Any and every one of us is living with at least an ailment. Sedentary lifestyle, stress, undisciplined food habits are the major contributors for several diseases. Endocrine disorders are the emerging leaders of disease cascade. Polycystic ovarian syndrome (PCOS) in women is one of the endocrine disorder reaching the edge of epidemic. PCOS is not just a disease but a composition of diseases. National Institute of Health defines PCOS as a set of symptoms related to a hormonal imbalance that occurs in women and girls of reproductive age. Commonly it also named as hyperandrogenism or androgen excess syndrome.
At least two of the following conditions are present in women with PCOS:
- Irregular menstruation due to absence of ovulation.
- High levels of androgens
- Cysts (fluid filled sacs) in one or both ovaries
- Irregular menstruation due to absence of ovulation
- High level of androgens causing excessive growth of the body or facial hair.
- Polycystic ovaries (having various cysts in the one or both the ovaries)
Menstrual disturbances: Irregularity of menses is the characteristic feature of PCOS. This irregularity may either be in form of little menstruation (oligomenorrhea) or no mensuration (amenorrhea). Profuse bleeding for long duration is prevalent. It has also been reported that 30% of women with PCOS have normal menses.
Hirsutism: Hyperandrogenism is a common condition associated with PCOS. This condition leads to excessive hair growth on the body and face. This serves as the evaluation parameter for PCOS. In the process of diagnosis the hair growth on upper lip, chin/face, chest, back, abdomen, arms, and thighs is taken into consideration.
Infertility: 90%–95% of women with anovualtory infertility are found to be suffering from PCOS. Frequency of spontaneous abortions is also more in women suffering from PCOS.
Family history of PCOS:People with a family history of PCOS are more likely to have the disease. Greater prevalence of PCOS in first degree relatives suggests that the disease bears a genetic influence. The occurrence is more prominent in siamese twins.
Epilepsy:A number of reproductive disorders are found to be associated with epilepsy. Studies demonstrated that 30% of epileptic women were diagnosed with PCOS. The antiepileptics are associated with features of polycystic ovary syndrome. These medications increase the levels of testosterone (male hormone) and serum insulin.
Diabetes:Diabetes increases the risk of PCOS. The prevalence of PCOS was verified in 18% in women with type I diabetes. PCOS is more common in type II diabetics. 6% of women with gestational diabetes were diagnosed with PCOS.
Women with PCOS are likely to have following conditions:
Insulin resistance: Body stops responding to insulin causing high levels of glucose which leads to further secretion of insulin. This increased level of insulin further increases the appetite along with patched skin and increased the production of androgens. This clinical condition is a contributing factor to diabetes type II which is very common in these women.
Metabolic disorders: Prevalence of metabolic disorders is more in women with PCOS. Higher glucose levels, insulin resistance, high blood cholesterol and high blood pressure are the characteristics of metabolic disorders.
Emotional disorders: Mood disorders are more likely to be found in women with PCOS. Anxiety, bipolar disorder, depression, mood swings and eating disorders like binge eating are more common to found in cases of PCOS. Hyperandrogenism is a contributing factor for mood disorders.
Sleep apnea: Sleep apnea is a medical condition characterized with narrowing of airways during sleep. Clinical evidences support the fact that obese women with PCOS are more common to have sleep apnea. Sleep apnea is one of the predisposing factor for heart diseases, obesity and diabetes.
Obesity: Obesity and PCOS have two way relationship. Prevalence of PCOS to obese women is less than the prevalence of obesity to women with PCOS. Insulin resistance causing fat deposition, hormonal disturbances, metabolic disturbances and mood swings leading to binge eating may contribute to obesity in women with PCOS.
Heart diseases: Women with PCOS are at increased risk of heart diseases like cardiomyopathy, high blood pressure, coronary artery disease and hardening of the arteries (atherosclerosis). Insulin resistance decreases the hepatic clearance of low density lipoproteins (bad cholesterol) which causes blockage of arteries.
Management of PCOS
There are three major characteristics of PCOS: irregular menses, hirsutism and infertility. The point of focus for the management of this clinical condition also revolve around these three spheres.
Irregular menses: Irregular menses with pain and heavy flow create nuisance. This can further cause endometrial carcinoma. The patients are recommended to visit the doctor. The oral contraceptive are prescribed by clinicians in such cases. These medications restore the hormonal balance. It is evidenced from the observational studies that weight loss is much effective in management of irregular menses.
Hirsutism:There are two possible approaches for management of hirsutism: decrease either the secretion or action of testosterone which is mainly responsible for excessive hair growth on female body. Oral contraceptives decrease the testosterone levels in the blood by decreasing the production of this hormone. Clinicians prescribe aldosterone antagonist in combination with oral contraceptives. There are also the mechanical methods for the removal of excessive hair like shaving, plucking, electrolysis and laser. These mechanical ways have their own disadvantages such as pain, irritation, folliculitis, edema, temporary hyper or hypopigmentation.
Infertility:Incidences of first trimester miscarriage is high in case of women with PCOS. Certain efforts can produce good results in the management of infertility. Weight loss is the prudent preliminary step in the management of infertility. Excessive exercise decreases the androgen secretion and increases levels of insulin. In certain cases clinicians found it advisable to prescribe insulin sensitizers.
Pregnancy and PCOS
Pregnancy in PCOS women exacerbate the insulin resistance. There are increased risk of preterm birth with double the chances of gestational diabetes. Infants of mothers with PCOS are more than their gestational age and may have meconium aspiration (the first stool of infant getting stuck in his/her lungs and causing aspiration). There are also the greater risks of miscarriage in first trimester. It is better to seek the medical advice before going for conception in case of PCOS.
Diet is required to be tailored as per individual needs. Diet with low carbohydrates intake improves quality of life, improves menstrual irregularities, reduces insulin resistance and high density lipoproteins. Restricting the fats to monounsaturated fats result in weight loss. High protein diet improves the depression. Higher intake of carbohydrates leads to weight gain and increase free androgen index. Fibrous food along with proper iron, vitamins and consistent disciplined eating habits in combination with optimized tailored physical activity helps to bring back the homeostasis in the body.