Have you heard of the term Polycystic Ovary Syndrome (PCOS)? I’ve only learned of this in recent years, and since I first heard of it, I’ve come across this more often in conversations with friends and finding it in more reading materials.
Since PCOS is a condition that affects women and fertility, Motherhood Story would like to raise more awareness about it by having an expert help us learn what it is and how to manage PCOS.
We are privileged to have Dr Prakash M Chandrakanthan, MBBS (Manipal), MRCOG (UK), a Consultant Obstetrician & Gynaecologist with Sri Kota Specialist Medical Centre, to take us through understanding PCOS.
What Is Polycystic Ovary Syndrome (PCOS)?
Polycystic ovary syndrome is the commonest endocrine condition to affect women with a prevalence of 10% to 15%. It is a condition that affects your periods, fertility and aspects of your appearance. The symptoms of PCOS include menstrual cycle disturbance, increased facial and body hair, oily skin, acne and loss of hair on your head. There is also associated fertility problems, obesity and psychological issues.
What Causes the Condition?
The cause of PCOS is still unknown. Women with PCOS tend to have hormonal imbalances with high levels of androgen which is a male hormone that interferes with the normal functions of the ovary resulting in menstrual irregularities and many of the symptoms of the condition.
PCOS also leads to failure in ovulation causing fertility related problems. Women with PCOS may also have problems with responding to insulin, resulting in high blood glucose levels and this indirectly leads to an increase in weight.
Is PCOS Hereditary?
PCOS appears to run in families with approximately 50% of first-degree female relatives being affected, which means that if any of your relatives (mother, aunts, sisters) are affected with PCOS, your risk of developing PCOS will be higher.
How Does PCOS Affect Fertility?
PCOS is a common cause of fertility problems in women. The failure to ovulate regularly results in fertility being affected. PCOS accounts for approximately 80-90% of anovulatory infertility which in turn comprises about a third of those attending the infertility clinic.
What Is a Common Fertility Treatment Protocol for a PCOS Woman?
The principles of the management for women with infertility from PCOS is to optimise their health before commencing on therapy. This is done by achieving weight loss for those who are overweight with the help of consuming the right diet and in-cooperating physical exercise as part of their daily routine.
Subsequently, medication can be given to help in the ovulation process. Some women who do not respond to medication for ovulation may need a key hole surgery to their ovaries to ease the commencement of ovulation.
What Are the Risks for PCOS?
PCOS is associated with a number of long-term health problems. 10% to 20% of women with PCOS go on to develop diabetes mellitus at some point. Women who are obese and also many slim women with PCOS will have insulin resistance leading to diabetes.
The risk of developing diabetes is increased further if you have the following risk factors;
- Age over 40
- Have relatives with diabetes
- Developed diabetes during pregnancy
- Obese with a BMI of more than 30
Women with PCOS are also at risk of developing high blood pressure. This is likely to be related to the associated diabetes and to being overweight rather than to the PCOS itself. This further could be a contributory factor for heart problems in the future.
Women with PCOS tend to have reduced amounts of periods and most have fewer than three periods a year. This results in thickening of the lining of the womb which can further lead to an increased risk of endometrial cancer.
Other complications would include depression and mood swings, which are contributed by the infertility and weight issues. Excessive facial hair has been shown to be one of the major causes of marked psychological stress in women with PCOS.
Other less common complications would include generalised fatigue or sleepiness during the day and snoring during sleep.
What Are the Symptoms To Look Out For?
The symptoms of PCOS vary from woman to woman. Some women have very mild symptoms, while others are affected more severely by a wider range of symptoms. The symptoms include irregular periods or no periods at all, increase in facial or body hair, loss of hair on the head, being overweight, experiencing a rapid increase in weight or having difficulty in losing weight, oily skin, acne and difficulty in getting pregnant.
How Is PCOS Diagnosed?
In view of the varying symptoms that different women present with, the diagnosis of PCOS should be made if two out of the three criteria are met, which are;
- Irregular or absence of periods
- Increase in facial or body hair / or blood test that show higher testosterone levels than normal
- An ultrasound scan that shows polycystic ovaries
How Does One Get Treated?
The management for a woman with PCOS has to be tailored individually based on her presenting symptoms. For example, if fertility is the issue, then she can be given medication to stimulate ovulation and if that does not work, a surgical procedure called ovarian drilling can be done to stimulate ovulation.
Women with increase in facial and body hair can be prescribed medication which may take up to 9 months before any improvement can be seen. In the meantime, physical treatments such as electrolysis, waxing and bleaching may be helpful while waiting for the medical treatment to work.
For women with menstrual irregularities, hormonal medication which need to be taken regularly can be prescribed.
Having said that it is important to note that PCOS has no cure.
What Should We Know About a PCOS Lifestyle and Diet?
Various factors influence ovarian function and fertility, the most important being obesity. Ideally a weight reduction of less than BMI 30 kg/m2 is preferred. However, even a moderate weight loss of 5–10% of body weight can be sufficient to restore fertility and improve metabolic parameters.
There is no evidence to say that women with PCOS will benefit from a specific type of diet. However, it is advisable to lower the sugar content in the food and generally to avoid fatty food. Low caloric diet may be appropriate as well.
For women with BMI greater than 40 kg/m2, bariatric surgery also known as the weight loss surgery is an option.
When it comes to physical activities, it is important to inculcate exercise as part of a daily routine. Thirty minutes per day of brisk exercise is encouraged to maintain health, but to lose weight, or sustain weight loss, 60 to 90 minutes per day is advised.
Will PCOS Go Away if I Keep Up with the Recommended Lifestyle and Diet?
There is no cure for PCOS. Maintaining a healthy life style and diet will definitely make a difference in resuming normal menstrual cycles and even helping achieve fertility. Encouraging weight loss remains the most effective first-line therapeutic intervention in these women, although hard to achieve, it has shown to bring about positive results.
Source: Dr Prakash M Chandrakanthan, Consultant Obstetrician & Gynaecologist with Sri Kota Specialist Medical Centre
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner.
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