Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among women affecting as many as one out of 15 women or 7%. But this percentage may vary in different ethnic groups, countries and socio-economic circumstances.
According to experts, the actual number of women affected by PCOS may be as high as one out of 10 simply because so many cases remain undiagnosed.
PCOS can affect a woman’s menstrual cycle, fertility, hormones and aspects of her appearance. It can also affect long-term health.
A syndrome is a collection of clinical features which occur together which a doctor detects by listening, questioning, examining and testing.
PCOS gets the name from the changes seen in the ovaries (the female egg producing organs) which appear to have many (poly) tiny liquid filled rounded structures called cysts (cystic).
Twenty percent of women can have polycystic ovaries but all of them do not have PCOS. In other words, just because one has polycystic appearance in the ovaries, she will not be having PCOS. In fact, a woman could be having PCOS without the ovaries being polycystic. Therefore, the cysts themselves do not seem to be the cause of the problem. However, internationally we still refer to this condition as PCOS.
To understand PCOS, we have to first understand a little bit about hormones. Hormones are chemical messengers in both plants and animals. These messengers set off many different processes, including growth and energy production. Each hormone has a specific job but often, one hormone signals the release or prevents the release of another hormone.
For reasons that are yet to be ascertained, in PCOS, some hormones, particularly sex hormones get out of balance. Sex hormones give the males and females their gender identity, both physical features and behaviour. Male sex hormones are called androgens.
The word androgen is derived from Greek word andro meaning man, and gen meaning giving birth to. Similarly, the female hormone called estrogen gets its name from the Latin word oestrus meaning sexual desire.
Any healthy female produces a minute amount of androgens. It comes from two sources, ovaries and adrenal glands, the latter being a small gland sitting on the kidneys in all humans.
Women with PCOS start producing slightly more androgens. This may cause a woman to stop ovulating, get acne, and grow extra facial and body hair.
Women with PCOS may also have a problem using insulin, the hormone which controls sugar in the body. They have insulin but it is not utilized. This is called insulin resistance. When the body doesn’t use insulin well, blood sugar levels go up. Over time, this increases the chance of getting diabetes and becoming overweight.
In short, women have both male and female hormones but in women with PCOS, higher levels of male hormones can be found along with higher levels of insulin.
What causes PCOS is not yet known. It is likely to be the result of a number of both genetic (inherited) as well as environmental factors. If any of your relatives (mother, aunts, sisters) are affected by PCOS, your own risk of developing PCOS may be increased. There is evidence that the initial trigger may be before birth.
Why are so many cases of PCOS undiagnosed?
Because the symptoms can vary from woman-to-woman it is often difficult to accurately diagnose PCOS unless the medical practitioners are on the lookout for the clinical features.
PCOS affects the reproductive system and also causes significant long-term health consequences. This makes it imperative that an accurate diagnosis is made, followed by proper treatment and long term follow up.
The symptoms of PCOS can include:
- irregular periods or no periods at all for severamonths
- being overweight
- difficulty in losing weight
- difficulty becoming pregnant (reduced fertility)
- having more facial or body hair (hirsutism)
- Skin in the neck and armpits becoming darker and thickened
- loss of hair on the head
(hair pattern appears like in a male)
- oily skin, pimples
- depression and mood swings
The symptoms of PCOS most often begin with the attainment of age but can start earlier in the pre-teen years or develop later at any time during a woman’s childbearing years. Of course it is less common to see the beginning of PCOS in the older age groups closing on menopause but it has to be remembered that all the detrimental effects of PCOS surface as one gets older.
Women with PCOS are at a higher risk for a number of illnesses, including high blood pressure, diabetes, heart disease, increase in blood lipid levels, cancer of the womb (endometrial cancer) and all the issues related to obesity (overweight).
Conceiving while having PCOS is possible but often there is a delay. If conception occurs there are some issues which can have an effect on the course of the pregnancy. The Obstetrician will take additional precautions in such mothers.
The diagnosis of PCOS is generally made on the basis of clinical signs and symptoms as discussed above. Other illnesses that have similar features have to be excluded. These include low thyroid hormone blood levels or elevated levels of a milk-producing hormone. Also, tumours of the ovary or adrenal glands can produce elevated male hormone (androgen) blood levels which will mimic some symptoms of PCOS. Blood tests of male sex hormones are sometimes done to make the diagnosis of PCOS. The polycystic ovaries are diagnosed by a careful assessment of the ovaries by ultrasound examination, commonly called a scan.
A doctor will piece all the information and conclude the diagnosis of PCOS.
Treatment varies from one individual to another. Conceiving may be a priority for one, another may be more disturbed by irregular periods while a third may have both issues with the fourth being concerned with obesity with or without any of the previous issues. Important considerations are the age of the patient, the most disturbing issues to her life and the complications which may be already present or are likely to appear in the future.
Weight loss is an integral component of treatment and can be the most difficult target to achieve. Exercise and other lifestyle modifications are imperative. Drug therapy obviously varies according to the specific issues in individual patients. Different drugs are used to regularize the periods, increase fertility, reduce obesity, high blood pressure, diabetes, high cholesterol and many other associated issues.
There is no cure for PCOS. Medical treatment aims to manage and reduce the symptoms or consequences of having PCOS.
Many women with PCOS successfully manage their symptoms and long-term health risks without or with minimal medications. They do this by eating a healthy diet, exercising regularly and maintaining a healthy lifestyle.
At a glance
PCOS is very common
Has short and long term consequences
Easy to diagnose
Difficult to manage
Individualized management
Meticulous follow-up necessary
Needs sustained commitment on the part of both the patient and the doctor
(The writer is a Consultant Obstetrician and Gynaecologist) |
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