Polycystic Ovarian Disease (PCOS/ PCOD)
Pcos/pcod- The Problem.
Polycystic ovary syndrome (PCOS) is a multi-factorial disorder, which leads to irregular menstrual cycles and elevate levels of male hormone in a female body. The prevalence is increasing with westernization of our culture and is seen in approximately 5 to 10 percent of women.
The increased levels of male hormones can sometimes cause excessive hair growth at unwanted places over body, acne, and male-pattern hair loss.
Most of the women with PCOS are overweight and at higher risk of developing diabetes and sleep apnea.
There is no complete cure for PCOS, but a number of treatments are there that can control the progress of the disorder.
Causes Of Pcos
Reproductive system abnormalities — It has been proposed that there is some alteration in the pituitary hormones luteinizing hormone (LH) along with high levels of male hormones (androgens) that interfere with normal function of the ovaries.
Insulin abnormalities — Insulin is a hormone that is produced in the pancreas; and regulates blood glucose levels. After meals, insulin is released to help the body use glucose for energy. PCOS is associated with:
- Excess insulin production (hyperinsulinemia).
- There is increased resistance to the function of insulin (insulin resistant).
- Even increased levels of insulin fail to normalize the glucose levels (glucose intolerance).
- Type 2 diabetes develops when blood glucose levels continue to rise despite increased insulin levels.
Insulin abnormalities can develop in both normal-weight and overweight women with PCOS. A family history of diabetes and obesity play a major role in developing diabetes among women with PCOS.
Symptoms of PCOS usually begin around puberty and vary from woman to woman.
Menstrual irregularity — Majority of the cycles in PCOS are anovulatory, which means that ovulation doesn’t occur in all the cycles. The absence of ovulation results in thickening of the endometrial lining of the uterus, which ultimately sheds irregularly, resulting in heavy and/or prolonged bleeding. Irregular menstrual cycles if left untreated, can increase a woman’s risk of endometrial cancer.
Weight gain and obesity — Weight gain and obesity are seen in almost half of women suffering from PCOS. It can develop at any point of time starting as early as puberty.
Hair growth and acne — Excessive hair growth (hirsutism) may be seen on unwanted areas like upper lip, chin, neck, chest, abdomen, inner thigh etc. This is due to increased levels of male hormone in the body. For the same reasons, acne is also commonly seen in women with PCOS.
Infertility — Anovulatory cycles are common in PCOS. This usually results in sub-fertility and infertility in women.
Heart disease — Obese women with insulin resistance or diabetes have an increased risk of heart attack. PCOS can result in weight gain and insulin resistance, thus increasing the risk for heart disease. This risk can be reduced with lifestyle modification, weight loss and treatment of insulin abnormalities.
Sleep apnea — It may occur in up to 50 percent of women with PCOS. In this condition there are brief spells of apnea during sleep, which results in daytime sleepiness fatigue.
For confirming the diagnosis of PCOS, a woman should have any two out of three of the following criteria:
- Irregular menstrual cycles.
- Clinical or biochemical signs of hyperandrogenism.
- Polycystic ovaries on pelvic ultrasound.
Pregnancy test, prolactin level and thyroid-stimulating hormone (TSH) levels are recommended for ruling out other causes of irregular cycles.
Once PCOS is confirmed, blood glucose and cholesterol testing are usually performed. An oral glucose tolerance test (OGTT) is the preferred test for diagnosing prediabetes and/or diabetes. Blood tests for testosterone and dehydroepiandrosterone sulfate (DHEAS) are recommended in women with moderate to severe hirsutism (excess hair growth),
A health care provider should monitor women with PCOS over time because untreated PCOS can increase a woman’s risk of other health problems like obesity, heart disease, diabetes and endometrial cancer over time.
Oral contraceptives — Combined Oral contraceptives are the most commonly used treatment for regulating menstrual periods in women with PCOS. They induce monthly periods and protect the woman from endometrial hyperplasia or cancer. These are also effective in treating hirsutism and acne along with providing protection from pregnancy
OCPs can be used in combination with anti-androgens to reduce the hair growth and acne.
Side effects — OCPs are safe and effective.
Minor side effects include irregular spotting, nausea, breast tenderness, and bloating. Weight gain is generally not seen with the low dose pills. These symptoms usually resolve on their own after two or three months.
Major risk of thrombosis is occasionally seen in obese, older women and those who smoke. It is rare in young, healthy women who do not smoke.
Progestin — Progesterone when taken for 10 to 14 days every 1 to 3 months induces regular cycles but neither does it address the cosmetic concerns (hirsutism and acne), nor provide any contraception. It does reduce the risk of endometrial cancer.
Hair treatments — In PCOS, initially a combined contraceptive pill is prescribed for first few cycles. If the hormonal treatment results in a satisfactory reduction in excess hair growth, this therapy is continued. In cases of unsatisfactory results, antiandrogen can be added. Excess hair growth body can be removed by shaving, epilator or laser therapy.
Scalp hair loss can be treated with medications, hair transplantation and wigs.
Weight loss — It is the first line of management in patients with PCOS. Losing even 5 to 10 percent of the body weight results in regular periods. Weight loss can often be achieved with a combination of both diet and exercise. In resistant cases, medicines and weight loss surgery can be of help.
Metformin — It is useful in PCOS with obesity and with deranged sugar levels.