All about Polycystic Ovary Syndrome (PCOS)

Overview

The commonly used name for Polycystic Ovary Syndrome is PCOS. These days it is a common health problem, in which numerous small cysts (fluid-filled sacs) develop in the ovaries, which affects a woman’s hormone levels. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormones (androgen) levels.

Early diagnosis and treatment along with weight loss reduce the risk of long-term complications such as type 2 diabetes and heart disease.

What are the possible causes of PCOS?

The exact cause of PCOS is unknown. Factors that may play a role include:

• Heredity: The risk of PCOS may be higher if there is a family member with PCOS.
• Excess Insulin: Insulin is produced in the pancreas, which lets cells utilize sugar present in the blood, to produce energy. If the cells become resistant to the action of insulin, then the blood sugar levels can rise and the body may produce more insulin. Excess insulin may increase androgen production, causing difficulty with ovulation.
• Low-Grade Inflammation- Women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgen, which can lead to heart and blood vessel problems.
• Excess Androgen: The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne.

What are the symptoms of PCOS?

Signs and symptoms of PCOS vary and may include:

• Irregular periods and lack of ovulation prevent the uterine lining from shedding every month.
• Acne, male hormones can make the skin oilier than usual and cause breakouts in areas such as the face, chest, and upper back.
• Hair Growth, women with this condition grow hair on their face and body including on their back, belly, and chest.
• Heavy Bleeding, The uterine lining builds up for a longer period, resulting in periods heavier than normal.
• Weight gain, especially around the waist
• Male pattern baldness, the hair on the scalp gets thinner and falls out.
• Skin darkening, dark patches of skin can form on the neck, in the groin, and under the breasts.
• Headaches, hormone changes can trigger headaches
• Difficulty getting pregnant as a result of irregular ovulation or failure to ovulate
• Skin tags, small pieces of excess skin on the neck or armpits

What are the complications of PCOS?

• Type 2 Diabetes: Women with PCOS usually develop type 2 diabetes.
• High Blood Pressure: Women with PCOS are at greater risk of having high blood pressure, a leading cause of heart disease and stroke.
• Unhealthy Cholesterol: Women with PCOS often have higher levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol. High cholesterol raises the risk of heart disease and stroke.
• Sleep Apnea: It is a respiratory problem in which a person experiences pauses in breathing while asleep. Many women with PCOS are overweight or obese, which can cause sleep apnea. Sleep apnea raises the risk of heart disease and diabetes.
• Metabolic syndrome: Many women with PCOS are overweight or obese. Both obesity and PCOS increase the risk for high blood sugar, high blood pressure, low HDL (good) cholesterol, and high LDL (bad) cholesterol. Together, these factors are called metabolic syndrome, and they increase the risk of heart disease, diabetes, and stroke.
• Infertility: Women diagnosed with PCOS, suffer from an imbalance in female sex hormones(estrogen). This imbalance may prevent the development and release of mature eggs which inhibits ovulation or pregnancy.
• Depression and Anxiety: Depression and anxiety are common among women with PCOS.
• Endometrial Cancer- Problems with ovulation, obesity, insulin resistance, and diabetes (all common in women with PCOS) increase the risk of developing cancer of the endometrium (lining of the uterus or womb).

What is the impact of PCOS on pregnancy?

Women with PCOS can struggle to become pregnant and are at higher risk of developing the following complications during pregnancy:

• Miscarriage: A miscarriage is the loss of the baby before 20 weeks of pregnancy.
• Gestational diabetes: Gestational diabetes mellitus (GDM) is a type of diabetes that can occur in the second part of the pregnancy and goes away once the baby is born. It is diagnosed when a woman has higher than normal blood glucose levels during pregnancy. Women with gestational diabetes, as well as their children, are at higher risk for type 2 diabetes later in life.
• Pre-eclampsia: Pre-eclampsia is one of the most serious conditions during pregnancy where there is a sudden rise in blood pressure and swelling, mostly in the face, hands, and feet. If left untreated, it can lead to serious complications such as liver or renal failure and in rare cases, progress to eclampsia.
• Pregnancy-induced high blood pressure: This condition is due to an increase in blood pressure that may occur in the second half of pregnancy and can lead to early delivery, low birth weight, placental separation, and other complications for the baby.
• Preterm birth: Most pregnancies last around 40 weeks and babies born between 37 and 42 weeks are considered full-term. Babies that are born before 37 weeks are considered premature. Premature babies often have complicated health problems, both right after birth and later in life.
• Cesarean section (C-section): A cesarean section is a surgical procedure to deliver a baby through a cut in the mother’s abdomen and uterus. Women with PCOS often undergo this surgery, due to the complications associated with PCOS, such as pregnancy-induced hypertension.

Lifestyle tips in PCOS

A healthy diet and regular exercise help to lose weight and reduce PCOS symptoms. The following changes may be included in lifestyle:

• Increase intake of
  • Foods rich in protein such as dals, sprouts, milk products, fish, chicken, eggs
  • High fiber vegetables
  • Whole grains such as brown rice, whole wheat, millets
  • Nuts like almonds, walnuts, pistachio
  • Anti-inflammatory foods and spices such as turmeric, cinnamon, amla
• Avoid
  • Foods high in refined carbohydrates, such as white bread and muffins
  • Sugary snacks and drinks
  • Inflammatory foods, such as processed and red meats
• Regular exercise like walking, cycling, swimming, or weight training can help to control the associated metabolic problems and weight gain.

Diagnosis of PCOS.

The doctor will typically evaluate a woman’s signs and symptoms, medical and family history, and physical exam as well as laboratory test results to help make a diagnosis.

Laboratory Tests:

Follicle-stimulating Hormone (FSH)

Follicle-stimulating hormone (FSH) is a hormone associated with reproduction and the development of eggs in women and sperm in men. This test measures FSH in the blood and helps in the evaluation of menstrual irregularities, hypogonadism, infertility and helps in diagnosing pituitary disorders. FSH will be normal or low with PCOS.

Luteinising Hormone (LH)

Luteinizing hormone (LH) is a hormone associated with reproduction. This test measures the amount of luteinizing hormone in the blood and is used to help diagnose the cause of infertility. LH will be elevated in PCOS.

Testosterone, Total

Testosterone is the main sex hormone in men, produced mainly by the testicles, and is responsible for male physical characteristics. It is present in the blood of both males and females. The testosterone test may be used to help evaluate PCOS, infertility, hirsutism, and virilization in girls and women.

Sex Hormone Binding Globulin (SHBG)

Sex hormone binding globulin (SHBG) is a protein produced by the liver that transports the hormones testosterone, dihydrotestosterone (DHT), and estradiol in the blood as biologically inactive forms. This test measures the level of SHBG in the blood and may be used to help evaluate women for excess testosterone production. SBGH may be reduced in PCOS.

Anti Mullerian Hormone (AMH)

Anti-Müllerian hormone (AMH) is a hormone produced by reproductive tissues, including the testicles in males and the ovaries in females. This test measures AMH in the blood and is used to assess ovarian function, menopausal status, and evaluation of PCOS in women. An increased level of AMH is often seen with PCOS.

Prolactin

Prolactin is a hormone whose primary role is to promote breast milk production (lactation). This test measures the amount of prolactin in the blood. A high level of prolactin may be seen in PCOS.

TSH (Thyroid Stimulating Hormone)

This test measures the amount of TSH (Thyroid-stimulating hormone) in the blood. TSH stimulates the thyroid and is produced by the anterior pituitary gland. Women with PCOS usually have normal TSH levels. TSH is checked to rule out other problems, such as an underactive or overactive thyroid, which often causes irregular or lack of periods and anovulation.

Hemoglobin A1c (HbA1c)

This test is used to detect Diabetes. It’s also called HbA1c, glycated hemoglobin test, and glycohemoglobin.

Androstenedione

Androstenedione is an androgen responsible for the onset of sexual differentiation in males and females. This test measures the amount of androstenedione in the blood and may be used to help diagnose PCOS.

 

Non-Laboratory Tests:

Ultrasound

Ultrasound may be used to check the appearance of the ovaries and the thickness of the lining of the uterus.

Pelvic Exam

A pelvic examination of the whole pelvic region helps the doctors to detect if a woman has abnormal or enlarged ovaries.