September is a designated month to raise worldwide awareness of PCOS (polycystic ovary syndrome) and promote PCOS education…
Polycystic ovary syndrome or PCOS is a hormonal disorder that women in their reproductive or childbearing age that is from 15 to 44 suffer from. Women with polycystic ovary syndrome suffer from Oligomenorrhea- or infrequent periods (where some women have less than six periods in a year) or prolonged periods.
It affects the ovaries where the hormones estrogen and progesterone are produced, and these hormones affect a woman’s menstrual cycle, thereby affecting fertility, the ovaries of women with polycystic ovary syndrome are seen to produce excessive amounts of the male hormone Androgen.
Since polycystic ovary syndrome affects the normal functioning and the balance of hormones, it, in turn, affects a woman’s ability to have children. Some women develop the symptoms and signs of polycystic ovary syndrome early during puberty, while some develop it later in life due to sudden and excessive weight gain.
Polycystic Ovary Syndrome (PCOS) – – What Is It?
PCOS generally affects the hormonal levels in the body; it mostly occurs in women that are in their reproductive age between 15 and 44 years. As much as 2.2 to 26.7 of the women of this age group are affected by PCOS. Some women are not even aware that they are suffering from PCOS because as per one study as much as 70 percent have PCOS that have not been diagnosed yet.
In essence, Polycystic Ovary Syndrome (PCOS) targets the ovaries, which are a very important part of the female reproductive system. The two hormones that help in regulating menstruation are estrogen and progesterone, and the ovaries produce these two hormones.
Along with these hormones, the ovaries are also responsible for producing a very tiny amount of the male hormones known as androgens as well. The ovaries produce one egg every month through the process of ovulation if the egg is fertilized by a male sperm the woman gets pregnant.
FSH or Follicle-stimulating hormone and LH or luteinizing hormone regulate ovulation. The follicle-stimulating hormone works by stimulating the ovaries to produce a sac known as follicle that contains the egg. In contrast, the luteinizing hormone stimulates the ovaries to release a mature egg.
Polycystic ovary syndrome causes malfunctioning in the ovulation process, and therefore it affects the ovaries.
It has three important features which are:
- cysts on or in the ovaries
- increased level of the male hormones
- irregular menstrual cycle or cessation of periods
The word polycystic refers to many cysts which are the occurrence of several cysts in the ovaries that are filled with liquid. The cysts or sacs consist of immature eggs that never reach maturity, and so ovulation does not occur. When ovulation does not occur, there is a great imbalance in the level of Follicle-stimulating hormone, luteinizing hormone, estrogen, and progesterone. the levels of estrogen and progesterone are low while the level of androgens increases than the normal amount.
Since the increased level of the androgens affects the menstrual cycle, those women that are suffering from polycystic ovary syndrome experience fewer menstrual cycles in comparison to a woman that does not have PCOS.
What Are Its Causes?
The exact reasons as to why polycystic ovary syndrome occurs are still not known, but it is believed that the increased levels of the male hormones act as a hindrance in the normal production of the female hormones by the ovaries which again disrupts the ovulation process. The increased production of androgens has been linked to insulin resistance, genes, and inflammation in the body.
As much as 70 percent of women that are suffering from polycystic ovary syndrome also suffer from insulin resistance. The pancreas produces insulin which helps the body to use sugars occurring in food for energy. With insulin resistance, the demand for insulin in the body increases; as a result, the pancreas produces more of it. This causes an increase in the level of insulin, and the ovaries produce more androgens due to that. Insulin resistance is mainly caused by being overweight. Insulin resistance, along with obesity, can trigger type 2 diabetes.
Those women that are suffering from polycystic ovary syndrome have increased inflammation in the body. Inflammation can be caused by being obese, and more inflammation has been linked to higher levels of androgens.
Polycystic ovary syndrome generally has been seen to be hereditary in nature. A lot of researches have shown that genes contribute to its occurrence rather than one.
Some Common Signs And Symptoms Of PCOS
For some women, the symptoms can be seen when they have their period for the first time. On the other hand, some women see the symptoms only when they have piled on the pounds or when they encounter fertility issues.
Some of the most common symptoms of PCOS are:
If the lining of the uterus gets thickened for a long time period menstruation can be very heavy.
The increased level of the male hormones makes the skin more oily as result breakouts are frequent such as on the upper back, chest, and face.
The absence of ovulation prevents the lining of the uterus from shedding each month; as a result, women suffering from polycystic ovary syndrome have less than eight menstrual cycles in the entire year.
As much as 80 percent of the women suffering from polycystic ovary syndrome are seen to be overweight.
Women with PCOS also suffer from male-pattern baldness where the hair gets thinner and eventually falls out.
Excessive Hair Growth
Around 70 percent of women with polycystic ovary syndrome experience hair growth on their body like on the chest, stomach, back, and the face. This condition is known as hirsutism.
Changes in the level of the hormones can also cause headaches.
Dark Patches of Skin/ Skin Tags
Women with PCOS have high levels of insulin in their bodies due to which patches of darkened skin, also known as acanthosis nigricans, appear on the neck, groin, armpits. They are also prone to skin tags, which are not at all aesthetically pleasing, and as a result, it takes a toll on their self-esteem.
PCOS: How Does It Affect The Body?
The increased level of male hormones can cause issues with getting pregnant and can also affect the overall health of the woman.
Pregnancy is directly related to ovulation, and in the absence of ovulation, there is no pregnancy. Women with polycystic ovary syndrome do not ovulate regularly; as a result, there are no eggs to be fertilized by the male, and so they suffer from fertility issues.
Sleep apnea is known as the condition in which there are frequent pauses in breathing while sleeping at night, which disturbs sleep.
In women that are obese sleep apnea is very common, which is more so if the woman is suffering from polycystic ovary syndrome. Women with PCOS that are also obese have upto ten times more risk of suffering from sleep apnea compared to those women that do not have PCOS.
As much as 80 percent of the women that are dealing with polycystic ovary syndrome are obese. Polycystic ovary syndrome along with obesity increases the chances of suffering from high blood pressure, high blood sugar, lower levels of the good cholesterol HDL, and an increase in the levels of the bad cholesterol LDL.
All these are known as metabolic syndrome, and they can also increase the chances of complications like diabetes, cardiac issues, and stroke.
The imbalance in the level of the hormones along with the symptoms likes excess growth of hair, can have negative consequences on the emotions. A lot of women suffering from PCOS suffer from anxiety and depression, as well.
When the uterine lining is built up during the menstrual cycle at the time of the periods, this lining is shed through the vagina. Without ovulation, the lining of the uterus keeps on thickening which greatly increases the likelihood of endometrial cancer.
Diagnosis of Polycystic Ovary Syndrome
Women with polycystic ovary syndrome have one of the three symptoms based on which the doctors make their diagnosis:
- High levels of androgens
- Irregular periods
- Cysts in ovaries
Apart from these, the doctor also might ask about any possible acne issues, hair growth on the body and face along with weight gain. A pelvic exam might be done to check the ovaries. During a pelvic exam, the doctor can insert gloved fingers inside the vagina in order to check for any abnormalities in the uterus and the ovaries.
Along with that, a blood test can also be done in order to check for the increased level of the androgens. A blood test can also reveal the level of insulin, cholesterol, and triglyceride, which helps in determining the risk of diseases like diabetes and cardiac issues.
The diagnosis of polycystic ovary syndrome is also performed via ultrasound. Through an ultrasound, the doctor checks for any cysts in the ovaries or any other issues with the uterus and the ovaries.
Polycystic Ovary Syndrome And Pregnancy
Since polycystic ovary syndrome affects ovulation women with PCOS have difficulty getting pregnant. From 70 to 80 percent of women with PCOS face this issue. Polycystic ovary syndrome also increases the risk of suffering from pregnancy-related complications.
Women with polycystic ovary syndrome carry the risk of delivering their baby early or prematurely. Other than that, such women are also at an increased risk of suffering from a miscarriage, gestational diabetes, and high blood pressure.
Women suffering from polycystic ovary syndrome can, however, conceive with the help of fertility treatments that help them in ovulating. Women can also start by losing excess weight and bringing down the level of blood sugar, which can help them get pregnant.
Diet And Lifestyle Changes To Help With PCOS
Changes in diet and lifestyle can help treat polycystic ovary syndrome. Just by losing 5 to 10 per cent of weight can help in the regulation of the periods and improve the symptoms of PCOS. By losing weight, the level of cholesterol improves as well other than that insulin levels are also lowered, and the risk of diabetes and cardiac issues are also reduced.
Women with polycystic ovary syndrome can follow the low-carb diet that has been seen to be very effective in losing weight and also reducing the level of insulin in the body. Aside from that, a low glycemic index diet has also been seen as effective in losing weight. This type of diet involves consuming more fruits, whole grains, and vegetables which helps in weight loss and the regulation of the menstrual cycle.
In addition to diet changes, it has also been seen that doing half an hour of moderately intense exercise three days a week can cause weight loss in women suffering from polycystic ovary syndrome. Losing weight with the help of exercising also helps in improving ovulation and the levels of insulin. It has been seen that a healthy diet, along with exercising, has been the most effective way to lose weight when compared to doing one of the two. A combination of diet and exercising also helps in reducing the risk of developing heart problems and diabetes.
Some Common Medications For PCOS
BIRTH CONTROL PILLS
Birth control that consists of hormones estrogen and progestin can help in balancing the amount of the hormones in the body along with improving ovulation, helping with the symptoms such as hair growth along with protecting against serious complications like endometrial cancer. Estrogen and progestin come as a pill, vaginal ring, or patch.
Clomiphene is a fertility inducing drug that helps women suffering from polycystic ovary syndrome in getting pregnant. However, it has been seen that taking this drug increases the chances of getting pregnant with twins and having multiple births. It is a non-steroidal fertility medicine. Clomiphene is used to induce ovulation (egg production) in women; however, they can increase the risk of twin or multiple births.
It is used in the treatment of type 2 diabetes. Since it helps in improving the level of blood sugar, it helps with treating PCOS. Taking Metformin while having a healthy diet and working out increases weight loss, reduces blood sugar, and regulates the menstrual cycle in a much better way.
In case the other treatment methods fail to work a woman with polycystic ovary syndrome can also go for surgery. Ovarian drilling is a surgical procedure through which several tiny holes are made in the ovaries with the help of heated needles or laser that can regulate the ovulation process.
HAIR REMOVAL MEDICINES/Eflornithine
Eflornithine is a prescription medicine that comes as a cream, and it helps in getting rid of the excess hair by slowing down the growth rate of the hair. Aside from that, electrolysis and laser hair removal can also help in getting rid of the excess hair on the body and face.
When to See a Specialist?
In the case of the following symptoms, it is important to see a doctor as soon as possible:
- Missed periods with fertility issues
- Symptoms of polycystic ovary syndrome-like excessive hair on body and face
- If a woman has been trying to conceive for the past 12 months with no success
- Symptoms associated with diabetes like blurred vision, rapid weight loss without any reason, or excessive hunger or thirst.
Commonly Asked Questions about PCOS
Who can get PCOS?
Polycystic ovary syndrome or simply PCOS is a hormonal disorder that affects around 10-15 % of women in their reproductive age that is 15-44 years. The signs of PCOS start early during puberty and continues to develop throughout a woman’s reproductive age. The risk of developing it is not restricted to a particular race as women of every race can develop it. The risk is usually higher if some have a family history of PCOS or if they are obese.
Can you still get pregnant if you have PCOS?
Yes, it is possible. The imbalance in hormones caused by polycystic ovary syndrome causes the body to skip the process of ovulation by which an egg is released by an ovary each month; without ovulation, a woman cannot get pregnant. Infertility caused by PCOS is very common and also treatable. Doctors can prescribe various medications to treat infertility caused by PCOS.
Is PCOS linked to other health problems?
Yes, PCOS has been linked to various other health problems like:
- Diabetes: Women with PCOS have insulin resistance where the body cells do not respond readily to the insulin levels in the blood, and it causes insulin levels to build up in the blood and to compensate for that, the pancreas produces more insulin, which can increase the risk of developing type 2 diabetes.
- High blood pressure: PCOS also causes hypertension or high blood pressure, which can lead to cardiovascular diseases in the longer run.
- Unhealthy cholesterol: Women with PCOS have higher levels of bad cholesterol or LDL in their blood, which can raise the risk of developing cardiovascular diseases in them.
- Sleep apnea: Brief but repeated pauses in breathing during sleep is known as sleep apnea. Women with PCOS are at a higher risk of developing sleep apnea due to obesity. Sleep apnea can raise the risk of developing heart problems and diabetes.
- Depression and anxiety: The various symptoms of PCOS, including weight gain, acne, excess body, and facial hair, raises the risk of women experiencing depression, mood swings, and anxiety.
- Endometrial cancer: During a normal menstrual cycle, the uterine lining is shed every month, but during a menstrual cycle with PCOS, since ovulation does not occur, the uterine lining does not shed and can keep on building up, this can cause endometrial cancer in women with polycystic ovary syndrome.
What are the treatment options for PCOS if you want to get pregnant?
Many options can make a woman with PCOS to get pregnant:
- Losing weight: Even losing 10-15% of body weight can help in regulating the menstrual cycle in women with PCOS, thus improving fertility. Through a combination of exercising and a healthy diet, weight can be managed in a better way.
- Medicine: Another option to treat PCOS is through medications. Clomiphene is such a drug that is used to induce ovulation in women who do not ovulate.
- In vitro fertilization (IVF): IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo is then transferred to the uterus to develop. This method is prescribed when medications do not work. IVF has a higher pregnancy rate as compared to medications, and it also helps avoid the risk of twin or multiple births.
- Surgery: Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have polycystic ovary syndrome. In this small punctures are made in the ovaries using a laser beam or thin heated needles. It helps in regulating ovulation.
How does PCOS affect pregnancy?
Polycystic ovary syndrome exposes a woman to infertility and various gestational complications like:
- Cesarean section (C-section)
- Gestational diabetes
- Preeclampsia- a sudden rise in blood pressure and swelling in the face, hands, and feet.
- Macrosomia- where a baby is born much larger than the average for their gestational age.
- Learn more about pregnancy-related complications and risks for young women in our blog Common-Pregnancy Complications Types, Risk, and Treatments.
Polycystic ovary syndrome can cause difficulties in a woman getting pregnant. The increased levels of the male hormones in the body also cause symptoms like excessive hair growth on the body and face. Making changes in lifestyle is one of the things that doctors suggest treating polycystic ovary syndrome, and they have been proven to be effective.
Losing weight can treat polycystic ovary syndrome and improve the chances of conceiving. A healthy diet, along with aerobic type exercises, can help in losing weight. In case making changes in the lifestyle does not work, medicines can be resorted to. Metformin and birth control pills can help in regulating the menstrual cycle and easing the symptoms of polycystic ovary syndrome.