Polycystic Ovarian Syndrome: Do You Have It?

1. What is PCOS?
Polycystic ovary syndrome, or PCOS, is the most common endocrine condition to affect women, with a prevalence of 10% to 15%. It is a condition that affects your periods, fertility, and aspects of your appearance. The symptoms of PCOS include menstrual cycle disturbance, increased facial and body hair, oily skin, acne, and loss of hair on your head. PCOS is also linked to fertility problems, obesity, and psychological issues.

2. What causes PCOS?
The cause of PCOS is still unknown. Women with PCOS tend to have hormonal imbalances with high levels of androgen, which is a male hormone that interferes with the normal functions of the ovary, resulting in menstrual irregularities and many of the symptoms of the condition. PCOS also leads to failures in ovulation, causing fertility-related problems. Women with PCOS may also have problems responding to insulin, resulting in high blood glucose levels, which indirectly lead to an increase in weight.

3. What are the symptoms of PCOS? Is PCOS hereditary?
While some women only have a small number of symptoms, others are more severely affected by a broader spectrum of symptoms. The signs include irregular or absent menstrual cycles, a rise in face or body hair, hair loss on the head, being overweight, gaining weight quickly or struggling to lose it, an oily complexion, acne, and trouble getting pregnant.

It is evident that PCOS is genetic when about 50% of first-degree female relatives exhibit the condition. In other words, the likelihood of them having PCOS is high if any of their family members (mother, aunts, or sisters) have it.

4. How is PCOS diagnosed?
Given the wide range of symptoms that different women experience, PCOS should be diagnosed if two of the following three conditions are present:

• Irregularity or absence of periods

• Increase in facial or body hair or blood tests that show higher testosterone levels than normal

• Polycystic ovaries identified through an ultrasound scan

5. What is the treatment for PCOS? Is there any medication to reduce symptoms?
It is important to highlight that there is currently no cure for PCOS. However, the good news is that there are ways to manage the symptoms. As mentioned earlier, the symptoms may vary among patients. Therefore, PCOS management needs to be tailored for each patient.

For instance, if infertility is the problem, the patient can be prescribed medication to promote ovulation, and if that doesn't work, ovarian drilling surgery can be an option for treatment.

For those with menstrual irregularities, hormonal medication can be prescribed. The medication must be taken regularly for it to be effective.

For women with more facial and body hair due to PCOS, medication can be administered, but it may take up to nine months for improvement.

6. Are there any long-term health risks associated with PCOS? Does PCOS increase the risk of other health problems?
PCOS is often linked to several long-term health problems, such as:

Diabetes: Based on studies, about 10% to 20% of women with PCOS eventually develop diabetes mellitus. This has impacted both obese and slim women with PCOS, as insulin resistance leads to diabetes. The risk of developing diabetes is increased further if they have the following risk factors:

• Age over 40

• Have relatives with diabetes

• Developed diabetes during pregnancy

• Obese with a BMI of more than 30

High Blood Pressure: Women with PCOS are also at risk of developing high blood pressure. This is likely to be related to the associated diabetes and being overweight rather than to the PCOS itself. This could be a contributing factor to heart problems in the future.

Irregular Period: Women with PCOS tend to have irregular periods, with most having fewer than three periods a year. As a result, this can thicken the lining of the womb, which may lead to an increased risk of endometrial cancer.

Depression and Mood Swings: Other complications would include depression and mood swings, which are caused by infertility and weight issues. Excessive facial hair has been shown to be one of the major causes of marked psychological stress in women with PCOS, too.

Fatigue or sleepiness: Other less common complications would include generalised fatigue or sleepiness during the day and snoring during sleep.

7. Can PCOS cause infertility? How do you help some women conceive?
PCOS is a common cause of fertility problems in women. The failure to ovulate regularly results in fertility being affected. PCOS accounts for approximately 80–90% of anovulatory infertility, which in turn comprises about a third of those attending the fertility clinic.

The principles of management for women with infertility from PCOS are to optimise their health before commencing therapy.

This is done by achieving weight loss for those who are overweight with the help of the right diet and incorporating physical exercise as part of their daily routine. Subsequently, medication can be given to help with the ovulation process.

Some women who do not respond to medication for ovulation may need keyhole surgery on their ovaries to ease the commencement of ovulation.

8. Is there a cure for PCOS?  What lifestyle changes can help with PCOS?
Maintaining a healthy lifestyle and diet will make a difference in resuming normal menstrual cycles and even helping achieve fertility. Encouraging weight loss remains the most effective first-line therapeutic intervention for these women, and although it is hard to achieve, it has been shown to bring about positive results.

Various factors influence ovarian function and fertility, the most important being obesity. Ideally, a weight reduction of less than BMI 30 kg/m2 is preferred. However, even a moderate weight loss of 5–10% of body weight can be sufficient to restore fertility and improve metabolic parameters. There is no evidence to say that women with PCOS will benefit from a specific type of diet.

However, it is advisable to lower the sugar content of the food and generally avoid fatty foods. A low-calorie diet may be appropriate as well. For women with a BMI greater than 40 kg/m2, bariatric surgery, also known as weight loss surgery, is an option. When it comes to physical activities, it is important to inculcate exercise as part of a daily routine. Thirty minutes per day of brisk exercise is encouraged to maintain health, but to lose weight or sustain weight loss, 60 to 90 minutes per day is advised.

9. What is the long-term outlook for PCOS?
PCOS is a chronic condition that requires ongoing management. Regular check-ups with healthcare providers are essential to monitor hormone levels, assess metabolic parameters, and address any emerging concerns promptly.

It is important that women with this condition work closely with healthcare professionals to develop an individualised treatment plan that considers the specific needs and goals of each person.

It is worth noting that medical advancements and research continue to expand our understanding of PCOS. New treatments and interventions may emerge in the future, potentially further improving long-term outcomes for women with PCOS.

Diagnosis and Treatment
In conclusion, PCOS may require different preventative measures and treatment to manage symptoms.

If patients display any symptoms, it is advisable to consult with a gynaecologist for medical advice and treatment.

For more information on Sri Kota Specialist Medical Centre (SKSMC) and the treatment options available, kindly visit: https://www.srikotamedical.com/

By Dr Prakash M Chandrakanthan
SKSMC Consultant Obstetrician and Gynaecologist

This content is provided by Sri Kota Specialist Medical Centre