Polycystic Ovarian Syndrome

Polycystic ovary syndrome or PCOS is a condition in which hormone levels of a woman are out of balance. This leads to problems with their menstrual cycle and difficulty in getting pregnant. Apart from the internal problems, PCOS also causes unwanted changes in the appearance. If not checked early, it can lead to serious health issues.

What is Polycystic Ovarian Syndrome?

Polycystic Ovarian Syndrome or PCOS is a condition resulting due to hormonal imbalance occurring in women owing to the presence of excess of androgens and irregularity or absence of ovulation. This is one of the primary causes of infertility in females.

Symptoms of Polycystic Ovarian Syndrome

The symptoms of PCOS can appear as early as adolescence until late twenties. The symptoms usually include:

  • Irregular periods or absence of periods
  • Irregular ovulation or lack of ovulation
  • Infertility and Inability to get pregnant
  • Excess of unwanted hair growth in the face, chest, back and hip regions
  • Increase in weight
  • Thinning of hair and loss of hair from the scalp
  • Acne prone oily skin
  • Depression and mental stress.

Epidemiology and Prognosis of Polycystic ovarian syndrome

It has been observed that with treatment, women with polycystic ovarian syndrome were able to get pregnant.  Though there still exists a great risk of miscarriage, high blood pressure, and gestational diabetes during pregnancy.

According to the recent PCOS studies in India, the occurrence of the disease account for 3.7 to 22.5 percent of females, amongst which 9.13 to 36 percent are teenagers. Its occurrence has been witnessed in females at a very young age of 11 years.

Causes of Polycystic ovarian syndrome

Each ovary constitutes minute sacs filled with fluid known as follicles or cysts. Once the egg develops, the fluid starts building up in the follicle, further on maturity, the follicle opens up to release the egg which then travels to the womb via the fallopian tubes. This process is known as ovulation.

A number of reasons could contribute towards a woman having polycystic ovarian syndrome. These includes:

  • Genetic Predisposition for Polycystic Ovarian Syndrome: Polycystic ovarian syndrome often runs in the families. It is often found that a woman whose primary relative like mother, sister or aunt have PCOS, has an increased chance of having the problem.
  • Hormonal Imbalances contributing to Polycystic Ovarian Syndrome: A number of hormones contribute in the proper functioning of the menstrual cycle. Any imbalances in them could cause the condition. Some of the known imbalances and their influences are:
  1. Increased levels of Testosterone and Androgens: Although small amounts of these hormones are produced by women, it primarily is a male hormone. Hence, increased amount of testosterone and androgens hamper the process of ovulation leading to the follicles turning into cysts which neither matures nor ruptures. These cysts in the ovaries cause the condition.
  2. Lower levels of Follicle Stimulating Hormone (FSH): Follicle stimulating hormone is the hormone that is responsible to the initial growth of the eggs during the first 7 days of a menstrual cycle. Lower levels of this hormone don’t allow the eggs to grow to the full size which then turns into cysts.
  3. Higher Levels of Luteinizing Hormone: Once the egg grows to a certain size, the luteinizing hormone helps it grow to the point it reaches maturation and also promotes the rupture of the egg. Elevated levels of this hormone from an early stage of egg growth hamper the development and they form a cyst which doesn’t rupture thus causing the condition.
  4. Increased Levels of Prolactin: It is found that some women with polycystic ovarian syndrome have an elevated level of the hormone prolactin which is responsible for stimulating the breast gland for the production of milk. It is thought that higher levels of this hormone can cause polycystic ovarian syndrome.
  5. Altered Levels of Sex hormone-binding Globulin (SHBG): This is a protein that binds tightly with the dihydrotestosterone, testosterone, and estradiol making them inactive. An altered level of this protein reduces the impact of these hormones, causing polycystic ovarian syndrome.
  • Increased Levels of Insulin as a cause for Polycystic Ovarian Syndrome: Insulin is the hormone that controls the levels of blood sugar by converting glucose into energy. An increased level of insulin results in over production of the testosterone hormone by the ovary thus hampering the ovulation process. Furthermore, insulin resistance, where the tissues of the body become resistant to the insulin hormone, promotes weight gain which again hampers ovulation thus making PCOS worst.

Polycystic ovarian syndrome in a woman can be due to any one of the above mentioned reason or a combination of it. Moreover, being overweight can also contribute to PCOS as increased weight brings in imbalance in the LH hormonal level and also stimulates the production of more insulin.

Risk Factors of Polycystic ovarian syndrome

The prime risk factor for PCOS is the family history of the patient. There are increased chances of PCOS in a female if a related female member suffers from polycystic ovary, irregular periods or diabetes. PCOS can be inherited from both paternal as well as maternal side. If diabetes runs in the family history, then it may increase the risk for PCOS because diabetes has a direct influence on polycystic ovarian syndrome. Also, a long-term exposure to seizure medicine, Valproate has also been associated to a greater risk of PCOS.

Complications of Polycystic Ovarian Syndrome

PCOS is a condition which leads to several other complications like:

  • Endometrial cancer
  • Infertility
  • Increased risk for Breast cancer
  • Hypertension
  • High cholesterol
  • Diabetes
  • Anxiety and depression
  • Increased risk of heart attacks
  • Sleep Apnea, a condition in which a person ceases to breathe periodically during sleep.
  • For pregnant women, it may lead to miscarriage, gestational diabetes, and premature delivery.

Diagnosis of Polycystic Ovarian Syndrome

There is no conclusive test for PCOS. To perform a proper diagnosis, the doctor needs to review the medical history and symptoms associated. Several tests need to be performed in order to rule out other possible conditions.

  • Physical Examination: A physical and pelvic examination is conducted to observe the signs of PCOS which include swollen ovaries and swollen clitoris, increased body and facial hair, loss of hair from the scalp and increased weight.
  • Blood tests: These are conducted to measure hormone levels which are done in a specific order:

Thyroid Function tests: These determine the amount of thyroid hormone produced by the body.

Fasting Glucose tests: These measure the blood sugar levels in the body.

Lipid Level tests: This test evaluates the amount of cholesterol present in the blood.

  • Vaginal Ultrasound: This examination gives the medical supervisor a clear picture of the patient’s reproductive organs which can be used to assess the criticality of the condition. The ultrasound also provides the image of the ovary and presence of cyst can be identified.
  • Pelvic Laparoscopy: It is a surgical procedure which involves insertion of a tiny camera in the abdomen by making a small incision, to check for growths on the ovaries. In case, there is a presence of growths then a small tissue sample is taken for further examination.

Treatment of Polycystic Ovarian Syndrome

There exist no accepted medication for PCOS, but there are several alternative treatments which help in the prevention of the problem.

  • Lifestyle Modification:A regular check on the weight can be achieved with healthy eating habits and regular exercising. A well maintained weight may restore the normal menstrual cycle of the body.
  • Oral Contraceptives:Consumption of birth control pills helps in controlling the menstrual cycles, lowering of androgen levels and prevents acne. This can be done as long as pregnancy is not desired because once stopped the benefits would stop as well.
  • Medication for Diabetes:Metformin, a medicine known for controlling the blood sugar levels also aids in reduction of androgen production, decrease in cholesterol and maintaining of body weight.
  • Fertility Medications:Ovulation stimulators like Clomiphene and Gonadotropins, are medications that help women with PCOS for getting pregnant. These should be taken only when other causes of infertility are ruled out.
  • Surgery:Surgical measures are chosen when no positive response is gained from fertility medication or when the severity of condition is very high. Ovarian drilling is a surgical procedure in which rupturing of ovary is done using a small needle with electric current. This procedure helps in puncturing the follicles thus reducing the androgen levels and further promotes ovulation. However, the effects are not permanent.
  • Medication for reducing levels of Male Hormones:Anti-androgen drugs like Aldactone and Finasteride help in reduction of hair growth from body and clearing of acne. These drugs can also be given with birth control pills for enhanced results.

Prevention of Polycystic Ovarian Syndrome

There are many prevention measures for PCOS, which are known to provide fruitful results with time:

  • Detoxification: Detoxification can be achieved by removal of the male hormones and preservation of optimal metabolism of sex hormones.
  • Stress release with a Balanced Life: Stress causes hormonal imbalances. Anxiety and stress is also one of the root causes behind the inability to conceive which often leads to depression. Hence, practicing stress release techniques and cures is required.
  • Nutritional Supplements:The patients can consume supplements for multivitamins, minerals and antioxidants to prevent the condition. Vital nutrients like vitamin B- complex, C, D and E, essential minerals like vanadium, chromium, magnesium, and manganese and omega-3 supplements, all together aid in reducing the consequence of insulin resistance.
  • Herbal Supplements: Herbs like ashwagandha, astragalus, raspberry leaf, maca, chasteberry, red clover, kudzu, and milk thistle, are known to support the hormonal and endocrine functions of the body.
  • Maintaining a Healthy and a Physically Active Body: A regularexercise routine with a healthy diet will not only help in checking the weight but will also help in reducing insulin resistance and regularizing the menstrual cycles.
  • Prevention of Bad Habits: One must refrain from smoking, consumption of liquor and drugs to ensure the normal functioning of the body.
  • Routine Check-up: A routine checkup is a must for in-time assessment of complications like diabetes, heart diseases. Also, sensitivity check for endocrine disruptors should be done to take up timely preventive measure.

Conclusion

Polycystic ovary syndrome or PCOS is an endocrine system disorder which prevails in women, especially in the early reproductive age. The condition results in enlarged ovaries containing follicles which are tiny fluid filled sacs that turn into cysts. PCOS can result into scarce or absence of menstrual periods along with excess body and facial hair growth, acne, and weight gain. The particular cause behind the polycystic ovary syndrome is still not known but an early diagnosis and proper treatment and simultaneous weight loss can greatly reduce the risk of long-term complications.

 

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Note: This information is only for reference and is not a substitute of a medical care in any form. Kindly consult with a Healthcare Professional for detailed diagnosis, treatment and follow up.

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