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What is PCOS?

The condition is defined by the presence of hormonal problems, excess hair growth, irregular menstrual cycles and polycystic ovaries, although not all patients have all these features. The term 'polycystic' means 'many cysts' and PCOS gets its name because of the clusters of small, pearl-size cysts in ovaries. These cysts are fluid-filled bubbles (called follicles) that contain eggs that have not yet been released because of the hormonal imbalance.

How common is PCOS?

PCOS affects 7-10% of women of childbearing age (15 to 45 years).

In women of Indian subcontinent, prevalence rates as high as 50% have also been detected.

PCOS is the most common hormonal disorder among women of reproductive age and is a leading cause of infertility. Unfortunately, this disorder often goes undiagnosed because of its seemingly unrelated symptoms.

PCOS was responsible for 18% of infertility and 40% of hirsutism cases in a study conducted at Srinagar.

When should a woman suspect that she may be having PCOS?

PCOS affects several body systems, putting women at increased risk for several problems. The following symptoms should raise a suspicion for PCOS:

1. Irregular or absent menstrual cycles at puberty or later
2. Acne, increased facial and body hair growth, loss of scalp hair
3. Weight gain
4. Darkening of skin at the back of neck or axilla (acanthosis)
5. Irritability, mood swings
6. Difficulty in conceiving (subfertility or infertility)

What causes PCOS?

While PCOS was identified almost 80 years ago by Drs. Stein and Leventhal, the cause remains unknown.

Research suggests that many women with this condition may have decreased sensitivity to insulin, called 'insulin resistance.' More insulin than normal is required to be produced by pancreas to ensure that the body cells absorb enough sugar. This leads to high insulin levels in the blood stream which makes the ovaries overproduce male hormones, triggering or worsening some of the symptoms of PCOS. The high insulin levels may also cause areas of skin (for example on the neck) to darken or develop skin tags. Eventually, pancreas may not be able to maintain high insulin levels necessary to keep sugar levels normal and one may develop diabetes.

There are also disturbances in the reproductive hormone axis at various levels – hypothalamus, pituitary and ovaries.

PCOS seems to run in families, and it is likely that it is a genetic disorder. Sisters of PCOS patients have about a 50% chance of also having PCOS.

How is PCOS diagnosed?

If you have any of the symptoms listed above, consult a specialist who will go through your medical history, perform a physical exam, and check your hormone and glucose levels. She or he may also schedule an ultrasound to look at your ovaries.

Other disorders such as those that affect the adrenal, thyroid or hypothalamus-pituitary glands may mimic PCOS. For this reason, a careful evaluation of your individual case history and laboratory tests are essential for an accurate diagnosis. A specialist familiar with this syndrome, such as an endocrinologist, is best qualified both to diagnose and to treat PCOS.

Is there any cure for PCOS?

While there is still no cure for PCOS, the good news is that there are many effective ways to treat these symptoms. Together with changes in diet and exercise, these treatments are empowering women with PCOS to lead healthier and more satisfying lives. Even the problem of infertility can often be corrected and conception can occur.

What treatment is recommended for ladies with PCOS?

It needs to be understood that PCOS is a syndrome complex; hence the earlier name PCOD (polycystic ovarian disease) was changed to PCOS (polycystic ovarian syndrome). The problem is not just at the level of the ovaries, it is a multisystem disorder and each of the various problems of the individual need to be assessed and targeted.

Once you are correctly diagnosed with PCOS, your endocrinologist can help you choose from a number of treatments depending on the specific symptoms you are experiencing, your age, and your plans regarding pregnancy.

The following treatment options have helped many women:

• Female hormone preparations help to regulate menstrual cycles, reduce abnormal hair growth and improve acne.
• Insulin-sensitizing medications improve the regularity of menstrual cycles and decrease hair growth. 
• Ovulation Induction. In some women who wish to become pregnant, inducing ovulation, which is the release of an egg, is necessary. The initial treatment to induce ovulation is usually an oral medication called clomiphene citrate. If clomiphene is not effective, the next order of treatment often includes an injection of gonadotropins. Other medications, laparoscopic surgery and in-vitro fertilization are other options.
• Anti-androgen medications can be used to reduce unwanted hair growth and, to a limited degree, acne and scalp hair loss.
• Topical anti-hair-growth medications also can help to slow the growth of facial hair in women with PCOS, specifically a lotion containing eflornithine hydrochloride.
• Other treatments for excess hair include bleaching, depilatory creams, and shaving excess hair. Waxing and tweezing, particularly of sensitive skin areas are discouraged, as they can damage the skin. Electrolysis and laser treatments to remove hair also can be effective.
• Proper nutrition and Exercise is a critical aspect of PCOS care. Some women with PCOS find success by reducing their total intake of refined carbohydrates (sugars and starches) and replacing them with complex carbohydrates (fruits and vegetables).
  Skin problems other than acne may be treated in different ways. A dermatologist can remove skin tags. The dark blemishes on your skin may fade if you can reduce your insulin level by weight loss or through the use of insulin-sensitizer medications.

What are the other problems associated with PCOS?

Women with PCOS are at higher risk for a number of serious health conditions. These conditions may go unnoticed, but are potentially dangerous, and include the following:

• Obesity
• Diabetes and insulin resistance.
• Hypertension
• Dyslipidemia (high cholesterol and triglycerides)
• Increased risk of cardiac disease and stroke
• Cancer of the uterus.
• Sleep apnea

Does the problem of polycystic ovaries improve with increasing age?

The more obvious signs of PCOS described above are particularly troublesome for women from puberty through their reproductive years. As women approach menopause, they may notice that many of their PCOS symptoms diminish in severity. Some women may even begin to experience regular menstrual cycles.

Unfortunately, the risk for diabetes and heart disease increases with age. This means that if you have had symptoms of PCOS for most of your life, then you should be carefully evaluated for diabetes, insulin resistance, and heart disease, even if your overall symptoms are improving with age.

Metabolic syndrome was diagnosed in 46% ladies with PCOS in a study at Kolkotta recently.

In a nutshell

• PCOS is a syndrome complex caused by hormonal imbalance and insulin resistance.
• The woman may have irregular periods, excess facial and body hair growth, acne, weight gain, difficulty in conceiving.
• PCOS is diagnosed by a detailed clinical evaluation, hormone assessment and ultrasound of ovaries.
• There is no cure but the various symptoms can be satisfactorily treated.
• If you are suffering from PCOS, you may be at risk of other hormonal diseases for which you should be evaluated and appropriately treated.

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