Polycystic_Ovarian_Syndrome (PCOS/PCOD)

Symptoms: Infrequent menstruation, heavy bleeding during periods, abnormal hair growth, acne, weight gain, darkened skin, persistent headaches, hair thinning and baldness, fatigue, trouble sleeping, abnormal lipid levels in the blood, problem with conception (pregnancy)

Causes: High percentage of male hormones or androgen, genetics or family history, insulin resistance, higher inflammation in the body

Risk Factors: Diabetes (type 1 and 2), gestational diabetes, unhealthy lifestyle, genetics

Prevalence: Polycystic ovary syndrome (PCOS) affects approximately 8-13% of reproductive-age women. Up to 70% of affected women go undiagnosed worldwide.

Severity: Mild to severe

Which doctor to consult: OB-Gynaecologist

Overview

Polycystic ovarian syndrome is a health condition that affects women during their reproductive years. It usually occurs due to excess androgen formation, insulin secretion resistance, and genetic factors.

The polycystic ovary contains many harmless follicles in which eggs develop. When the sacs fail to release eggs, the hormonal imbalance leads to PCOS.

This condition can lead to enlarged ovaries and the formation of multiple fluid-filled sacs called cysts on the outer edges of the organ. These cysts contain follicles carrying immature eggs up to 8 mm in size.

Depending on the extent of PCOS development or the cyst numbers, the severity of the condition varies. Usually, the patients exhibit mild to severe symptoms, including irregular periods, weight gain, excessive hair growth or thinning, oily skin, failed pregnancy, etc.

PCOS doesn't have a cure, but its symptoms can be treated with medication and lifestyle changes. In addition, laparoscopic ovarian drilling is also recommended for patients with fertility complications.

If not diagnosed and treated timely, PCOS can lead to an increased risk of type 2 diabetes and heart conditions. The prolonged presence of PCOS and hormonal imbalance can also cause ovarian cancer in patients and extreme fertility complications.

Types of PCOS:

• Insulin Resistance: In this type, your body starts secreting higher than normal insulin levels, causing hyperinsulinemia. It occurs due to the dysfunction of the pancreas. Due to the reduced sensitivity of the body cells towards insulin, the condition develops. 

     In this PCOS condition, your body will gain more weight around the abdomen and waist. It also causes sugar cravings along with brain fog. Such a heightened insulin level leads to enhanced androgen levels, causing hair growth, loss of male pattern, and acne. 

To improve the condition, your gynaecologist will recommend various lifestyle activities to enhance insulin sensitivity. The treatment will involve physical exercises, low-sugar food intake and supplementation with magnesium, inositol,  chromium, NAC and berberine.

• Post-Contraception PCOS 

It is one of the rare forms of PCOS which occurs after stopping contraception intake. In this condition, the usual PCOS symptoms start appearing only after you restrict pill usage. 

This condition occurs due to the impact of synthetic progestins in oral contraceptives. After stopping the medication, your body undergoes a regular balancing drive, increasing androgen. 

In this type, the patient will not face any insulin resistance, and it improves within 3-6 months. However, adequate medication and nutritional support can quickly alleviate the symptoms and resolve the complications.

• Adrenal PCOS 

Adrenal PCOS is one of the rarest forms of PCOS, which impacts 10% of the affected population. It occurs due to the rise in DHEA-S, which is a form of androgen in adrenal glands. 

Such elevation in the specific androgen isn't usually detected with normal diagnosis as other hormones remain in the normal range. 

Since this happens due to increased stress levels, your gynaecologist will suggest relevant treatment upon confirmation. It will also involve avoidance of food, which can spike bodily stress responses, such as caffeine. 

• Inflammatory PCOS 

Due to the prolonged exposure of ovaries to hormonal imbalance, chronic inflammation persists. This leads to the overproduction of testosterone in the ovaries. Such hyperactivity of testosterone causes headaches, fatigue, skin issues, joint pain, etc. 

Your gynaecologists recommend a range of blood tests to provide effective treatment. These assessments observe inflammatory markers like high CRP, fasting glucose levels, and insulin.

Symptoms:

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Here are some of the symptoms associated with PCOS:

Irregular periods or no periods at all can lead to difficulties in getting pregnant due to irregular ovulation or no ovulation.
Excessive hair growth (hirsutism), often on the face, chest, back, or buttocks.
Weight gain, especially around the belly area.
Thinning hair and hair loss from the head.
Oily skin or acne.

These symptoms are due to elevated levels of male hormones (androgens) and may lead to other health effects like diabetes and heart disease over time. If you’re experiencing any of these symptoms, it’s important to consult a healthcare provider for a proper diagnosis and treatment plan.

Causes:

The exact causes of Polycystic Ovary Syndrome (PCOS) are not fully understood, but several factors are thought to play a role:

Insulin Resistance: Many women with PCOS have insulin resistance, meaning their cells can’t use insulin effectively, which leads to high insulin levels and can cause increased androgen production.
Inflammation: Women with PCOS often have increased levels of inflammation in their bodies, which might contribute to insulin resistance.
Heredity: PCOS can run in families, so there may be a genetic link.
Hormonal Imbalance: An imbalance of androgens (male hormones) is common in PCOS, which can prevent ovulation and lead to irregular periods, hair growth, and acne.
These factors can disrupt the normal menstrual cycle and lead to the development of PCOS.

Risk factors:

Risk factors for Polycystic Ovary Syndrome (PCOS) include:

Excess Insulin: High insulin levels can increase androgen production, leading to difficulty with ovulation.
Low-grade Inflammation: This type of inflammation may stimulate the ovaries to produce androgens, leading to heart and blood vessel problems.
Heredity: A family history of PCOS may increase your risk of developing the condition.
Obesity: Being overweight is associated with higher androgen levels and can exacerbate the symptoms of PCOS.

It’s important to note that these factors can increase the risk but do not guarantee that someone will develop PCOS.

Possible Complications:

• Infertility: If left untreated, PCOS can continue to disrupt the hormonal balance inside the patient's body. With such an imbalance, the ovulation which enables reproduction is severely affected. This can lead to infertility and miscarriages after multiple attempts to conceive. In addition, untreated PCOS can cause premature birth and complications in the newborn.

• Diabetes: Due to the disturbance in the insulin tolerance level, you can struggle with obesity and weight gain. The impaired glucose tolerance combined with weight gain can become a major factor in the occurrence of type 2 diabetes. Even for pregnant patients, it can cause extreme discomfort due to the onset of gestational diabetes. 

• Cardiovascular Complication: PCOS causes pancreatic b-cell dysfunction in the body, leading to changes in lipoprotein profile. Such disruptions in hormonal secretions pave the way for clotting and obstruction in blood vessels. This causes an elevation in overall blood flow, which forms the primary factor for cardiovascular disorders. 

• Cancer of the uterus: If you have undetected PCOS, you're more at risk of developing cancer in the uterus. It can occur in the form of endometrial growth and ovarian tumours. In addition to the changes in ovulation patterns, hypertension, diabetes, and related factors can increase the chances of this life-threatening complication. 

• Metabolic Syndrome: Syndrome X is a combination of multiple risk factors associated with PCOS. It involves changes in abdominal weight, hypertension, high blood sugar and unhealthy cholesterol levels. Due to the combined effect of the symptoms, PCOS patients are more likely to develop metabolic syndrome if left undiagnosed.

• Depression and Anxiety: Female sex hormones create an impact on psychological health as well. Sleep apnea is also a major contributor to the psychological problems observed in PCOS patients. Consistent disruption of the hormonal secretions with a lack of proper rest leads to the development of mood swings. In addition, bodily changes also impact confidence and self-image. If you are a PCOS patient, you're more prone to postpartum depression after childbirth.

Prevention:

Preventing Polycystic Ovary Syndrome (PCOS) entirely may not be possible, especially since many cases are believed to be genetically linked and can run in families. However, some measures can help reduce the risk of developing PCOS and manage its symptoms:

Maintain a Healthy Weight: Obesity can increase insulin levels, which may worsen PCOS symptoms. Achieving and maintaining a healthy weight through diet and exercise can help.
Regular Exercise: Physical activity can help lower blood sugar levels, improve insulin sensitivity, and can help with weight management.
Balanced Diet: A diet low in refined carbohydrates and high in fibre can help manage insulin levels.
Regular Check-ups: Regular medical check-ups can help monitor symptoms and manage any complications early on.
While these measures may not prevent PCOS, they can lessen its impact on health and quality of life and, in some cases, may even reverse the condition.

When to Consult a Doctor?

On Symptoms: If signs such as infrequent menstruation, heavier bleeding, oily skin, acne, extreme hair loss, and hair growth in unwanted areas are observed, consultation with a gynaecologist is essential. The frequency and length of the periods must be considered when seeking consultation. That's to say, the appropriate time to consult an expert is as soon as the patient exhibits the related symptoms.

Failure to Get Pregnant:  PCOS can increase the risk of pregnancy failure in the first trimester of gestation. Moreover, if you're trying to conceive but have been failing for a year, your chances of carrying cysts in your ovaries are high. That's why immediate consultation is crucial if you're pregnant or aiming to in the near future.

On Annual Screening: Most ovarian disorders slowly build up inside the body without causing severe discomfort. For any person of childbearing age, it's essential to check the overall health and functioning of the reproductive system. That's why an annual gynae visit is a must to prevent complications.

Diagnosis:

Preliminary Discussion: The primary diagnosis for PCOS involves understanding the signs and symptoms through the patient's description. In this step, the gynaecologist will enquire about the first occurrence and observation of the signs. In addition, the doctor will require details about the family history associated with PCOS. Upon comprehensive evaluation, your gynaecologist will suggest a combination of diagnostic tests.

Physical Exam: Your doctor may also check for changes in blood pressure, alteration of skin and hair, and BMI. In addition, the PCOS analysis will include pelvic examination by evaluating the look and feel of body parts, including swelling around ovaries, and routine pelvic tests.

Diagnostic Tests

• Imaging Tests: Gynaecologists recommend ultrasound imaging of the ovaries to deduce the exact position and extent of PCOS. This involves checking the lining of the uterus, follicular growth, and swelling of the ovaries. Depending on the patient's sexual activity, the gynaecologists recommend screening tests comprising transvaginal ultrasound and abdominal ultrasound.

• Blood Tests: Your gynaecologist might also recommend a series of blood tests to analyse the androgen levels in the body. These tests help confirm the possibility of complications such as high blood pressure. Through these tests, your doctor checks the disturbance in reproductive hormones to exclude other similar-looking diseases.

• Advanced Tests: The gynaecologists can also prescribe advanced hormonal panel tests, including prolactin, luteinising hormone and follicle-stimulating hormone assessment. Any drastic elevation in the levels of these hormones is a sign of severe complications like cancer. In addition, the recommended analysis for PCOS also includes the CA125 marker test to confirm the likelihood of cancerous growth.

Treatment:

Lifestyle Changes: The specific PCOS treatment involves tackling the condition's symptoms with healthy habits. Lifestyle changes aimed at weight loss can help the medications work effectively and ensure good metabolism. Depending upon your goals, your gynaecologist might recommend handling bodily changes to determine the best management course.

Medication: The treatment for PCOS focuses on managing individual concerns, such as infertility, hirsutism, acne, or obesity. Here are some examples of medications used to treat PCOS:

Birth Control Pills: These can help regulate menstrual cycles, reduce levels of male hormones like testosterone, and alleviate symptoms like pain and excessive hair growth.
Anti-Androgens: Medications like Spironolactone can reduce the level of androgens, decreasing excessive hair growth and acne.
Fertility Drugs: Clomiphene citrate is often used to induce ovulation in women who are experiencing fertility issues due to PCOS.
It’s important to consult with a healthcare provider for a proper diagnosis and treatment plan tailored to individual needs. Lifestyle changes, such as regular exercise and a healthy diet, are also recommended as part of the overall treatment strategy for PCOS.
Surgery and Alternative Treatment:  In addition to the medications, your gynaecologists can also recommend a series of hormonal therapies, removal treatment and surgery. These methods are more helpful when medications fail to prove useful.

Hormonal therapies involve a combination of estrogen-progestin contraceptives with metformin and spironolactone. This helps address reproductive, metabolic and dermatologic disruptions in the patient's body.

Your expert doctor also recommends electrolysis and laser hair removal to treat excessive hair growth. The procedure involves multiple rounds of electrolysis on the affected area to control the follicular hair growth.

For patients dealing with complicated fertility problems, the laparoscopic ovary drilling procedure is used. This method enables the restoration of normal ovarian functioning through surgical treatment of cyst formations.

Additional Information

What does the diagnosis of PCOS require?

PCOS diagnosis requires clinical analysis of the symptoms. That's to say, there's no single test that affirms the presence of PCOS. 
That being said, your gynaecologists can recommend several analyses to assess the dysfunction in your hormones. These tests include: 

• Testosterone levels

• Luteinizing Hormone (LH) 

• FSH (follicle stimulating hormone) proportions

• Fasting glucose in the blood 

• Lipid/cholesterol levels

• Prolactin level

• Pregnancy test

• Thyroid levels

• Ultrasound or scanning of ovaries to observe cysts and other formations 

To confirm the presence of PCOS, your gynaecologists need to consider only two factors out of three, i.e.

• Increase in androgen through physical examination or lab tests with hormonal assessments. 

• Irregular periods 

• Fluid-filled cysts on the ovaries

• Since not all women having cysts on ovaries suffer from PCOS and vice versa, combined analysis ensures more effective treatment.