Editorial ↵


Polycystic Ovarian Syndrome


What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a common health problem that can affect a woman. It leads to irregular periods, weight gain, acne, increase in facial hair, difficulty in conceiving or infertility.

What causes PCOS?

A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.

It is now well established that insulin resistance is linked to PCOS. Insulin is a hormone secreted by the pancreas that controls the level of blood sugar. Due to insulin resistance, women with PCOS produce more insulin and the excess insulin appears to increase production of androgen. High androgen levels can lead to acne, excessive hair growth, weight gain and problems with ovulation. The lack of regular ovulation then leads to irregular menses and infertility.

The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:

  • Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is currently the most common cause of female subfertility
  • Infrequent, absent, and/or irregular menstrual periods
  • Hirsutism – increased hair growth on the face, chest, stomach and back
  • Multiple small cysts on the ovaries seen on Ultrasound scan
  • Acne, oily skin, or dandruff
  • Weight gain or obesity
  • Male-pattern baldness or thinning hair
  • Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
  • Skin tags – excess flaps of skin in the armpits or neck area

Why do women with PCOS have trouble with their menstrual cycle and fertility?

The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.

In women with PCOS, the hormonal imbalance leads to improper egg development and maturation. The follicles start to grow and build up fluid but ovulation does not occur. Instead, some follicles enlarge and may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent. The ovaries also make male hormones, which prevent ovulation.

What is the treatment for PCOS?

There is no absolute cure for PCOS, it needs to be managed on a long term basis to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:

Lifestyle modification :

This is the most important treatment for women with PCOS. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level. Healthy eating tips include:

  • Limiting processed foods and foods with added sugars
  • Adding more whole-grain products, fruits, vegetables, and lean meats to your diet
  • Drink 3-4 litres of water per day

This helps to lower blood glucose (sugar) levels, improve the body’s use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.

Combined Oral Contraceptive (COC) pills:

For women who don’t want to get pregnant, COC pills (birth control pills) can help to control menstrual cycles, reduce male hormone levels and help to clear acne. However, the COC pills do increase appetite and encourage fluid retention in some women, hence making the goal of weight loss more difficult. Also, keep in mind that the menstrual cycle will become abnormal again if the pill is stopped.

Oral hypoglycemic agents:

The medicine Metformin which is used to treat type 2 diabetes, has also been found to help with PCOS symptoms. Metformin improves the sensitivity of the body cells to insulin and affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. Metformin also helps to reduce the miscarriage risk associated with PCOS.

How does PCOS affect a woman while pregnant?

Women with PCOS appear to have higher rates of:

  • Miscarriage
  • Gestational diabetes
  • Pregnancy-induced high blood pressure (preeclampsia)
  • Preterm delivery

Babies born to women with PCOS have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets). Metformin also lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.

Does PCOS change at menopause?

Yes and no. PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.

Does PCOS put women at risk for other health problems?

Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:

  • More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
  • The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.
  • Women with PCOS are at greater risk of having high blood pressure.
  • Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
  • Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.

Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.

I have PCOS. What can I do to prevent complications?

If you have PCOS, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOS, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include- eating right, taking up regular exercise and not smoking.