I feel Polycystic Ovarian Syndrome has been a hot topic and the term has been thrown around a lot lately. Perhaps we hear more about it as we enter our motherhood years or when we first start trying to concieve. Some women are unaware that they even have PCOS until they have trouble falling pregnant so they make an appointment with their doctor for a check up and leave with the diagnosis of PCOS. This is certainly not to suggest that all women with PCOS will have trouble conceiving. Some women may find out they have PCOS after they notice they have had irregular periods with intermittent bloating or excessive weight gain & trouble loosing weight.
So what is it?
Polycystic Ovarian Syndrome (PCOS)
Polycystic ovarian syndrome, previously known as Stein Leventhal syndrome, is just as nasty as it sounds. As the name ‘polycystic’ suggests itself, it results in the formation of numerous cysts inside the ovaries. As it is a syndrome, it is related to many symptoms that we’ll discuss afterwards.
Let’s start with the general definition of Polycystic ovarian syndrome.
Definition and Diagnostic Criteria:
Polycystic ovarian syndrome is an endocrine disorder which mostly results in menstrual disturbances, hyperandrogenism, decreased fertility, anovulation and polycystic ovaries (of course), as any textbook would say.
The criteria for diagnosis, as stated by The American Association of Clinical Endocrinologists and PCOS Society is the presence of at least 2 of the following:
- Chronic anovulation,
- Hyperandrogenism (clinical or biological), and
- Polycystic ovaries.
But, what do these words really mean? We will break it down bit by bit.
Menstrual disturbances: PCOS usually results in irregular menses. Some women may experience prolonged gaps in between their menstrual cycles, while others may get extremely heavy bleeding.
Hyperandrogenism: Hyperandrogenism is simply increased production of androgens, usually thought of as “male sex hormones”. Androgens, like testosterone, are naturally produced by the female body and carry out multiple functions. Some of these functions include synthesis of estrogen, regulation of function of many organs including bones and kidneys, and stimulation of hair growth in pubic and underarm areas. The problem arises when there is an excess of these hormones, as it usually occurs in PCOS.
Chronic anovulation and decreased fertility: Anovulation means failure of ovulation to occur. Many women who suffer from PCOS experience frequent anovulatory cycles. When ovulation doesn’t occur, there is no release of egg from the ovaries, and hence, increased chances of infertility.
PCOS is also highly associated with many other disturbances in the body. These include:
- Type 2 Diabetes
- Sleep apnea
- High Blood Pressure
- Depression and anxiety
Causes of PCOS:
Worldwide, PCOS affects around 6-10% of women of reproductive age. Although there is research going on in this area, the cause of PCOS has not yet been clearly defined. It is thought to stem from a constellation of genetic and metabolic abnormalities.
Research suggests that women who suffer from PCOS usually have high insulin resistance, predisposing them to type 2 diabetes mellitus. Elevated insulin levels also cause an increase in androgen levels, manifested as hyperandrogenism. Excess androgen production can also result from dysregulation of enzymes that take part in their synthesis.
Symptoms of PCOS:
The most commonly noted symptoms include:
- Irregular periods (oligomenorrhea or polymenorrhea)
- No periods in months (amenorrhea)
- Facial hair Growth
- Neurological symptoms including depression, anxiety and suicidal thoughts
- High blood sugar (hyperglycemia)
How do you diagnose PCOS?
Your primary health care provider will most likely recommend an ultrasound, pelvic exam, blood tests among other labs to make a final diagnosis. On the ultrasound, cysts are usually very clearly identifiable providing clues to the diagnosis of the disease.
It is important to note, however, that the diagnosis of the syndrome is not based on the presence of cysts alone. It is important to have other related symptoms and signs to get diagnosed with it, as it is not just a disease but a syndrome.
The main goal here is the management and treatment of symptoms associated with PCOS. Some of the treatment options include:
- Lifestyle changes: Exercise is highly recommended as PCOS increases the risk of obesity and cardiovascular diseases. Both cardio & strength based exercises can prove very useful. There should be moderate changes in the diet recommended by a dietician too.
- Fertility medication may be indicated for some (The use of Clomid to induce ovulation)
- Medications to control high blood sugar for those who have been diagnosed with this by their doctor: Medication for type 2 diabetes mellitus includes the use of Metformin. Glucophage has proved very useful in treatment of disorders related to menstrual cycle.
Other treatment options include the use of medicines to reduce excess hair growth and acne. Surgery may also be recommended by your doctor. Please note that all treatment options must be discussed with your medical practitioner and prescribed by them as each person, their body and their needs are unique.
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