Polycystic Ovarian Syndrome (PCOS) – An Overview

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Polycystic Ovarian Syndrome (PCOS) affects about 5 to 10 percent of women of child-bearing age, but the incidence of the condition may be higher in some ethnic groups. It is caused by a surplus of male hormones in a woman’s body. The name refers to the appearance of cysts on the ovaries of some women who have PCOS.

What is Polycystic Ovarian Syndrome (PCOS)?

PCOS, is caused by hormonal imbalances. It has an impact on the reproductive system and can also affect the heart as well as the body’s ability to handle blood sugar. It can cause difficulties in women trying to conceive and is considered one of the common causes of infertility.

This condition can lead to delayed periods and cause certain physical changes. In PCOS, the sex hormones can go awry, causing excess facial and body hair or leading to insulin resistance in the body. Though the name suggests that women with this condition will have multiple cysts, it is not necessary that everyone diagnosed with PCOS has cysts. Similarly, not every woman with cysts will be diagnosed with PCOS. These ‘cysts’, in fact, are partially formed follicles with an egg.

How Does It Affect Pregnancy?

Women with PCOS who conceive will have to be monitored carefully throughout their pregnancy. This is because such women are three times more likely to have a miscarriage. Gestational diabetes and premature delivery are some PCOS side effects that might arise during the pregnancy. A doctor might recommend the continuing of Metformin during the pregnancy to minimise chances of a miscarriage.

Regular exercise is required during pregnancy when the mother has PCOS. Light exercise will boost the body’s use of insulin, create hormonal balance, and help keep weight in control. Walking and mild strength training are considered the best exercises for expectant women. Diet is also of importance when pregnant with PCOS. Higher intake of protein and fibre can help keep insulin levels in check during pregnancy.

Caesarian section is the preferred method of delivery for most pregnant women with PCOS. This is because the risk of complications is much higher when the mother has PCOS, and a C-Section reduces the chances of things going wrong during the delivery.

Getting pregnant with PCOS is not impossible, but trying to conceive with PCOS can certainly be more difficult than it would be otherwise. This is because women with PCOS tend to have hormonal imbalances that can interrupt normal ovulation and the menstrual cycle. The condition can also adversely impact the quality of eggs resulting in problems with conception. The relation between PCOS and infertility has been discussed and studied for a long time.

PCOS and Pregnancy

Many women with the condition can get pregnant and deliver full-term without the need for medical intervention in any form. But for those who require medical assistance, obstetricians and reproductive endocrinologists can guide them on conceiving and having a problem-free delivery. The PCOS pregnancy rate is an optimistic one, especially with the kind of progress being made in science every day. A large number of women with PCOS go on to get pregnant and have healthy offspring once they undergo treatment. The following statistics shed light on PCOS conception without medical intervention; it may help to bear in mind that it’s best to get a Doctor’s informed opinion since every woman’s body is unique.

  • Chances of getting Pregnant with PCOS:

Women with PCOS often face infertility issues, and may find it hard to get pregnant without medical intervention

  • PCOS affects 8 – 10% of the women of childbearing age and is associated with a very high rate of infertility. Since it causes infrequent or no ovulation, PCOS makes unassisted conception very difficult

Possible Reasons for Getting PCOS

No exact cause of Polycystic Ovarian Syndrome has been found yet. But genetics is strongly believed to be one factor, alongside insulin resistance and hormone imbalance. A woman’s risk for PCOS is increased by nearly 50 percent if a family member such as her mother, sister or aunt has PCOS.

Insulin resistance is present in nearly 80 percent of women who are diagnosed with PCOS. This is where the body has to work overtime to produce extra insulin to break down sugar. This, in turn, can stimulate the ovaries to produce an excess of testosterone, which then interrupts the normal development of follicles. This often leads to irregularities in ovulation.

Lifestyle factors are a common cause of insulin resistance as are genetic factors. Being overweight is yet another cause of insulin resistance. Hormone imbalances such as increased levels of testosterone, high levels of luteinising hormone (LH), and greater levels of prolactin can also cause PCOS.

Symptoms of Polycystic Ovarian Syndrome

The onset of symptoms of PCOS is gradual and often goes unnoticed. Though symptoms might start as early as the teen years, the condition may remain hidden until the woman gains a good amount of weight.

Menstrual problems such as infrequent periods or absence of periods, heavy, irregular bleeding during periods, loss of hair from the scalp while there is an increase in hair growth on the rest of the body such as the face, repeat miscarriages, depression, insulin resistance, and obstructive sleep apnea are some of the warning signs of PCOS.

Some other symptoms are darkened skin patches, mood swings, and difficulty in getting pregnant. Often, these are ignored or attributed to other reasons and result in a delay of PCOS diagnosis. In addition to these symptoms, women with PCOS might have health problems like diabetes, hypertension, and high cholesterol.

How is PCOS Diagnosed?

Since every woman is unique, no one will display all the symptoms of PCOS. There is also no single specific test for PCOS, and as a result, the method of diagnosis will vary slightly from doctor to doctor.

Firstly, the doctor will review the medical history of the woman and list information such as weight, BMI, menstrual cycle, diet, and exercise regimen. Family history, especially with regard to hormone problems and diabetes, will be sought.

This is likely to be followed by a physical exam of the breasts, thyroid gland, skin, and belly. A pelvic exam or PCOS ultrasound might be conducted to see if there is any abnormality of the ovaries. If signs of PCOS such as cysts and enlarged ovaries are present, they will show up during the examination.

The doctor might also ask for blood tests to check levels of testosterone, prolactin, triglycerides, cholesterol, thyroid stimulating hormone (TSH), and insulin levels among others. Lipid level tests, fasting glucose tests, and thyroid function tests will provide doctors with all the necessary information.

A diagnosis of this condition is arrived at if the patient satisfies at least two of the following three criteria:

  • Menstrual dysfunction which can mean absence of periods or irregularity in periods
  • Presence of high levels of male hormones in the blood which can manifest as acne or excess hair growth, especially on the body and face
  • Ovaries that are polycystic show an increase in the size of one or both ovaries; or the presence of 12 or more follicles on a single ovary

Treatment for Polycystic Ovarian Disease

There is no cure for PCOS, but it can be controlled through weight loss, a healthy diet, regular exercise, and medication. The treatment suggested will be based on the symptoms as well as the woman’s plans for pregnancy.

  • Weight Loss:

For overweight women, loss of excess weight can often prove to be the best treatment. Losing even 5 percent of weight can bring about the normalisation of the menstrual cycle and thus, ovulation

  • Exercise and a Balanced Diet:

Low-fat dairy products, whole grains vegetables and fruits constitute a balanced diet. Combined with exercise, a balanced diet helps balance your hormones

  • Quitting Smoking:

Androgens, or male sex hormones are present in higher amounts in women in smoke. These are the hormones which are responsible for PCOS. Quitting smoking can help in the treatment of PCOS

  • Medication:

Medication is often prescribed to treat the symptoms of PCOS. Contraceptive pills might have to be taken to ensure regular periods. Excessive hair growth or hair loss can also be controlled through medicines that can counter the effect of male hormones

  • Laparoscopy:

Since infertility is a fall out of PCOS, those trying to conceive might benefit from a minor surgery known as laparoscopic ovarian drilling (LOD). Here, the ovaries are subjected to heat or a laser to eliminate the tissue that is producing androgens (male hormones). This can help balance hormone levels lead the ovaries to function normally leading to pregnancy. But in some instances, this might prove to be a short-term solution

A majority of women with PCOS can get pregnant with the right treatment. This can include a course of clomifene or metformin depending on the individual’s symptoms and condition. IVF is also an option often offered to women with PCOS who fail to respond to medication.

Health Risks Associated with PCOS

Women with PCOS are more prone to conditions such as infertility, diabetes, endometrial cancer, heart attack, hypertension, high levels of cholesterol, sleep apnea, breast cancer, anxiety and depression. Sleep apnea can be particularly dangerous as the upper airway is obstructed during sleep. Metabolic syndrome is yet another condition that can occur as a result of PCOS while cardiovascular risk is twice as much in women with PCOS.

When women with PCOS get pregnant, they are often referred to a doctor experienced in high-risk pregnancies. This is because possible complications of pregnancies with PCOS include a higher risk of miscarriage, gestational diabetes, and premature birth.

How to Get Pregnant with PCOS

Since PCOS is a hormonal disorder which can lead to infrequent ovulation and poor quality of eggs, the guidance of an obstetrician and a reproductive endocrinologist can help afflicted women get pregnant quickly. It is important to seek their suggestions the moment one decides to start trying to conceive. They are likely to suggest the following tips to a successful pregnancy:

  1. Monitoring periods:

This helps to establish the pattern of frequency – Since PCOS can lead to irregular periods, it means fewer chances of ovulation which in turn translates to a reduced possibility of pregnancy every cycle. This is why doctors suggest charting periods to establish if ovulation is occurring or not

  1. Tracking ovulation patterns:

Use of ovulation test kits and basal body temperature monitoring can be of great help in determining the presence and absence of ovulation in each cycle. This will have to be done for a minimum of six months for a doctor to interpret results correctly

  1. Maintaining a healthy weight:

Excess weight can be the only hindrance to pregnancy for some women with PCOS. Eating a healthy diet and losing a few kilos can restore the hormonal balance and result in conception

  1. Eating healthy:

Since PCOS affects the body’s ability to regulate insulin, a diet for PCOS treatment should be rich in proteins and fibre which can counteract the condition. Staying away from processed foods and sugars is one way of ensuring this and restoring the hormonal balance. This can lead to normal ovulation and thus, pregnancy

  1. Medication:

If there is irregular or delayed ovulation, a doctor might prescribe Metformin or Clomid to help regulate ovulation and ensure periods occur. The absence of ovulation might see the doctor prescribe Provera

  1. Gonadotropins:

Treatment with gonadotropins is another option that doctors might suggest. Daily monitoring is required in this treatment

  1. IVF: 

When medications fail to produce results or are not suitable for a particular individual, the doctor might recommend opting for IVF or in-vitro fertilisation. In certain cases, PCOS might have an impact on the eggs, and then donor eggs might be required

  1. Laparoscopy:

Laparoscopic ovarian drilling is a minor procedure that might help pregnancy in certain cases of PCOS. The ovaries are targeted to destroy tissue that produces male hormones, and this can restore the body’s natural hormone balance leading to pregnancy

  1. Post-conception care:

Once pregnant, it is important to take care to sustain the pregnancy because PCOS increases the risk of miscarriages. Medications might have to be continued throughout the pregnancy to ensure a safe delivery.

When to Consult a Doctor If You Have PCOS

The symptoms of PCOS can be similar to those of other conditions such as thyroid problems, obesity, and diabetes. So, it might be difficult to know when to see a doctor. Early detection and treatment of the condition can prove beneficial in the long term, especially in preventing heart disease and diabetes. Some warning signs to watch out for and to consult a doctor immediately are severe vaginal bleeding, depression or mood swings, and symptoms of diabetes.

Increased thirst, frequent urination, bigger appetite, unexplained weight loss, blurred vision, and tingling in hands and feet are some symptoms that can indicate the presence of diabetes. Women who have regular menstrual cycles but fail to become pregnant after 12 or more months of trying should also consult their doctor immediately because a wait and watch approach does not help PCOS. Resorting to home remedies for PCOS might not be the best way for women wishing to conceive quickly.

Rising stress levels, pollution, late pregnancies and many other factors have led to PCOS becoming a common issue faced by women across the world. While it may lead to a delay in conception, and require extra care during pregnancy, it is a condition which can be addressed.  It is important to avoid stress and maintain a positive attitude during the treatment for a favourable outcome.

Also Read: Guide To Ovarian Hyperstimulation Syndrme

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