Polycystic Ovarian Syndrome
Written by Dr.M.D.Mazumdar, MD
Polycystic Ovarian Syndrome (PCOS) is also known as Polycystic Ovarian Disease, Stein Leventhal Disease or Ovarian Dysmetabolic Syndrome.
What is PCOS?
PCOS is a disease of the reproductive tract in young adult women.
It is characterized by a combination of multiple symptoms like irregular and heavy periods, occasional amenorrhea, obesity, hirsutism, and sometimes infertility. These symptoms occur due to imbalance of various hormones.
Ovary with PCOS
PCOS occurs in about 5- 10% of all women. It occurs in all races and communities.
Although more common in women in the reproductive age group, some cases are also seen in young teenagers. But it is rare above the age of 40 years.
Causes of Polycystic Ovarian Syndrome
The exact cause of PCOS is not known. It is believed to be due to hormonal imbalance brought on by a combination of genetic, environmental and lifestyle causes.
Causes of PCOS
- Insulin resistance: Insulin levels are frequently higher than usual in PCOS patients. The ovaries and their capacity to ovulate may be impacted by the high insulin levels . Additionally, it may result in a rise in androgen (male hormones) production. This may result in signs like acne, increased body hair growth, and weight gain.
The trigger for this excessive production of male hormones is believed to be either a high leutinising hormone (LH) level or a high insulin level in the blood.
- Hormonal imbalances: PCOS is characterized by an imbalance of estrogen, progesterone, and androgen hormones. The level of androgens is higher than normal, while estrogen and progesterone may be lower than normal. This can lead to irregular periods, difficulty ovulating, and the development of small cysts on the ovaries.
- Genetics: PCOS tends to run in families, suggesting that there may be a genetic component to the disorder. It has been seen that if someone is diagnosed with PCOS, careful history will reveal that mothers, sisters and other female relatives have similar symptoms to a greater or lesser degree.
- Diabetes:Women with a history of diabetes in the family are also at increased risk of developing PCOS since the causes of diabetes and PCOS are very similar - for example , insulin resistance and hormonal imbalance.
- Inflammation: Some studies have suggested that chronic low-grade inflammation may play a role in the development of PCOS. Some inflammatory markers like white blood cells, C reactive protein (CRP) and interleukin is higher in PCOS. The reaction is referred to as low-grade inflammation. According to research, patients with PCOS experience a specific kind of chronic, low-grade inflammation that causes their polycystic ovaries to produce excessive androgens.
- Obesity : An important related factor is obesity. Since fatty tissues produce estrogen, excessive fat increases the level of estrogen in the blood. This then starts off other hormonal variations. But, it has not been established whether obesity is the result or the cause of Polycystic ovarian Syndrome.
Obesity causes increased hormonal imbalance and insulin resistance leading to PCOS. At the same time, PCOS suppresses the metabolic rate of the body leading to obesity.
- Environmental factors like, stress, lack of physical activity, sedentary lifestyle and exposure to certain toxins may also play a role in the development of PCOS.
Symptoms of Polycystic Ovarian Syndrome(PCOS)
There are multiple symptoms of PCOS. Not all symptoms are seen in each woman. Some women may not have symptoms at all.
Symptoms of PCOS
Tests for Polycystic Ovarian Syndrome(PCOS)
Since the blood sugar level continues to be high even on adequate levels of insulin, the body tends to produce higher and higher quantities of insulin to convert the blood sugar. This causes a high insulin level in women with PCOS.
Ultrasound of an Ovary in PCOS
Ultrasonography is one of the main diagnostic aids in Polycystic Ovarian Syndrome (PCOS).
A normal ovary shows a number of follicles in various stages of growths and thus of various sizes.
In a polycystic ovary, the follicles are enlarged and form cysts arranged around the periphery of the ovary. This produces, what is called a ' necklace appearance' on ultrasound.
The ovary is also increased in size and on direct visualization, shows a thick whitish surface due to thickening of its cortex.
Treatment of PCOS
Treatment of Polycystic ovarian Syndrome can be by either medicines or surgery or a combination of both.
Since the pituitary gland receives signals from the receptors about the estrogen level in the blood, lack of signals form the receptors is perceived as a low estrogen level in the blood. The pituitary then produces more and more FSH in an attempt to stimulate development of follicles in the ovaries and increase the estrogen level.
The high FSH manages to overcome the inhibitions of hormones like LH and androgens to stimulate the ovary and cause ovulation.
The main idea behind ovarian surgery for ovulation was to puncture the cysts on the surface of the ovaries - called 'ovarian drilling'. This was often seen to reduce the level of androgens in the blood and stimulate ovulation in more than 70% of women.
But recent research suggests that surgery can do more harm than good by promoting infections and scar formations. It is now rarely, if ever, carried out.
Can PCOS be Prevented?
Currently, there is no known way to prevent polycystic ovary syndrome (PCOS) since the exact cause is not fully understood. However, some lifestyle changes can be suggested to help reduce the risk of developing PCOS.
- Regular Exercise: Regular exercise and a active lifestyle will decrease obesity, improving the hormonal balance and reducing teh risks of PCOS.
- Balanced diet: Eating a balanced diet will help increase insulin sensitivity and reduce inflammation. A balanced diet should contain low carbohydrates, high proteins, plenty of fruits and vegetables and whole grains.
- Avoiding smoking and excessive alcohol consumption: These habits can increase the risk of developing PCOS.
- Stress: Stress, due to any cause can trigger hormonal imbalance and worsen PCOS symptoms. Methods for managing stress, such as exercise, meditation, or counselling are necessary to prevent PCOS.
- Monitoring symptoms: It is important to see a doctor to rule out PCOS or other disorders if a woman has a family history of the condition or exhibits symptoms like irregular periods, excessive hair growth, or acne.
- Causes of Female Infertility.
- Causes of Male Infertility.
- Vaginal Discharge with Itching .
- Why Periods can get Delayed.