Understanding Polycystic Ovary Syndrome
Polycystic ovary syndrome also called PCOS is a complex hormonal disorder characterized by diverse signs and symptoms. This is due to excess production of male reproductive hormones, which normally should be present in minute quantities in women. The condition affects women of childbearing age. Although the exact figures are not known, it is believed that 1 in every 10 women suffers from PCOS. It is the most frequent hormonal disorder among women of reproductive age.
The precise underlying cause of PCOS is unclear, but genetic factors and lifestyle are likely to play a part.
Polycystic Ovaries
Ovaries are the organs in women responsible for the production and release of eggs. Each ovary has thousands of ‘follicles’ that sustain the eggs till they are released; these follicles also produce different hormones. Once developed, they break and release the egg inside for potential fertilization. Ovulation defines the release of eggs from the ovaries every month.
In women with PCOS, the follicles fail to mature and release the eggs. Many of the partially ripe follicles with eggs inside will be formed around the ovaries, and give the appearance of multiple cysts on ultrasound. The term ‘polycystic ovary’ syndrome imply to this. Despite the name, polycystic ovaries may not necessarily be present in everyone with PCOS. Conversely, women can have polycystic ovaries without having PCOS. Up to one-third of women with polycystic ovaries visible on ultrasound don’t have PCOS.
What are the Risk Factors?
While the exact cause for this condition is uncertain, still, family history of PCOS, especially in first-degree relatives is a predisposing factor. Aside from family history, other factors are:
- A higher prevalence in overweight people
- Having diabetes [1] during pregnancy or a history of diabetes in general increases susceptibility
- It is also more prevalent in some populations like Africans, Asians, and Aborigines.
Symptoms of PCOS
These are the most common symptoms of polycystic ovary syndrome
Menstrual abnormalities
Normal periods depend on regular ovulation. Since this process is altered in PCOS, there may be irregular, excess, or absent periods.
Difficulty getting pregnant
The abnormalities in ovulation due to hormonal imbalances also lead to difficulty getting pregnant.
Hirsutism
Excessive hair growth in areas such as the face, back, chest, or other body parts is also common. This occurs due to the elevated level of male hormones resulting in hair growth in unusual places for women.
Weight gain
PCOS alters the body’s response to insulin (the hormone that controls blood glucose levels) which leads to weight gain. It will also increase the risk of diabetes and high cholesterol.
Hair loss
The excess androgens can lead to hair loss from the scalp resulting in ‘male pattern boldness.’
Acne
Androgens lead to excess secretion of natural oil from the skin leading to acne.
How is PCOS diagnosed?
The three canonical features of PCOS are:
1. Irregular menses
2. Polycystic ovaries
3. Elevated androgen (male sex hormones) levels are characterized by symptoms such as acne, excessive facial or body hair, and hair loss or elevated level of these hormones in the blood.
Having two of these three in the absence of other possible causes is enough to diagnose the condition. Ultrasound, which will show the size of ovaries and verify the presence of cysts, and blood tests to measure the level of androgen hormones and glucose, may be requested.
The Psychological impacts of PCOS
Women with PCOS are at increased risk for multiple psychiatric and psychological problems. Other psychological issues are anxiety, depression, bipolar disorder, and social phobia. The different physical symptoms of PCOS can give rise to psychological distress.
Treatments
While there is no known cure for PCOS, there are different ways to treat its symptoms and long-term complications [2]. As symptoms and complications vary in people, it is best to work with your doctor over time and plan out the best treatment. The management is aimed at improving symptoms while preventing long-term health consequences.
Fertility is an issue that also needs to be addressed. Medical therapies should be combined with lifestyle modification as PCOS causes a range of symptoms. Additionally, coordinated treatment from different health professionals specializing in particular areas is essential.
Lifestyle changes
A healthy lifestyle that incorporates a balanced diet and regular exercise is essential. If you are overweight, weight loss as small as 5% of your body weight can significantly improve symptoms. Maintaining a healthy weight will aid in preventing long-term health consequences like diabetes and cardiac problems.
Multidisciplinary Team approach
Health professionals with expertise in specific areas should be involved in the management of PCOS. Because of the diverse symptoms and complications of PCOS, the team can include an endocrinologist, dietician, dermatologist, and psychologist/psychiatrist.
Medical treatment
Depending on the symptoms, different drugs can be prescribed by your doctor. Here are the treatment methods for various symptoms.
Irregular periods
Treatment involves prescribing hormonal contraceptives to help regulate periods.
Fertility problems
Treatment will enable most women with PCOS to get pregnant. Typically, the first line of treatment is to administer drugs that induce the release of eggs from the ovaries. If these don’t work, your healthcare provider may offer other medications and procedures, including IVF.
Excessive hair
Medications that interfere with the function or production of the male sex hormones responsible for the symptom can improve the condition. Using products that slow hair growth locally and hair removal in combination with the medication.
Acne
The use of oral contraceptives can treat PCOS-related acne. It is also wise to practice general good skin care.
Psychiatric/psychological problems
The role of a psychiatrist is crucial when treating PCOS, and screening for psychiatric problems should be done.
Written by: Selam Temesgen M. D.
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