Polycystic Ovarian Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a female medical condition in which the female reproductive organs (ovaries) produce an abnormal amount of androgens (male hormones). The name polycystic ovary syndrome elaborates the numerous small cysts (fluid-filled sacs) that form in the ovaries. However, some women with this disorder do not have cysts, while some women without the disorder do develop cysts.
The small fluid-filled cysts contain immature eggs. These are called follicles. The follicles fail to regularly release eggs. The exact cause of PCOS is still unknown. Early diagnosis and treatment along with weight loss may lower the risk of long-term complications such as type 2 diabetes and heart disease.
Skin (acne and pimples), weight gain, insulin resistance and hair loss issues can be the most common features of PCOS, and thus sometimes the reason for seeking medical care. However, features of PCOS also include menstrual irregularities, (Read our full article for acne treatment, symptoms and diagnosis)
Sign & Symptoms
- Weight Gain: PCO’s relationship with weight gain is complex, some researchers argue that obesity causes PCO’s whereas some clinical evidence suggests the other way around. However, the most recent studies indicate that PCO’s stress level and hormonal imbalance triggers biochemical reactions which causes fluctuations in Ghrelin level hence increasing appetite significantly.
- Irregular Periods. Having few menstrual periods or having periods that aren't regular are common signs of PCOS. So is having periods that last for many days or longer than is typical for a period. For example, patients might have fewer than nine periods a year. And those periods may occur more than 35 days apart. It also disturbs achieving pregnancy.
- Too much androgen. High levels of the hormone androgen may result in excess facial and body hair. This is called hirsutism. Sometimes, severe acne and male-pattern baldness can happen, too.
- Polycystic ovaries. Your ovaries might be bigger. Many follicles containing immature eggs may develop around the edge of the ovary. The ovaries might not work the way they should.
Causes
Diet:
Consuming a highly processed diet, high carbohydrate diet and carbonated drinks are known to significantly increase the risk of PCO’s. The extensive additives and processing cause the food to lose all its nutritional value and this ultimately impacts the fragile hormone system in female body.
Insulin Resistance:
Insulin is a hormone that the pancreas makes. It allows cells to use sugar, the body’s primary energy supply. If cells become resistant to the action of insulin, then blood sugar levels can go up. This can cause the body to make more insulin to try to bring down the blood sugar level. Too much insulin might cause the body to make too much of the male hormone androgen. One sign of insulin resistance is dark, velvety patches of skin on the lower part of the neck, armpits, groin or under the breasts.
Genetics:
Genetics plays a significant role in the development of PCOS. Research indicates that PCOS tends to run in families, suggesting a hereditary component. Several genetic studies have identified potential genetic markers and variations associated with an increased risk of developing PCOS. These include genes related to insulin resistance, androgen production, and inflammation. For instance, variations in the genes such as DENND1A, THADA, and LHCGR have been linked to PCOS.
Psychological:
The new research indicates that stress, anxiety and depression serve as precursor for hormonal imbalance. Studies show extensive exposure to stress causes PCO’s which leads to infertility
Low Grade Inflammation:
White blood cells make substances in response to infection or injury. This response is called low-grade inflammation. Research shows that people with PCOS have a type of long-term, low-grade inflammation that leads polycystic ovaries to produce androgens. This can lead to heart and blood vessel problems.
Contraceptives:
Oral Contraceptives, particularly hormonal ones, can influence the body's natural hormone balance. When used extensively and without proper medical supervision, they may disrupt the endocrine system, potentially leading to conditions like PCOS. Hormonal contraceptives work by altering the levels of estrogen and progesterone in the body, which can interfere with the normal functioning of the ovaries. This disruption can contribute to the development of ovarian cysts, a hallmark of PCOS.
Complications
- Infertility
- Gestational diabetes or pregnancy-induced high blood pressure
- Miscarriage or premature birth
- Nonalcoholic steatohepatitis (A severe liver inflammation caused by fat buildup in the liver)
- Metabolic syndrome (A cluster of conditions including high blood pressure, high blood sugar, and unhealthy cholesterol or triglyceride levels that significantly increase your risk of heart and blood vessel (cardiovascular) disease)
- Type 2 diabetes or prediabetes
- Sleep apnea
- Depression, anxiety and eating disorders
- Cancer of the uterine lining (endometrial cancer)
Diagnosis
There is not a single step diagnosis method for PCO’s. However, doctors use multiple techniques in diagnosis and treatment of PCO’s which includes discussing sign and symptoms, previous medical history, dietary intake, mental health and physical examination.
- Pelvic exam. During a pelvic exam, doctor can check your reproductive organs for masses, growths or other changes.
- Blood tests. Blood tests can measure hormone levels. This testing can exclude possible causes of menstrual problems or androgen excess that mimic PCOS. Other blood testing, such as fasting cholesterol and triglyceride levels. A glucose tolerance test can measure body's response to sugar (glucose).
- An ultrasound can check the appearance of ovaries and the thickness of the lining of uterus.
- Screening for psychological issues
- Dietary History
Treatment
Polycystic Ovary Syndrome (PCOS) treatment focuses on addressing specific concerns such as infertility, hirsutism, acne, or obesity. Effective management often involves a combination of lifestyle changes and medication.
Lifestyle Changes
Health care providers may recommend weight loss through a low-calorie diet combined with moderate exercise or use of oral and injectable medications such as: Saxenda (Read our full article for Saxenda, Uses, Side effects and benefits)and high molecular fiber. Even a modest reduction in weight, such as losing 5% of body weight, can significantly improve the condition. Weight loss can enhance the effectiveness of medications prescribed for PCOS and assist with infertility issues. Collaborating with a health care provider and a registered dietitian can help determine the most effective weight-loss plan.
Medications
To Regulate Periods:
- Combination Birth Control Pills: These pills contain both estrogen and progestin, which decrease androgen production and regulate estrogen levels. This hormonal regulation can lower the risk of endometrial cancer and correct irregular bleeding, excessive hair growth, and acne.
- Progestin Therapy: Taking progestin for 10 to 14 days every 1 to 2 months can regulate menstrual cycles and protect against endometrial cancer. However, this therapy does not improve androgen levels or prevent pregnancy. The progestin-only minipill or a progestin-containing intrauterine device is a better choice for those also seeking to avoid pregnancy.
To Induce Ovulation:
- Clomiphene: This oral anti-estrogen medication is taken during the first part of the menstrual cycle.
- Metformin: Typically used for type 2 diabetes, this medication improves insulin resistance and lowers insulin levels. If clomiphene is ineffective, metformin may be added to help induce ovulation. Metformin can also slow the progression to type 2 diabetes and aid in weight loss for those with prediabetes.
To Reduce Excessive Hair Growth or Improve Acne:
- Birth Control Pills: These pills decrease androgen production, which can reduce excessive hair growth and acne.
- Spironolactone (Aldactone): This medication blocks androgen effects on the skin, helping with excessive hair growth and acne. Since spironolactone can cause birth defects, effective birth control is necessary while taking this medication, and it is not recommended for those who are pregnant or planning to become pregnant.
- Eflornithine (Vaniqa): This topical cream can slow facial hair growth.
- Hair Removal: Options include electrolysis and laser hair removal. Electrolysis involves inserting a tiny needle into each hair follicle and sending an electric current to destroy it. Laser hair removal uses a concentrated beam of light to remove unwanted hair. Multiple treatments may be necessary for both methods. Temporary hair removal options include shaving, plucking, or using depilatory creams, although hair may grow back thicker.
To Treat Acne:
- Various medications, including pills and topical creams or gels, can help improve acne. Consulting with a health care provider can help determine the best treatment options. (Read our full article for acne treatment, symptoms and diagnosis)
Conclusion
Polycystic Ovary Syndrome (PCOS) is a complex and multifaceted condition that affects many women worldwide. In the United States, it is estimated that PCOS affects approximately 6-12% of women of reproductive age, making it one of the most common endocrine disorders among women. Although its exact cause remains unknown, effective management is possible through a combination of lifestyle changes and medication. Addressing specific symptoms such as weight gain, irregular periods, excessive hair growth, and acne can significantly improve quality of life and reduce the risk of long-term complications such as type 2 diabetes and heart disease. Early diagnosis and a personalized treatment plan, developed in collaboration with healthcare professionals, are essential for managing PCOS and promoting overall health and well-being.
