What is PCOS?
Polycystic ovary syndrome is a state that affects hormone levels during a woman’s childbearing years. PCOS affects women’s ovaries, the genitals that produce the estrogen, and progesterone that regulates the menstrual cycle.
Even a small amount of the male hormone called androgen is produced by the ovaries. Each month an egg is released by the ovary to be fertilized by the sperm of a male and this process is called ovulation.
The process of ovulation and the ovaries get affected by PCOS. It has three main characteristics:
- cyst in ovary
- high levels of male hormones
- irregular or skipped periods
In PCOS, many small, fluid-filled sacs or cysts develop inside the ovaries. The word “polycystic” means “multiple cysts.” Although cysts are not harmful, they can cause an imbalance in hormone levels.
Actually, these sacs are follicles and each of them contains an immature egg. Eggs are never mature enough to trigger ovulation.
The levels of estrogen, progesterone, FSH, and LH change, causing progesterone levels to be lower than normal and androgen levels to be higher than normal. Disruption of the menstrual cycle is caused by more male hormones, thus women with PCOS have fewer menstrual periods than usual.
Women stop menstruating due to higher amounts of male hormones than normal levels, thus this imbalance makes it difficult for them to get pregnant.
PCOS also causes facial and body hair growth, baldness, and long-term health problems like diabetes and heart disease.
Women with PCOS are more likely to have a miscarriage, gestational diabetes, high blood pressure due to pregnancy, and premature birth.
Causes of PCOS
Doctors do not know the main reason for PCOS. It is believed that high levels of male hormones inhibit the ovaries from producing normal hormones and eggs.
Although the exact cause of PCOS is unknown yet there is a sign that genetics plays a major role.
Several other factors play a role in generating PCOS:
Androgens (High levels of male hormones): High levels of androgens prevent the ovaries from releasing an egg (ovulation), leading to irregular periods. High androgens can also cause acne and excessive hair growth in women.
Insulin resistance: Insulin is a hormone produced by the pancreas to help the body use sugar from foods as energy. Increased insulin levels prompt the ovaries to produce and release male hormones, which ultimately put down ovulation and add to the other symptoms of PCOS. Obesity can also lead to insulin resistance and both factors can contribute to an increased risk of type 2 diabetes.
Mild Inflammation: Women with PCOS have a tendency to have chronic low-grade inflammation. Blood tests that measure the level of C-reactive protein (CRP) and white blood cells can show the level of inflammation in the body. Being overweight can also cause swelling. Excess inflammation is associated with high levels of androgen.
Common symptoms of PCOS
Some women show symptoms during their first period, while others find out that they have PCOS after gaining too much weight or having difficulty in conceiving.
The most common symptoms of PCOS are:
- Irregular periods: The lack of ovulation stops the shedding of the lining of the uterus each month, leading to missed periods or lack of periods.
- Heavy bleeding: The lining of the uterus builds up over a period of time, making menstruation (when they occur) heavier than usual.
- Hair Growth: Many women suffering from PCOS experience excessive hair growth on the face, body, back, belly, and Chest.
- Acne: Male hormones cause the skin to be oilier than normal, leading to breakouts on areas such as the face, chest, and upper back, which are usually difficult to treat.
- Weight gain: Over 80% of women with PCOS find it difficult to lose weight and reduce obesity.
- Male pattern baldness: Thinning of hair or loss of hair on the scalp.
- Darkening of the skin: In women with PCOS, dark spots of the skin are seen especially on the creases of the body like neck, armpits, and under the breasts.
- Headache: Hormonal changes in some women cause excruciating headaches.
- Skin tags: In women with PCOS, small flaps of extra skin are often found in the armpits or on the neck.
- Infertility: PCOS is the major player to cause infertility in women. Females cannot conceive due to lack of ovulation because they are not able to produce enough eggs to produce fertility.
Risk factors of PCOS
Most women with PCOS are overweight or obese. Both can increase the risk for:
- Increased blood pressure
- Elevated blood sugar
- High levels of LDL “bad” cholesterol
- Low levels of HDL “good” cholesterol
All of these factors are collectively called metabolic syndrome, and can be a high-risk factor for:
- Heart disease
The lining of the uterus falls off during ovulation. However, if the woman is not ovulating every month, this can lead to a build-up of lining. This thick uterine lining can increase the risk of endometrial cancer.
Symptoms like unwanted growth of hairs and hormonal changes negatively affect emotions, which eventually cause depression and anxiety in many patients with PCOS.
Pregnancy and PCOS
As the normal menstrual cycle is disrupted by PCOS, getting pregnant becomes difficult. Between 70 and 80 percent of women with PCOS experience fertility problems. PCOS also increases the risk of pregnancy complications, premature delivery, miscarriage, gestational diabetes, and high blood pressure.
Management and treatment
Treatment is based on the patient’s symptoms, medical history, and other health conditions, and if the patient wants to become pregnant. Dr. Shivani Bhutani best Gynecologist at Eva Hospital says that the management of PCOS involves medication, lifestyle changes, or a combination of both.
Lifestyle changes such as weight loss, diet, and exercise are the first steps in treating PCOS.
Losing weight can help regulate the menstrual cycle and improve cholesterol levels, lower insulin and reduce the risk of heart disease and diabetes, as well as improve PCOS symptoms.
Sometimes excessive hair growth or acne can lower self-confidence and self-esteem. Cosmetic treatment or consultation with a dermatologist can be helpful in this regard.
For those trying to conceive
Dr. Shivani adds that for those trying to conceive after being diagnosed with PCOS, the first thing to keep in mind is to eat healthily and reduce stress levels. These can prove to be very helpful in managing PCOS.
Treatment options for patients wishing to conceive are:
Hormonal birth control
A vaginal ring or an internal device (IUD), patches, birth control pills, and shots can help regulate the menstrual cycle, can also improve acne and increase hair growth and help to prevent endometrial cancer.
As an alternative to improving fertility, surgery is usually recommended when other treatments have not worked.
Surgical options include:
- Ovarian drilling: A procedure in which small holes are made in the ovaries to reduce the level of androgens being produced.
- Oophorectomy: Surgery for removing one or both ovaries.
- Hysterectomy: Removal of all or any part of the uterus.
- Cyst aspiration: A process to remove fluid from the cyst.
Medications to stimulate ovulation
Ovulation is an essential factor for a successful pregnancy. Some medications can help stimulate ovulation in women with PCOS. A combination of clomiphene and metformin called Clomiphene (Clomid), or injectable gonadotropin, like follicle-stimulating hormone (FSH) and luteinizing hormone (LH), are commonly prescribed or recommended by a gynecologist.
In Vitro Fertilization (IVF)
A woman’s egg is fertilized in a laboratory with a partner’s sperm and then transferred to the uterus. For women with PCOS who want to get pregnant and the medication does not help ovulation, IVF is a highly recommended and practical option.
PCOS can mess with a woman’s menstrual cycle making it difficult to conceive. High levels of male hormones cause unwanted symptoms such as facial and body hair growth.
Lifestyle changes are the first steps recommended by doctors for managing PCOS and are very effective.
Losing weight plays an important role to treat PCOS symptoms, and improves the chances of getting pregnant.
However, if lifestyle changes do not work, then medication is a viable option. Birth control pills and metformin restore the menstrual cycle to relieve the symptoms of PCOS.
Early diagnosis can be helpful to reduce symptoms and the risk of complications. Timely consultation with a physician can help manage the symptoms of PCOS and treatments such as ovulation drugs and in vitro fertilization (IVF) can help PCOS patients become pregnant and start a family.