Polycystic ovary syndrome (PCOS) also known as Stein-Leventhal syndrome is a common endocrine system disorder characterized by a hormonal imbalance among women of reproductive age. It is the leading cause of infertility in women.
The female body secretes two types of female hormones, Estrogen and a Luteinizing hormone and a very little amount of male hormone i.e. Androgen. In case of PCOS, the production of androgen is increased which leads to various problems in the ovaries.
Healthy ovaries produce egg which when not fertilized gets released every month as a part of the healthy menstrual cycle. Women with PCOS may have enlarged ovaries which contain small collection of fluids called as follicles that are located in the ovary as seen in the ultrasound scan. These harmless follicles are usually up to 8mm in size and are underdeveloped sacs in which the eggs develop. In case of PCOS, the egg may not develop or it may not be released during an ovulation as it normally should do.
The exact cause of PCOS is not known, but below are a few factors that may play a role:
Pancreas secretes insulin, a hormone that allows the body cells to use sugar (glucose). In the case of insulin resistance, body’s ability to use insulin effectively gets impaired as a result of which body has to produce an excess amount of insulin to make glucose available to all the body cells. An excess amount of insulin might affect the ovaries by increasing the androgen production, which interferes with the ovulation procedure.
- Raised Androgens:A male hormone, produced in small amounts in females. Hormonal imbalance leads to overproduction of androgen that prevents the ovaries from releasing the egg, which causes PCOS.
- Raised Luteinizing Hormone (LH): This is a female hormone that stimulates ovulation; however, a raised level of LH has abnormal effects on ovaries.
- Low level of Sex Hormone Binding Globulin (SHBG): This is a type of protein present in the blood which binds with testosterone and reduces the effect of testosterone.
- Raised Prolactin:This is a rare condition in women with PCOS. Prolactin is a hormone that stimulates breast glands to produce milk. Excessive secretion of prolactin can cause PCOS.
- Hereditary: It has been found that PCOS is common in females particularly with a family history of the condition. Researchers are also looking into the possibility of certain genes being linked to PCOS.
Signs and Symptoms
The symptoms associated with PCOS tend to start gradually. Hormonal changes typically start in early teens especially post first menstrual cycle. The symptoms in most of the cases are evident post weight gain. These symptoms are milder in the initial stages. While some patients may have only a few symptoms or some may have a lot of them. Below are the symptoms that are commonly seen in all cases of PCOS:
- Irregular periods: Often women with PCOS, have very few menstrual cycles which can be as less as 8 cycles a year or may have very longer intervals which are more than 35days. Some women have no periods at all or may have very heavy bleeding that continues for weeks together.
- Weight Gain and difficulty losing weight
- Thicker and darker facial hair, excess hair on chest, back and belly.
- Hair fall and thinning of hair on scalp
- Fertility issues: Women with PCOS have problems in conceiving leading to infertility problems
- Medical and Physical Examinations: Your Gynecologist will enquire about your period’s pattern, type of flow, duration of your periods etc. Your Doctor will also check for the presence of extra body hair, weight and height to know if you have a healthy Body Mass Index (BMI).
- Pelvic Examination: Your Doctor will check for signs of enlargement of ovaries due to cysts.
- Vaginal Sonogram: Ultrasound will be required to check the endometrial lining and to further confirm the presence of any cyst in the ovaries.
- Blood Test: This is done to check for the hormonal imbalance.
There is no definitive cure for PCOS but controlling it prevents further complications such as infertility, miscarriages, diabetes and heart disease. The line of treatment depends on multiple factors like your symptoms and whether you are planning a pregnancy.
- Hormone Therapy: If you are not planning for pregnancy, a hormonal therapy may help your ovary hormones. Birth control hormones keep your endometrial lining from building up for too long this helps in preventing Uterine Cancer. Birth control pills, patches or vaginal rings are prescribed as a part of hormonal therapy. Spironolactone is often used with combined birth control and this helps in reducing hair loss, acne and male pattern hair growth on face and body.
- Healthy Lifestyle: Hormonal therapy won’t help with heart, blood pressure, cholesterol and diabetes risk. This is why a healthy lifestyle is a must to prevent worsening of the condition along with the treatment.
- Regular Checkup: Regular checkups are important for detecting any associated complications such as high blood pressure, cholesterol, uterine cancer etc.
- Surgical Treatment: Surgical treatment is the next level of treatment in cases who fail to show improvement after taking medicines. In the surgical procedure, ovarian function is improved by reducing the number of small cysts in the ovary.
Following are the complications that are associated with PCOS:
- High blood pressure
- Type 2 Diabetes
- Cholesterol and lipid abnormality
- Depression and anxiety
- Abnormal uterine bleeding
- Uterine cancer
- Gestational diabetes
- Pregnancy-induced high blood pressure
- Nonalcoholic Steatohepatitis: Liver Inflammation caused by fat accumulation in the liver.
Seek immediate medical help if you notice:
- The sudden excessive growth of facial hair and body hair.
- The Severe outburst of acne and pimple.
- Irregular periods or absence of periods.