Polycystic Ovary Syndrome

Empowering Women's Health

Signs and Symptoms

PCOS patients have a wide variety of symptoms and not all patients have all the symptoms. Pcos patients will have period irregularity, usually delayed cycles, and sometimes absence of periods for 3 months and longer. Occasionally some patients may have heavy and frequent periods. Difficulty in getting pregnant: PCOS is the commonest cause of infertility, as patients are not able to conceive as they do not ovulate (make eggs). High levels of masculinizing hormones: This is Known as hyperandrogenism. The most common signs are acne (pimples) and hirsutism (male pattern of hair growth, such as on the chin, side face and chest.

Cause

The cause of PCOS is not clear. There may be genetic and hereditary factors that have a role to play. Weight and Obesity influences the severity of PCOS.

Polycystic ovaries have a disturbed function and tend to produce a large amount of male hormones and have low female hormones due to multiple reasons. The ovaries show multiple small cysts, but they are the premature eggs that start to grow, but the growth is arrested due to faulty hormonal balance and therefore the enlarged follicles are seen at the periphery of the ovary like a string of pearls.
Majority of patients with PCOS have insulin resistance. They are not able to utilize the Insulin that is made in the body and therefore tend to have high levels of Insulin.

Diagnosis

The diagnosis is based on various criteria. The symptoms and signs of decreased or lack of ovulation, increased androgens and presence of polycystic appearance of the ovaries is taken as the criteria for diagnosis. It is not necessary that all the signs and symptoms should be present in each and every patient. Not everyone with PCOS has polycystic ovaries (PCO), nor does everyone with ovarian cysts have PCOS.

History of irregular menses, presence of acne, male pattern hair growth and or obesity can indicate PCOS.

Sonography of the pelvis may show multiple follicles arranged at the periphery giving it a string of pearls appearance. This is because many follicles start to grow but get arrested and not one follicle reaches maturity. When more than 12 follicles are seen in the periphery, or when the volume of the ovary is more than 10 ml it is suggestive of PCOS.

Certain Blood tests are conducted to aid diagnosis. Eg Serum levels of DHEAS (Dehydroepiandrosterone sulphate), Free testosterone levels, and Free androgen index. In case of patients desiring tp conceive, Serum FSH, LH , AMH , and E2 are also done for assessment of ovarian reserve and function.

2-Hour oral glucose tolerance test (GTT) is advisable in women with risk factors (obesity, family history of diabetes, and history of gestational diabetes). Frank diabetes may be diagnosed in some patients. Fasting insulin level or GTT with insulin levels is also useful in some patients.

There are other causes of irregular menstruation and hirsutism such as thyroid disorders, pituitary disorders, congenital adrenal hyperplasia, Cushing’s syndrome and androgen secreting neoplasms and all necessary tests need to be done to exclude these if required.

Factors such as presence of renal stones, abnormal anatomy of urinary tract, depressed immunity, diabetes, anaemia, steroid treatment, surgical procedure in pelvic area, catheter use can also predispose to urine infection.

Many times women approach us for PCOS treatment. Women with PCOS have a hormonal imbalance and metabolic problems that may affect their overall health and appearance.

What is PCOS?

Polycystic ovary syndrome (PCOS), is a common health problem caused by an imbalance of reproductive hormones which affects the follicle (egg) production in the ovaries. In PCOS, the egg may not develop or may not release thereby leading to changes in periods and difficulty in conceiving.

How does PCOS affect you?

It affects about 5% and 10% of women between 15 and 44 years of age. Women of all races and ethnicities are at risk of hS. Various genetic and hereditary factors also contribute to PCOS.

What is the cause of PCOS?

The exact cause of PCOS is not known. Several factors play a role.

Women with PCOS have more androgens than normal. Higher androgen levels prevent the release of an egg from the ovary during each menstrual cycle and can cause extra hair growth and acne.
High levels of insulin. Women with PCOS have Insulin resistance i.e. the cells of the body do not respond to insulin as they should. The body compensates by making more insulin. These high levels can interfere with hormone production in the ovary. Insulin resistance can lead to type 2 diabetes in the future.

Symptoms of PCOS

Irregular menstrual cycle. They are commonly delayed.
Infertility. The hormonal imbalance interferes with the growth and release of eggs from the ovaries thereby leading to difficulty in getting pregnant.
Hirsutism. this is the presence of too much hair on the face, chin, or parts of the body where men usually have hair.
Pimples or Acne on the face, chest, and upper back
Hair loss or thinning on the scalp suggestive of male-pattern baldness.
Weight gain or difficulty losing weight.
Acanthosis nigricans which is darkening of the skin, particularly along neck creases, in the groin, and underneath breasts

PCOS and other metabolic issues. PCOS can eventually lead to various other health issues such as

Diabetes
High blood pressure
High cholesterol
Heart disease
Stroke
Sleep apnea
Depression and anxiety
Endometrial cancer

Diagnosis of Polycystic Ovary Syndrome

There is no single test to diagnose PCOS. It involves a clinical examination and some investigations.

Clinical check beside the routine includes blood pressure, body mass index (BMI), waist size, assessment for hair, acne, and acanthosis
Pelvic examination.
Pelvic ultrasound (sonogram
Blood tests. These include tests for various hormones lipids and tests for Insulin Resistance/diabetes.
PCOS is diagnosed if at least two out of three of the following symptoms are present
Signs of abnormal ovulation
Signs of high levels of androgens
Polycystic appearance on one or both ovaries.

PCOS Treatment

There is no single test to diagnose PCOS. It involves a clinical examination and some investigations.

PCOS Treatment depends on various factors such as current symptoms, risk of health issues for the future and the desire for fertility.

Lifestyle measures: Losing weight in case you are overweight is the single most important step. Healthy eating habits and regular physical activity can help relieve PCOS-related symptoms.

Manage the hair growth: Various methods such as hair removal creams, waxing, laser hair removal, electrolysis are effective and can be used.

Hormonal birth control, in the form of the pill, patch, injections or vaginal ring, and hormone intrauterine device (IUD) is used very effectively for management of the periods, acne and hair growth. Additionally, they provide birth control where required.

Anti-androgen medicines: These medicines block the effect of androgens and help reduce acne and hair growth.

Metformin: Metformin is often used to treat type 2 diabetes and is useful in some women with PCOS. It helps in managing insulin resistance and lowering cholesterol. It can improve ovulation thereby assisting regulation of periods and facilitating ovulation.

Management of infertility: This requires the use of ovulation induction drugs and assisted reproductive techniques.

Surgery: Ovarian drilling is a surgery in which few holes are made on the surface of the ovary using lasers or a fine needle heated with electricity. It can restore ovulation in some patients, but they have to be selected carefully. Too many holes can be detrimental.

PCOS Impact On Pregnancy

Miscarriage
Gestational diabetes
Preeclampsia
Caesarean section (C-section)
Increased perinatal morbidity
Increased chances of twin or multi-fetal pregnancy (secondary to Assisted reproductive techniques).
It is advisable to control weight and have a healthy lifestyle to improve the outcome of pregnancy.

Learn More about Polycystic Ovary Syndrome

PCOS And Acne Treatment

PCOS-related acne treatment includes hormonal therapy, oral contraceptives, anti-androgens, topical treatments, and lifestyle changes to manage excess oil production..

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PCOS And Health

PCOS impacts hormonal balance, metabolism, fertility, and increases risks for diabetes, heart disease, and endometrial cancer, requiring ongoing management..

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PCOS And Hirsutism

PCOS can cause hirsutism, resulting in excessive male-pattern hair growth on the face, chest, and abdomen due to hormonal imbalances..

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PCOS and Pregnancy

PCOS can affect fertility, making conception challenging, but with treatment, many women can successfully become pregnant and have healthy pregnancies..

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PCOS Treatment Case Studies

PCOS treatment case studies show success with medications, lifestyle changes..

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Reproductive Health Risks

Reproductive Health Risks in the young are unwanted pregnancy, unsafe abortion, STDs, sexual violence and indulgence in sex not by choice

The young indulge in sexual activity impulsively and many a times it is not planned. They may not have a condom or the emergency contraceptive and may not be aware of the need for contraception. Even if they get pregnant they are more likely to not realize that they are pregnant. They may not seek help early as they are scared or shy or simply unaware and are more likely to indulge in unsafe practices for abortion with the help of friends or quacks and are more likely to have complications.

Relationships are not stable in this age group, thereby increasing the risk of sexually transmitted infections including HIV, and their complications such as chronic pelvic pain, ectopic pregnancy, long term health risks and infertility.

Pregnancy carries a lot more risks for the young. They have more risks of anaemia, pregnancy induced hypertension, addiction, malnutrition, obstructed labour and growth restricted babies.

Most young people do not access and accept contraception services due to lack of access, information, confidentiality, and to the myths associated with them.