PCOS

CONDITION

What is PCOS?

Polycystic ovary syndrome (PCOS) is a common condition characterised by the presence of multiple small fluid-filled cysts called follicles during a woman’s reproductive age. These cysts cause hormonal imbalance, which leads to various changes in your appearance and menstrual cycle.

PCOS

PCOS

What is the percentage of population affected by PCOS?

Globally, around 8% to 20% of women are affected by PCOS.

How does PCOS affect you?

PCOS affects the regularity of your menstrual cycle, your appearance as well as your fertility.

Which part of the body is affected?

The ovaries are a part of the female reproductive system. Their main function is to produce ova. They are paired organs situated on either side of the uterus. Each month, one ovum matures, is released and picked up by the fallopian tubes for reproduction.

The ovaries develop cyst-like structures every month called follicles. Each follicle has an egg that floats in a fluid that protects it as it develops. When the egg matures, the follicle bursts open, releasing the egg and the fluid.

In PCOS, these follicles do not release eggs, thus ovulation does not take place. The ovaries also release sex hormones such as androgens. Androgens are the main sex hormones in men, responsible for growth, reproduction and secondary sexual characteristics such as facial hair. In lower quantities, androgens are also required in women for strong muscles and bones, sexual desire and positive protein balance. In the presence of cysts, the ovaries produce higher than normal levels of androgens, leading to the presentation of male characteristics.

What are the causes of PCOS?

The exact cause for PCOS is not clear, but certain factors contribute to the condition:

  • Genetic mutation
  • High insulin levels due to insulin resistance signal the increased production androgen by the ovaries
  • Low-grade inflammation
  • High levels of luteinising hormone (LH), which stimulates ovulation
  • Low levels of sex hormone-binding globulin (SHBG), a protein that reduces the function of testosterone
  • High levels of prolactin, which stimulates milk production during pregnancy

Who is at risk of PCOS?

The following are risk factors that may increase your chances of PCOS:

  • Family history of PCOS
  • Family history of diabetes
  • Long-term use of seizure medicine

What are the signs and symptoms of PCOS?

You may notice symptoms when you begin your period or later during your reproductive years when you gain a substantial amount of weight. The signs and symptoms may vary. To diagnose PCOS, you should have at least two of the following:

  • Irregular periods that can be
    • At intervals longer than 35 days
    • Less than eight cycles in a year
    • No periods for four months or longer
    • Extended periods with heavy or scant flow
  • Excess androgen causing
    • Excess facial hair (hirsutism)
    • Severe acne
    • Male-pattern baldness (androgenic alopecia)
  • Enlarged ovaries and multiple cysts

What are the related disorders that occur with PCOS?

PCOS can increase your risk of developing other conditions such as:

  • Type 2 diabetes
  • High blood pressure
  • Stroke
  • Cholesterol
  • High triglycerides
  • Low high-density lipoprotein (HDL)
  • Non-alcoholic steatohepatitis: fat accumulation in the liver leading to severe inflammation
  • Infertility
  • Sleep apnoea
  • Depression and anxiety
  • Endometrial cancer
  • Gestational diabetes
  • Pregnancy-induced high blood pressure
  • Repeat miscarriages

How is the PCOS diagnosed?

When you visit the clinic with PCOS symptoms, your doctor will review your medical and family history, details of our menstrual cycle, changes in weight, and perform a thorough physical examination (height, weight and blood pressure). PCOS may be confirmed by ultrasound and by measuring hormone levels in the blood. Early diagnosis is important, as it will allow symptoms to be managed and may prevent long term health problems from developing.

TREATMENT

What are the consequences of not treating PCOS?

Left untreated, PCOS can result in various complications such as diabetes and heart problems.

When should I consider watchful waiting of PCOS?

Watchful waiting is not recommended for PCOS as early diagnosis and treatment can prevent further complications.

What are the treatment options for PCOS?

Some of the treatment options for PCOS may include:

Lifestyle changes

  • Eat healthy
  • Exercise regularly
  • Maintain a healthy weight
  • Quit smoking

Medications

  • Contraceptive pills prescribed to initiate regular periods
  • Control hirsutism and hair loss
  • Maintain normal weight
  • Treat acne
  • Lower cholesterol
  • Initiate ovulation as a part of IVF treatment and attain pregnancy
  • Lower insulin and blood sugar levels

Surgery

  • Laparoscopic ovarian drilling (LOD): extreme heat or laser is used to destroy ovarian tissue producing excess androgens

What is the likelihood of PCOS recurrence? How can it be managed?

There is no cure for PCOS. The condition can be managed by maintaining a healthy weight and following a balanced diet.

What are the current research regarding PCOS?

Extensive research is being done to find better treatment options for PCOS. Some of the recent studies are listed below:

  • Moore AM, Campbell RE. Polycystic ovary syndrome: Understanding the role of the brain. Front Neuroendocrinol. 2017 May 24. pii: S0091-3022(17)30024-9. doi: 10.1016/j.yfrne.2017.05.002. [Epub ahead of print] Review.
  • Elkhateeb R, Mahran AEE, Kamel HH. Long term use of clomiphene citrate in induction of ovulation in PCO patients with clomiphene citrate resistance. J Gynecol Obstet Hum Reprod. 2017 May 23. pii: S2468-7847(17)30139-3. doi: 10.1016/j.jogoh.2017.05.007. [Epub ahead of print]
  • Hong SH, Sung YA, Hong YS, Jeong K, Chung H, Lee H. Polycystic Ovary Morphology Is Associated with Insulin Resistance in Women with Polycystic Ovary Syndrome. Clin Endocrinol (Oxf). 2017 May 20. doi: 10.1111/cen.13380. [Epub ahead of print]
  • Cunningham P. Pathophysiology, diagnosis and treatment of polycystic ovary syndrome. Nurs Stand. 2017 May 24;31(39):44-51. doi: 10.7748/ns.2017.e10595.