Polycystic Ovarian Syndrome (PCO) is one of the leading causes of infertility among women today

Don’t let PCOS take over your life

Polycystic Ovarian Syndrome is one of the leading causes of infertility among women today

    When a recently concluded health survey disclosed that Polycystic Ovarian Disease or Syndrome (PCOD/ PCOS) was one of the leading causes of infertility among women, it brought to the forefront some alarming facts.
    Gynaecologist and infertility specialist Dr Hrishikesh Pai says that Polycystic Ovarian Disease or Syndrome (PCOD/ PCOS) is a condition in which the ovaries show many small cysts arranged in the shape of a necklace within it. “This results in an abnormality of the hormones, with the male hormone dominating. As a result, the girls with this syndrome show features such as acne, excessive facial hair growth (hirsutism), weight gain and irregular or scanty periods,” he says.
    PCOS is also known as Stein Leventhal syndrome and most women with this condition have a number of small cysts in the ovaries. “The words ‘polycystic ovary syndrome’ fill many women with fear and dread and they want to know whether their ovaries are diseased, if they can have kids and can the cysts be cut out? However, women may have cysts in the ovaries for a number of reasons, and it is the characteristic constellation of symptoms, rather than the presence of the cysts themselves, that is important in establishing the diagnosis of PCOS,” says gynaecologist and gynaecologic cancer specialist Dr Samar Gupte. 

WHAT HAPPENS
    While the exact cause of PCOS is unknown, there is an imbalance in the levels of hormones and a slight increase in the male hormones (androgens), there is insulin resistance and a change in the female sex hormone levels. Insulin is a hormone that regulates sugar control in the body. In PCOS the body does not respond to insulin as it should. So the
sugar level rises, consequently more insulin is produced which itself increases the androgen levels, causes weight gain, irregular periods and infertility. One tends to feel hungrier and the body does not respond to exercise. The high levels of androgens prevents ovulation (egg/ovum is not released), imbalances the female hormones, causes periods to be irregular and promotes a male pattern change in the skin, hence the thick oily skin and male pattern hair distribution. Ovulation does not happen and multiple small cysts tend to develop in the ovaries. 

SYMPTOMS IRREGULAR MENSTRUAL CYCLE: Periods may be delayed, absent, scanty or occasionally heavy and unpredictable.  

INFERTILITY: Difficulty in getting pregnant.  

OBESITY: Upto 80% women with PCOS are overweight and have difficulty in losing weight although even thin women can have PCOS.  

HIRSUTISM: Excess hair growth on the face, chest, abdomen or upper thighs. Almost 70% women have varying degrees of hirsutism. 

HAIR LOSS ON THE SCALP: Severe acne or acne that occurs after adolescence and does not respond to usual treatment.  

ACANTHOSIS NIGRANS: Patches of thickened, velvety and darkened skin. Ovaries are larger than normal and have multiple small ovarian cysts

HOW DO YOU DIAGNOSE PCOS? Diagnosis is based on a combination of signs and symptoms, blood reports, hormonal assays and ultrasound findings. 

TREATMENT In married women, the PCOS often manifests as infertility or inability to conceive. “In this condition, ovulation may not occur regularly, and as the egg does not come out each month, chances of pregnancy are low. It can be treated by tablets and injections, which cause a woman to ovulate and she may become pregnant. The doctor may often prescribe drugs, which are used in diabetic patients, as these drugs are insulin sensitisers and improve the insulin insensitivity, which is the main problem behind PCOS. In some patients of infertility, in whom a laparoscopy (keyhole surgery) is being done to check the womb and tubes, a laparoscopic drilling of the cysts can be done. In this, cysts in the ovary are burnt using a thin needle with an electric current passing through it. This improves hormones and may help in achieving a pregnancy,” says Dr Pai. These women in their 30s and 40s are more prone to diabetes and later to cancer of the uterus, if they are not careful and do not take proper medication. It is important to bring on the periods regularly with medicines if they do not come monthly on their own. “This prevents hyperplasia of the lining of the womb and subsequent cancer. A lot of patients with PCOS are obese and one of the main treatments is lifestyle change with exercise, good diet and weight loss. This is the only thing which is effective in the long term. This problem of PCOS can affect women of all age groups, causes different problems at different stages of life and should be diagnosed and treated with care,” he adds. 

 
LONG TERM HEALTH RISKS PCOS affects all areas of the body and not just the reproductive systems. Insulin resistance increases the chance of the metabolic syndrome, which means that there is a much higher chance of developing diabetes mellitus, heart disease, obesity, hypertension and increased levels of cholesterol. The lining of the uterus (lining of the womb), called the endometrium tends to become thicker with time. This is called hyperplasia and can lead to cancer of the endometrium. Depression, mood swings, day time drowsiness and snoring are also linked to the effects of PCOS. 

 
IS THERE A CURE? “There is no straightforward cure. Medical treatments aim to manage and reduce the symptoms and consequences of PCOS. Medications alone are never helpful — it is a lifestyle change (weight loss, exercise, dietary modification) that together help to control the condition. In fact majority of women respond excellently to lifestyle modifications only,” ends Dr Gupte. 

 
INCIDENCE IN INDIA The incidence of PCOS appears to be rising or perhaps it is now being diagnosed more often. “It is seen in as many as 25 to 30% of young women. In young girls, symptoms are mainly cosmetic as they get disturbed by the acne, weight gain and facial hair,” says Dr Pai.
    Every woman with PCOS should have the cause of her problem determined. “If it is due to insulin resistance, it is important she understands her risks of diabetes, heart attack, stroke and blood clots and be tested for those risks. She should understand her treatment options, including the risks of treatment. Diabetes and vascular risk factors should be assessed regularly. PCOS can be a difficult condition — difficult to live with, difficult to understand and difficult to find treatment for. There is help for all these difficulties, however. The first step in making life with PCOS tolerable is being able to understand what is happening. But the most important is finding a physician who is aware of recent research and can properly apply the new treatments,” adds Dr Gupte. 

 
EATING RIGHT
Experts agree that eating right can help control insulin levels, make one feel better, keep the heart healthy, lower the risk of getting diabetes and help losing weight. Include fruits, vegetables and whole foods (like whole meal bread, whole grain cereals, brown rice etc) in your diet. Choose lean meat, chicken and fish over red meat. Avoid excess sugar, salt, caffeine, alcohol and smoking. Have regular meals.