to modern lifestyle - excessive consumption of fast foods, indequate physical activities & altered circadian rythm that has direct bearing on the hormonal balance.

In women, ovaries are the primary organs producing female sex hormones (estrogen & progesterone). Normal ovaries also produce small amounts of male sex hormones called androgens. However, in PCOS  excessive quantities of androgens are produced. These hormone levels interfere with ovulation and the release of eggs, this can lead to the formation of numerous small cysts (fluid-filled sacs) in the ovaries. There are exceptional cases seen where cysts are absent in women with PCOS.

Though the exact cause of PCOS is unknown, these factors could play a role

  • Excess Insulin due to insulin resistance or obesity
  • Increased androgen levels
  • Low-grade inflammation
  • PCOS may also run in families, you are more likely to get PCOS if your mother or sister has it.

The most common symptoms of PCOS are :

  • Irregular or prolonged menstrual cycles
  • Difficulty in conceiving
  • Excess hair growth on the face and body (hirsutism)
  • Thinning of scalp hair
  • Pimples
  • Darkened skin patches
  • Weight gain
Over weight & Obesity has a compounding effect on the symptoms of PCOS leading to psychological efects that impact the emotional well being of patients. This in turn affects the hormonal balance further exacerbating the condition.
PCOS is the commonest cause of the symptom - "mahina late ata hai" 

The evaluation of PCOS include

A) Clinical criteria with signs

  • Hyperandrogenism - hirsutism,

Ovulatory dysfunction - oligomenorrhea, secondary amenorrhea.

B) Diagnostic tests to measure serum levels

  • Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH)
  • Testosterone, DHEA-S
  • Blood glucose levels (FBS, PPBS, HbA1C)
  • Lipid & thyroid profile.

C) Imaging studies

  • Ultrasonography of ovaries - to assess the volume, number and size of follicles.
  • Computed Tomography(CP) or Magnetic Resonance Imaging(MRI) of the adrenal gland is done in some cases.

The management of PCOS depends on the patient’s desired outcome.

  • For restoration of regular menstruation & fertility - oral contraceptive pills, progesterone withdrawal and ovulation-inducing drugs are used.
  • Insulin sensitizers, estrogen, progesterone and GNRH supplements are given to treat hirsutism, acne and insulin resistance.
  • Surgical management includes pelvic laparoscopic procedures like ovarian drilling.
  • Lifestyle modifications such as a healthy diet and exercise are advised to all patients.

Non medical management of PCOS

  • Weight loss - Lifestyle modifications, particularly weight loss is recommended for obese patients because of the interrelationship between PCOS and obesity. The main contributing factor to weight loss is dietary restriction of calories and physical activity supplemented by behavioral therapy and social support.
  • Dietary modifications - A well balanced nutritious diet with whole foods like plenty of fruits, vegetables, whole grains, legumes and low carbohydrate intake is shown to improve insulin sensitivity, body mass composition with reduced fat mass and PCOS associated symptoms.
  • Physical activity - Daily physical activity with a combination of aerobic and resistance exercises are shown to improve overall metabolic health, insulin sensitivity, improve reproductive function, decrease androgen levels and quality of life in women with PCOS.
  • Nutritional supplementation - Multiple studies are going on to find out the efficacy of supplements like omega-3 fatty acid/ cod liver oils, vitamin D, calcium, inositol and n-acetylcysteine. Although the results are promising regarding the benefits of nutritional supplements in PCOS, further research and regulation is required before it is endorsed, kindly consult your physician before intake of supplements.

Early diagnosis and treatment of PCOS increases the chance of having a regular menstrual cycle, healthy pregnancy and can prevent long-term complications such as
  • Infertility
  • Obesity
  • Heart disease
  • Type 2 diabetes
  • Metabolic syndrome
  • Reducing the risk of endometrial, ovarian & breast cancer.

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