All You Need To Know About PCOS

Introduction

Polycystic ovary syndrome (PCOS) is a prevalent hormonal disorder. It leads to irregular menstrual cycles, excessive hair growth, acne, and infertility. The treatment approach for PCOS varies depending on whether or not pregnancy is desired. Individuals with PCOS might also face an increased risk of health issues such as diabetes and hypertension.

What exactly happens in PCOS?

Polycystic ovary syndrome (PCOS) is a condition characterised by a hormonal imbalance in the ovaries, which are responsible for producing and releasing eggs. In PCOS, the ovaries produce excessive amounts of androgens, leading to an imbalance in reproductive hormones. This imbalance often results in irregular menstrual cycles, missed periods, and unpredictable ovulation. Ultrasound scans may show small follicle cysts (fluid-filled sacs containing immature eggs) on the ovaries due to anovulation (lack of ovulation). However, the presence of these cysts is not necessary for a PCOS diagnosis, and they are typically neither harmful nor painful.

At what age does PCOS typically develop?

Women can develop PCOS at any time after puberty. Most diagnoses occur in their 20s or 30s, often when they are trying to conceive. The risk of developing PCOS is higher if you have obesity or if it runs in your biological family.

What are the symptoms of polycystic ovary syndrome (PCOS)?

The most common signs and symptoms of PCOS include:

1. Irregular Periods: This can involve missing periods, having no periods at all, or experiencing heavy bleeding during periods.
2. Abnormal Hair Growth: You may notice excessive facial hair or significant hair growth on your arms, chest, and abdomen (hirsutism), affecting up to 70% of people with PCOS.
3. Acne: PCOS can lead to acne, particularly on your back, chest, and face, which may persist beyond teenage years and be challenging to treat.
4. Obesity: Between 40% and 80% of people with PCOS have obesity and struggle to maintain a healthy weight.
5. Darkening of the Skin: You may develop patches of dark skin, especially in the folds of your neck, armpits, groin, and under your breasts. This condition is known as acanthosis nigricans.
6. Cysts: Many people with PCOS have ovaries that appear enlarged or contain numerous follicles (egg sac cysts) visible on an ultrasound.
7. Thinning Hair: You may experience hair loss or balding patches on your head.
8. Infertility: PCOS is the leading cause of infertility in women, due to irregular or infrequent ovulation, making conception difficult.

Is it possible to have PCOS without showing any symptoms?

Yes, you can have PCOS without exhibiting any symptoms. Many individuals are unaware they have the condition until they encounter difficulties with conception or unexplained weight gain. Some may have a mild form of PCOS, where the symptoms are not pronounced enough to be noticeable.

What primarily causes PCOS?

The precise cause of PCOS is unknown, but genetics appear to play a role. Several other factors, particularly obesity, also contribute to the development of PCOS:

1. Higher Levels of Male Hormones (Androgens): Elevated androgen levels can prevent the ovaries from releasing eggs, leading to irregular menstrual cycles. Irregular ovulation may cause the development of small, fluid-filled sacs on the ovaries. High androgen levels also contribute to acne and excessive hair growth in women.
2. Insulin Resistance: Increased insulin levels prompt the ovaries to produce and release more male hormones (androgens). These elevated male hormones inhibit ovulation and contribute to other PCOS symptoms. Insulin resistance, where the body doesn’t process insulin effectively, leads to high blood glucose levels. While not all individuals with insulin resistance have elevated glucose or diabetes, it can increase the risk of diabetes. Obesity can exacerbate insulin resistance. Elevated insulin levels, even with normal blood glucose, can indicate insulin resistance.
3. Low-Grade Inflammation: People with PCOS often have chronic low-grade inflammation. Healthcare providers can measure inflammation levels through blood tests that assess C-reactive protein (CRP) and white blood cell counts.

How do healthcare providers diagnose polycystic ovary syndrome (PCOS)?

Diagnosing PCOS typically involves a series of steps that healthcare providers follow:

1. Symptom Discussion and Medical History: Your healthcare provider will discuss your symptoms and medical background, including family medical history.
2. Physical Examination: They will conduct a physical exam to assess for signs like excess facial hair, hair loss, acne & discoloured skin.
3. Measurements: Weight and blood pressure measurements are taken to evaluate overall health.
4. Pelvic Exam: This may be performed to examine for any other potential causes of abnormal bleeding.
5. Blood Tests: Tests are ordered to check hormone levels (including androgens), insulin levels, and glucose levels to screen for insulin resistance.
6. Pelvic Ultrasound: An ultrasound of the pelvis may be conducted to examine the ovaries, evaluate the thickness of the uterine lining, and identify any other abnormalities.

These diagnostic steps help healthcare providers confirm PCOS and differentiate it from other conditions with similar symptoms.

What are the key indicators used to diagnose PCOS?

Healthcare providers typically diagnose PCOS if you exhibit at least two of the following symptoms:

1. Irregular or Missed Periods: This may include very heavy bleeding during menstruation for those with PCOS.
2. Signs of Excess Androgens: This can manifest as acne, excessive hair growth (hirsutism), or confirmed high levels of androgens through blood tests.
3. Enlarged Ovaries or Polycystic Appearance on Ultrasound: While not all individuals with PCOS develop ovarian cysts, an ultrasound may reveal enlarged ovaries or a polycystic appearance.

These criteria are used collectively to diagnose PCOS, considering the variability in how the condition presents among individuals.

How is polycystic ovary syndrome (PCOS) managed and treated?

Treatment for PCOS is tailored by healthcare providers based on individual symptoms, medical history, and reproductive goals, whether immediate pregnancy is desired or not. Treatment options may include medications, lifestyle adjustments, or a combination of both.

For those not planning pregnancy, treatment options include:

1. Hormonal Birth Control: This can include pills, patches, shots, vaginal rings, or intrauterine devices (IUDs). Hormonal birth control helps regulate menstrual cycles and can improve acne and excessive hair growth.
2. Insulin-Sensitizing Medications: Drugs like Metformin, typically used for diabetes, can help regulate insulin levels, which in turn may improve menstrual regularity in some individuals with PCOS.
3. Medications to Block Androgens: Certain medications can block the effects of androgens, helping to manage acne or excessive hair growth. 
4. Lifestyle Changes: Adopting a healthy diet and maintaining a suitable body weight can positively impact insulin levels and overall health.

For those aiming to conceive, treatments may include:

1. Ovulation Induction Medications: Drugs like clomiphene, letrozole (taken orally), or gonadotropins (administered by injection) can stimulate ovulation, increasing the chances of pregnancy.
2. Surgical Options: While less common due to advancements in medication, surgical procedures may be considered to restore ovulation by removing androgen-producing tissue from the ovaries.
3. In Vitro Fertilization (IVF): IVF may be recommended when medications fail to induce ovulation. This involves fertilizing an egg with sperm outside the body and then transferring the embryo to the uterus.

These treatment approaches are tailored to address the specific symptoms and reproductive goals of individuals with PCOS, aiming to improve overall health and fertility outcomes.

Can PCOS be cured or go away?

PCOS does not have a cure, but healthcare providers can assist in managing its symptoms. The effects of PCOS may fluctuate over time, potentially becoming less noticeable, but there is no treatment that permanently eliminates the condition.

Is it possible to conceive if I have PCOS?

Yes, it is possible to get pregnant if you have PCOS. While PCOS can make conception challenging and increase the risk of certain pregnancy complications, many individuals with PCOS do conceive naturally. Your healthcare provider will collaborate with you to develop a tailored treatment plan aimed at promoting ovulation. This plan may include medications or assisted reproductive technologies such as In Vitro Fertilization (IVF).

Can PCOS and its effects be minimized or prevented?

Although there is no known way to completely prevent PCOS, you can take proactive steps to reduce its impact. This includes maintaining a healthy weight, exercising regularly, and eating a balanced diet, all of which can help manage symptoms associated with PCOS.

Are there other health conditions associated with PCOS?

PCOS is associated with an increased risk of several health conditions, including:

1. Diabetes.
2. Hypertension (high blood pressure).
3. Cardiovascular disease.
4. Endometrial hyperplasia.
5. Endometrial cancer.
6. Sleep disorders like sleep apnea.
7. Depression and anxiety.

Managing PCOS through appropriate treatment and lifestyle changes can help mitigate these risks.

How can I manage PCOS?

Managing PCOS involves several strategies to improve symptoms and overall well-being:

1. Maintain a Healthy Lifestyle: Focus on achieving and maintaining a healthy body weight through nutritious eating habits and regular physical activity. These lifestyle changes can help regulate hormone levels and improve menstrual regularity.
2. Address Cosmetic Concerns: If excess hair growth or acne affects your self-confidence, consider cosmetic treatments or consult with a dermatologist for personalized skincare advice.
3. Seek Support: Remember that PCOS is a common condition affecting many individuals. Connecting with support groups or seeking counselling can provide emotional support and helpful information.
4. Fertility Considerations: If you are trying to conceive, discuss your options with a healthcare provider specializing in reproductive health. Treatments such as medications or assisted reproductive technologies may be recommended to enhance fertility.

By proactively managing PCOS with these strategies, you can better cope with the condition and improve your quality of life.

When should I consult my gynaecologist?

It is advisable to seek medical attention if you suspect you may have PCOS. Look out for the following signs, which may indicate PCOS:

1. Irregular menstrual cycles, often with intervals longer than 40 days between periods.
2. Excessive hair growth, acne, or other indications of elevated androgen hormone levels.
3. Difficulty conceiving.

Prompt consultation with your doctor can lead to early diagnosis and appropriate management of PCOS symptoms.

Jain Multispeciality Hospital has renowned gynaecologists who offer complete care for women with PCOS. They provide tailored treatments and expert consultations to address symptoms such as irregular menstrual cycles, excessive hair growth, and fertility issues. With a commitment to improving quality of life, Jain Multispeciality Hospital invites you to schedule a consultation today to receive personalized support and effective management strategies for PCOS.