Polycystic Ovarian Syndrome: Signs, Symptoms and Treatment

Among the several health complications that women grapple with, polycystic ovarian disease or polycystic ovarian syndrome is a very common endocrine disorder that affects millions. It affects the functioning of women's ovaries in their reproductive age between 15-45 years. Also known as Stein-Leventhal syndrome, this disease is where hormones spiral out of control, disrupting the normal menstrual cycle. So it is likely that a woman with PCOS will have difficulties with having a child and face periods that defy predictability. While in a normal ovary, testosterone (androgens or male hormones) are produced in minuscule quantities, in PCOS, it crosses the boundaries of normal. Then comes the acne, excessive facial and body hair. A number of complications can follow suit, especially if left untreated. In a lot of women, PCOS can go undetected and might show strong symptoms in some.

Risk factors

• The genetic component to PCOS can put you at increased risk. It is known to run in families. If your mother or sister has PCOS, chances are you might have it too.
• A family history of Diabetes can also increase your risk.
• Obesity is also strongly associated with the syndrome.

Symptoms

Along with the presence of several cysts in the ovaries, the other symptoms identified for this condition are as below. Their incidence and extent can vary.

• Oligomenorrhea: Oligomenorrhea refers to infrequent or very light menstruation. While slight variations in menstruation is normal, if you regularly have menstrual periods at intervals higher than 35 days, you may be diagnosed with oligomenorrhea. You typically will not have more than 4 to 9 periods in a year.
• Amenorrhea: Amenorrhea refers to an absence of menstruation. If you have missed more than three menstrual cycles in a row, you may be having amenorrhea. You may have signs of hyperandrogenism (acne, male pattern baldness, hirsutism, acne).
• Hirsutism: Hirsutism refers to unwanted, male pattern growth of facial and body hair which is dark and coarse. This is mainly due to excessive male hormones in PCOS.
• Infertility: Almost 3/4ths of women with PCOS find it difficult to conceive as they dont have all make the hormones necessary for the eggs to mature fully. The follicles develop and amass fluid, but the eggs arent released and they cant get pregnant as a result.
• Acne and excessive oily skin can also indicate the presence of the condition
• Obesity is another common symptom where women tend to gain weight rapidly primarily due to the functionality of insulin being affected.
• Recurrent miscarriages are also commonly seen in PCOS due to the endocrine issues caused by elevated levels of LH hormone and insulin which can negatively affect the quality of the egg and the functioning of the reproductive organs post ovulation.
• Skin overgrowth which includes increased skin pigmentation (darker skin) that is velvety in texture can occur in the axillae and nape of the neck. This is termed as Acanthosis Nigricans.

Diagnosis

There's no one test that can help diagnose this condition. Your doctor is likely to discuss your medical history, weight changes, and menstrual periods along with a physical exam for signs of insulin resistance, excess hair growth, and acne. Your doctor may prescribe any of the following tests to confirm or rule out PCOS:

• Ultrasound Abdomen & Pelvis
• Serum Luteinizing Hormone(LH)
• Serum Follicular Stimulating Hormone(FSH)
• LH/FSH ratio
• Serum Testosterone
• Serum Estrogen
• Fasting and Post Prandial Blood Sugars
• Thyroid profile
• Lipid Profile

Prevention

PCOS cannot be prevented. With the effects of PCOS on the body being tremendous, early diagnosis and treatment is the key in the management of the condition. Medication and lifestyle management are important facets that are considered as the first step in managing the disease. They can help with improving menstrual cycles, improving other hormonal issues in PCOS, reducing insulin resistance, enhancing fertility, and reducing the risk of complications such as type 2 diabetes. Steps that you can include in your day to day life are:

• Get a workout and cardio regularly. Ideally, try to get a minimum of 150 minutes per week of moderate-intensity aerobic physical activities such as jogging, brisk walk, cycling, swimming, etc.
• Bring down those kilos and try to attain and maintain a BMI of <25kg/m2.
• Stop smoking if its a part of your lifestyle
• There is nothing that a healthy balanced diet cant help. Reduce saturated and trans fats in your diet. Unsaturated fats such as olive oil, vegetables and fruits that are high in fiber should account for a larger pie on plate. Carbohydrate foods, specially those such as oats and wholegrain wheat provide important fiber and nutrients and fibre. In contrast, you must stay away from heavily processed carbohydrates such as white flour and white rice. Ensuring you have a balanced intake of protein is also essential.
• Keep tab of your blood sugar levels

Treatment

Treatment of PCOS is usually aimed at the managing the symptoms presented by the patient.

• Irregular and Absent Periods: Progesterone and Oral contraceptive pills are usually advised in patients with absent or reduced menstruation.
• Insulin resistance: Metformin (A drug used in diabetics) is routinely advised in patients of PCOS.
• Infertility: Drugs to induce ovulation like Clomiphene and human chorionic Gonadotrophin are advised.
• Hirsutism: One or more of the following are advised in patients with excessive facial hair
  • Topical creams like Eflornithine to reduce hair growth are advised.
  • Anti-androgens to lower the male sex hormones are also advised.
  • Metformin is advised routinely if the patient is obese and has insulin resistance.
  • Laser removal of facial hair.

• Surgery: Laparoscopic ovarian drilling is done in patients who have not responded to weight loss and fertility medicine. This is done to trigger ovulation in patients with infertility.

Complications

Complications of PCOS include

• Type 2 Diabetes - Women with PCOS may develop resistance to insulin. Over time, if this is left untreated, the occurrence of Type 2 Diabetes is almost inevitable.
• Diabetes of Pregnancy (Gestational Diabetes)
• Increased Cholesterol levels
• Infertility
• Metabolic syndrome: This syndrome includes high blood pressure, high cholesterol levels and high blood sugar levels in the patient.
• Recurrent miscarriages
• Depression and Anxiety Disorders PCOS can drag you down. While excessive facial and body hair and weight gain can be distressing, it is also linked to mental illness.

In a lot of cases, PCOS can go undiagnosed. So if you notice any signs or symptoms such as excess hair and irregular periods, its best if you see a doctor.

Article by Dr. Anchal Pandey, D.N.B (Family Medicine)
Consultant Physician, CallHealth

Have a Question? Consult Dr. Anchal Online.