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What is PCOS (Polycystic Ovary Syndrome)?

PCOS, commonly known as the polycystic ovarian syndrome, is a prevalent health issue and the most common endocrine disorder that results from an imbalance of reproductive hormones. The ovaries are affected by hormonal imbalances. The ovaries are responsible for producing the egg that is released monthly as part of a normal menstrual cycle. Due to PCOS, there are multiple eggs leading to improper maturation of eggs and the eggs may not be released during the time of ovulation. The incidence of PCOS is between 5-15% of women.

PCOS can result in irregular menstrual cycles. These irregular periods caused due to improper ovulation or anovulation can result in Infertility or the inability to get pregnant. In fact, PCOS is one of the most prevalent reasons for female infertility. Cyst formation in the ovaries (small fluid-filled sacs)

What are PCOS Causes in Women?

The cause of PCOS is multifactorial, doctors believe that multiple variables including genetics, are involved:

1. Genes or Heredity

A family history of PCOS may increase your risk of having the disorder. Studies suggest 70% chances of developing PCOS due to hereditary.

Genes or Heredity

2. Insulin Resistance and Obesity

When the body’s cells do not react to insulin as they should, this is known as insulin resistance, which thereby leads to high levels of insulin in the body. Due to this, insulin in the blood rises to beyond normal levels. Thus, insulin resistance is common in women with PCOS, especially those who are overweight or obese, practice bad eating habits, get little exercise, or have a diabetes-related family history (usually type 2 diabetes). Insulin resistance can eventually result in type 2 diabetes.

3. Low-Grade Inflammation

In reaction to an infection or damage, white blood cells produce several chemicals which causes low-grade inflammation. According to research, patients with PCOS have a specific kind of chronic, low-grade inflammation that causes their polycystic ovaries to manufacture androgens. Heart and blood vascular issues may result from this.

What are PCOS Symptoms?

Main features of PCOS are chronic anovulation, hyperandrogenism- phenotypical or biochemical and ultrasound finding of polycystic ovarian morphology. Infertility in females is the main symptoms of PCOS in women. And then there are other indicators as well, that run parallel to infertility.

1. Polycystic Ovaries Leading to Infertility

PCOS leads to difficulty in achieving pregnancy. The numerous fluid sacs or follicles that enclose eggs known as oocytes, lead to enlarged ovaries. This causes inconsistent ovulation and egg release known as anovulation leading to irregular menstrual cycles, this then causes female infertility.

2. Irregular Menstrual Cycle

PCOS causes irregular or a smaller number of periods known as oligo-menorrhea which is defined as menstrual cycles lasting more than 35 days. Alternatively, they may experience periods every 21 days or more often. Some PCOS sufferers cease their periods altogether. And this leads to infertility in women.

3. Heavy Bleeding

Sometimes throughout their menstrual cycle, women with PCOS have menorrhagia or increased menstrual bleeding. Low progesterone levels linked to PCOS are the root reason. One of the most prominent PCOS symptoms, here the extreme bleeding continues for at least seven days or even more and happens with severe cramps and pain(dysmenorrhea).

Menstrual Cycle

4. Skin Darkness

PCOS causes rough, dark, velvety areas of skin. Acanthosis nigricans is the name for this condition, which affects the neck or armpits. This is a sign of androgen excess. Skin tags, which are enlarged masses of skin, can also appear in women with PCOS.

 5. Weight Gain

PCOS can affect both thin(lean) and obese women. However, PCOS-positive women have more chances of being obese.

6. Excessive hair (Hirsutism)

Another most prominent of the PCOS symptoms, is that affected women encounter excessive hair growth in male pattern hair growth locations since the disorder is hormonal and is in part characterized by greater amounts of androgens (male hormones). PCOS causes excessive hair growth on the face, arms, back, chest, and belly when they have PCOS with excessive male hormones.

7. Acne

It is a sign of hyper-androgenism, acne can be associated with alopecia and hirsutism as both are caused by the same androgen hormone. Unfortunately, increased androgen levels are at work once more, causing skin issues like acne.

8. Multiple Small Follicles

Ultrasound scan finding of polycystic ovaries is commonly seen in women who undergo an evaluation for infrequent menses. Multiple small follicles of about 2-9mm size are seen and it is known as polycystic ovarian morphology.

What are PCOS Complications?

After PCOS symptoms let’s talk about the PCOS Complications. PCOS can result in major long-term consequences if it is not properly controlled. And these include:

  • Infertility
  • Miscarriage
  • Endometrial cancer- due to increased levels of estrogen hormone and chronic anovulation
  • Heart disease- as a result of hyperlipidemia
  • Diabetes- type 2 diabetes mallitus and impaired glucose tolerance due to insulin resistance
  • Metabolic syndrome- hypertension, dyslipidemia, diabetes mallitus
  • Liver disorders like fatty liver

Type 2 diabetes

Prevention of Complications in PCOS

Although there is no known method to stop PCOS, you can take simple measures to lessen your symptoms. You may prevent the consequences of PCOS, for instance, by maintaining a healthy weight, engaging in regular exercise, and consuming nutritious meals.

Also, having PCOS might raise your risk of various pregnancy problems, including gestational diabetes, high blood pressure, metabolic syndrome and endometrial cancer. Hence a routine evaluation for these conditions should resorted to by seeking a consultation with an IVF specialist in Indore.

Correlation between PCOS and Difficulty in Pregnancy (Infertility)

PCOS is one of the major factors that lead to infertility. The hormonal imbalance in PCOS patients prevents the development and discharge of eggs from ovaries (ovulation). And this causes infertility.

Drugs which induce ovulation are necessary to be given in such women to help such women get pregnant.

PCOS in Adolescent Girls

PCOS, also known as a polycystic ovarian syndrome, is a prevalent health issue that can afflict young girls and women throughout their adolescent years. Periods may become heavier, less regular, or even stop as a result of it. Additionally, a girl may get acne and extra hair as a result of increased male hormones.

PCOS in Reproductive Age

When they have trouble conceiving and seeing their doctor, most women in their 20s and 30s learn they have PCOS. However, PCOS can develop at any age following puberty. Women frequently learn they have PCOS when they have problems getting pregnant; however, it frequently manifests as early as age 11 or 12, just a few months after the first menstrual cycle. But it may occur in your 20s or 30s too.

Postpartum PCOS or PCOD after Child Birthing -What Complications can Cause?

1. Endometrial Hyperplasia

The continued exposure of the endometrium to uncontrolled estrogen brought on by anovulation in PCOS is the primary factor contributing to the risk of endometrial cancer. Endometrial hyperplasia and endometrial cancer can also occur due to this extended exposure.

2. Dyslipidemia

Low-density lipoprotein cholesterol (LDL-C), triglycerides, and high-density lipoprotein are among the lipids that are imbalanced in Dyslipidemia (HDL). A relatively prevalent metabolic problem in women with PCOS. Since insulin resistance is a significant pathophysiology of PCOS, Dyslipidemia in PCOS-affected women may be consistent with that of insulin resistance, thereby leading to diabetes.

3. Metabolic Syndrome leading to DM (Diabetes Mellitus) HTN (hypertension)

The liver, pancreas, skeletal muscle, and excess androgen all negatively create several metabolic issues in PCOS women. And this leads to an increase in body fat and a decrease in insulin sensitivity. And obesity and insulin resistance finally lead to hypertension and diabetes Mellitus/type 2 diabetes.

PCOS Treatment via Lifestyle Management

Overweight or obese women are prevalent among PCOS patients. Even a little amount of weight loss – 5% to 10% – can help your period become more regular and relieve certain discomfort. Raised blood sugar and ovulation issues may also be better managed with its aid. And this is how you can do it.

1. PCOS Treatment Diet

Artificial hormones, sweeteners, and preservatives are not present in whole foods. These foods are as near as possible to their unaltered, unadulterated natural condition.  You may include entire foods in your diet such as whole grains, fruits, vegetables, and legumes and an ideal PCOS Treatment Diet. A low carbohydrate diet is also helpful in patients with PCOS.

PCOS Diet

2. Exercise

Walking quickly, running, cycling or swimming are all excellent exercises that can benefit PCOS. By increasing your body’s sensitivity to insulin, this kind of exercise lowers your chance of developing type 2 diabetes and cardiovascular disease. Daily activity of about 30 minutes is recommended as the fat increases the male hormone levels and reduces the insulin levels in the body.

PCOS Management by Medical Treatment

1. Hormonal Contraceptive pills

It is the first line treatment for PCOS after lifestyle modification as they help regulate the cycles and lower the male hormone levels.

2. Insulin sensitizer- Metformin

Metformin reduces the serum insulin levels which is the main culprit behind the development of PCOS hence it helps in reducing the signs and symptoms of PCOS and helps regularize the cycles.

3. Myoinositol

It helps increasing the insulin sensitivity and is helpful when used along with other adjuvants.

4. Treatment of Infertility

Drugs which help in inducing ovulation are recommended in patients who seek help for conceiving. These drugs have shown good results in IVF Treatment.

PCOS treatment using IVF

FAQs

A. PCOS is a very common health condition, If PCOS is left uncontrolled it can not only cause infertility, but also various serious issues like diabetes, hypertension and even endometrial cancer.

A.The majority of women with PCOS receive this therapy for infertility. Clomiphene and letrozole are typically recommended as the first-line treatment for PCOS in women who are having trouble becoming pregnant. They do not treat or cure PCOS but help in inducing ovulation.

A.PCOS is not curable, however obese and overweight women can help regulate their levels of hormones by decreasing weight via PCOS Treatment Diet and lifestyle changes and the consequences of PCOS can be prevented by seeking help of professionals.

A.PCOS and Pregnancy? Women, who have PCOS, can still become pregnant. But without treatment, there are high chances of miscarriage in women with PCOS.

A.Yes, PCOS is one of the major causes of infertility in women.

Dr Shefali Jain

Dr. Shefali Jain is Gynecologist, Obstetrician & Infertility Specialist in Indore with more than 27 years of experience in the field of ART with highest success rate. She has received many awards for her exceptional work in the field of infertility. She has been an invited speaker to many national and international conferences.

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