Polycystic ovarian syndrome (PCOS) is a common endocrinal disorder as well one of the common causes of infertility among women characterized by an ovulation dysfunction or impedance to the normal growth and release of eggs from the ovaries. It is commonly seen in women of the child bearing age and is rare after menopause. The hormonal imbalance results in enlarged ovaries containing several small cysts (fluid-filled sacs).
Who gets PCOS?
About 5 to 10 percent of women of childbearing age (between 15 and 44) have PCOS. Most often, women find out they have PCOS in their 20s and 30s, when they have problems getting pregnant and see their doctor. But PCOS can happen at any age after puberty.
Women of all races and ethnicities are at equal risk for PCOS, but risk for PCOS may be higher for obese women or those having a mother, sister, or aunt with PCOS.
The exact cause of the polycystic ovarian syndrome is not known. However, several factors including genetics have been implicated to play a role in the development of PCOS. Women with a prior family history of polycystic ovarian syndrome are at a higher risk of developing this condition. Researchers have also found an association between excessive insulin production and the development of PCOS. The insulin hormone regulates the blood sugar levels and any disorder affecting the insulin mechanism may result in excessive insulin secretion, which triggers androgen secretion from the ovaries. Low grade inflammation, in response to ingestion of certain foods, may lead to the release of substances that may cause insulin resistance and cholesterol accumulation in the blood vessels or atherosclerosis. Clinical studies have demonstrated the presence of low grade inflammation in women with PCOS. Excessive exposure to the male hormone in foetal period may disrupt the function of normal gene and increase the risk of insulin resistance and low grade inflammation.
The symptoms of the polycystic ovarian syndrome vary from person to person and the nature and severity of the condition. Some of the symptoms of PCOS include:-
- Infertility: PCOS is one of the most common causes of female infertility.
- Menstrual disorders: can include absent or irregular menstrual cycle. periods that occur infrequently or too frequently, heavy periods, or unpredictable periods.
- Obesity or accumulation of fat, usually around the waist. Up to 80% of women with PCOS are obese.
- Abnormal facial and body hair: Excess hair growth on the face, abdomen, chest, or upper thighs, This condition is called hirsutism and affects more than 70% of women with PCOS.
- Adult acne usually occurs after adolescence and does not respond to usual treatments.
- Male pattern of baldness or hair thinning may also develop due to excessive androgen secretion.
- Patches of thickened skin: In some patients black or dark brown patches darkened skin called “acanthosis nigricans” are seen around the skin of the neck, arm, breasts or thighs.
- Patient may often experience anxiety or depression and breathlessness during sleep.
There is no definitive test for PCOS. The diagnosis is primarily based on the medical history along with physical and pelvic examination. Medical history along with the physical and pelvic examination evaluates the condition of the patient and helps identify the underlying cause. Blood tests are conducted to determine the level of various hormones. Addition tests such as glucose tolerance test and evaluation of blood cholesterol may also be conducted in these patients. Pelvic ultrasound is performed to evaluate the appearance of the ovaries and the uterine lining.
Treatment for PCOS is mainly directed at the symptoms and individual concerns such as infertility, irregular menstrual cycle, acne or obesity. Both medications and surgical treatment can be used for the management of PCOS. Treatment goals include correcting anovulation, inhibiting the action of androgens on target tissues, and reducing insulin resistance.
- Weight reduction for obese patients with PCOS is beneficial in many ways. Weight loss helps to decrease androgen, luteinizing hormone (LH), and insulin levels. It also helps to regulate ovulation, thereby improving the potential for pregnancy.
- Infertility may be treated by fertility therapy with ovulation-inducing drugs. Clomiphene citrate, an oral anti-oestrogen, may be prescribed to the patients.
- In some patients, the doctor may add metformin to Clomiphene help induce ovulation.
- In patients not responding to Clomiphene and Metformin, gonadotropins, namely, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) can be administered by injection.
- Oral contraceptives may be prescribed for the management of irregular menstrual cycles. Oral contraceptives effectively reduce the level of male hormone and are also effective in reducing the excessive body hair growth and also minimize the risks of uterine cancer.
- Lifestyle modifications and anti-diabetic medications may be prescribed for the management or prevention of obesity and diabetes mellitus.
- Surgery may be recommended in patients who do not respond to medications. Laparoscopic ovarian drilling, an outpatient surgical procedure, may be used to treat the condition and induce ovulation.
PCOS affects all areas of the body, not just the reproductive system. It increases a woman’s risk of serious conditions that may have lifelong consequences.
- Patients with PCOS may frequently develop other serious medical conditions such as diabetes mellitus, cardiovascular diseases, pregnancy induced high blood pressure, miscarriage or premature delivery.
- Women with PCOS also tend to have “endometrial hyperplasia”, in which the lining of the uterus becomes too thick. This condition increases the risk of endometrial cancer.
- These patients are also at risk of sleep apnea, anxiety or depression.
Can I still get pregnant if I have PCOS?
Yes. Having PCOS does not mean you can’t get pregnant. PCOS is one of the most common, but treatable, causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation). If you don’t ovulate, you can’t get pregnant. Your gynecologist can talk with you about ways to help you ovulate and to raise your chance of getting pregnant.
How can I get pregnant with PCOS?
You have several options to increase your chances of getting pregnant if you have PCOS:
- Losing weight. If you are overweight or obese, losing weight through healthy eating, including eating the right amount of calories for you, and regular physical activity can help make your menstrual cycle more regular and improve your fertility.
- Medicine. After ruling out other causes of infertility in you and your partner, your doctor might prescribe medicine to help you ovulate, such as clomiphene (Clomid).
- In vitro fertilization (IVF). IVF may be an option if medicine does not work. In IVF, your egg is fertilized with your partner’s sperm in a laboratory and then placed in your uterus to implant and develop. Compared to medicine alone, IVF has higher pregnancy rates and better control over your risk for twins and triplets (by allowing your doctor to transfer a single fertilized egg into your uterus).
- Surgery. Surgery is used only if the other options do not work. The outer shell (called the cortex) of ovaries is thickened in women with PCOS and thought to play a role in preventing spontaneous ovulation. Ovarian drilling is a surgery in which the doctor makes a few holes in the surface of your ovary using lasers or a fine needle heated with electricity. Surgery usually restores ovulation, but only for six to eight months.
How does PCOS affect pregnancy?
PCOS can cause problems during pregnancy for you and for your baby. Women with PCOS have higher rates of:6
- Gestational diabetes
- Cesarean section (C-section)
- Your baby also has a higher risk of being heavy (macrosomia) and of spending more time in a neonatal intensive care unit (NICU).
How can I reduce problems from PCOS during pregnancy?
You can lower your risk of problems during pregnancy by:
- Reaching a healthy weight before you get pregnant. Use this interactive tool (link is external) to see your healthy weight before pregnancy and what to gain during pregnancy.
- Reaching healthy blood sugar levels before you get pregnant. You can do this through a combination of healthy eating habits, regular physical activity, weight loss, and medicines such as metformin.
- Taking folic acid. Talk to your doctor about how much folic acid you need.