Dr. Shelly Sharma
Do you suffer from irregular periods? Abnormal facial hair growth like in males?
Are you overweight and have difficulty losing weight?
Are you a woman of child-bearing age group and have difficulty conceiving?
If the answer to any or all of these questions is yes then you may be suffering from PCOS.
Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. It can affect up to 1 in 5 to 1 in 10 women. Women with PCOS produce higher-than-normal amounts of androgens (male hormones). This hormonal imbalance causes them to have irregular menstrual periods and makes it harder for them to get pregnant. PCOS is a common and treatable cause of infertility. It also causes abnormal hair growth on the face and body and baldness. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.
Who gets PCOS?
Between 5% and 10% of women between 15 and 44, or during the childbearing years, have PCOS. Most women find out they have PCOS 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 risk of PCOS. The risk may be higher in those with obesity or if a blood relative like the mother, sister, or aunt suffers from PCOS.
What are the Symptoms of PCOS?
A person suffering from PCOS may have all or some of the symptoms of PCOS include:
- Irregular Women with PCOS may miss periods or have fewer periods (fewer than eight cycles in a year). The periods when they come are associated with heavy bleeding. Sometimes some women with PCOS can stop having menstrual periods.
- Men like hair growth or too much hair on the face, chin, or parts of the body where men usually have hair. This is called “hirsutism” and it affects up to 70% of women with PCOS.
- Oily and acne-prone skin- Acne may be present on the face, chest, and upper back.
- Excessive hair loss- Thinning hair or hair loss on the scalp, may result in baldness
- Weight gain or difficulty losing weight- Excessive weight is distributed around the waist and is difficult to lose weight.
- hers like- Darkening of skin, along neck creases, in the groin, and underneath breasts. Skin tags, which are small excess flaps of skin in the armpits or neck area.
What happens in PCOS?
Polycystic ovary syndrome (PCOS) is a common health problem caused by an imbalance of reproductive hormones, which creates problems in the ovaries.
The ovaries have multiple follicles out of which one matures and an egg is released each month as part of a healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be. PCOS can thus cause missed or irregular menstrual periods, these in turn leads to infertility or inability to get pregnant. In fact, PCOS is one of the most common causes of infertility in women. It also leads to development of small fluid-filled sacs or cysts in the ovaries.
What causes PCOS?
The exact cause of PCOS is not known. An interplay of several factors, including genetics, play a role. There are high levels of androgens(male hormones) and Insulin.
Although all women make small amounts of androgens, the androgen levels are significantly increased in those with PCOS. Androgens control the development of male traits, such as male-pattern baldness and hair growth on the body. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle and can cause extra bodily hair growth and acne, two signs of PCOS.
Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body cells do not respond normally to insulin. As a result, insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who are overweight or obese, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.
Can I still get pregnant if I have PCOS?
PCOS is one of the most common, but treatable, causes of infertility in women, and having PCOS does not mean you can’t get pregnant. 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 doctor can talk with you about ways to help you ovulate and to raise your chance of getting pregnant. You can also use an ovulation calculator and calendar (available online) to see which days in your menstrual cycle you are most likely to be fertile.
Is PCOS linked to other health problems?
Yes, studies have found links between PCOS and other health problems. However, researchers do not know if PCOS causes some of these problems or if these problems cause PCOS. Or whether there are other conditions that cause PCOS and other health problems. The health problems include:
Depression and anxiety. Depression and anxiety are common among women with PCOS. Eating disorders like binge eating and anorexia are also common.
Sleep apnea. This is when momentary and repeated stops in breathing interrupt sleep. Many women with PCOS have overweight or obesity, which can cause sleep apnea. Sleep apnea raises the risk of heart disease and diabetes.
Unhealthy cholesterol. Women with PCOS often have higher levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol. High cholesterol raises the risk of heart disease and stroke.
Diabetes. More than half of women with PCOS will have diabetes or prediabetes (glucose intolerance) before the age of 40.
High blood pressure. Women with PCOS are at greater risk of having high blood pressure compared with women of the same age without PCOS. High blood pressure is a leading cause of heart disease and stroke.
Endometrial cancer. Problems with ovulation, obesity, insulin resistance, and diabetes (all common in women with PCOS) increase the risk of developing cancer of the endometrium (lining of the uterus or womb).
How is PCOS diagnosed?
There is no single test to diagnose PCOS. To help diagnose PCOS and rule out other causes of patient’s symptoms, the doctor takes medical history and does physical exam and different tests:
Pelvic ultrasound (sonogram). This test uses sound waves to examine the ovaries for cysts and check the endometrium (lining of the uterus or womb).
Blood tests. Blood tests check androgen hormone levels, sometimes called “male hormones.” Other hormones related to other common health problems that can be mistaken for PCOS, such as thyroid disease may also be checked. Doctor may also test for cholesterol levels and diabetes.
Once other conditions are ruled out, PCOS is diagnosed if at least two of the following symptoms are present.
1. Irregular periods, including periods that come too often, not often enough, or not at all
2. High levels of androgens- based on symptoms or blood tests.
3. Multiple cysts in one or both ovaries on Ultrasound.
What lab tests are done for diagnosing PCOS?
- Follicle-stimulating hormone (FSH) affects the ability to get pregnant. Its level might be lower or even normal, in patients with.
- Luteinizing hormone (LH) encourages ovulation. It could be higher than normal.
- Testosterone is a sex hormone that would be higher in women with PCOS.
- Estrogens are group of hormones that allow women to get their periods. Its level may be normal or high in patients with PCOS.
- Sex hormone binding globulin (SHBG) levels may be lower than normal.
- Androstenedione levels may be at a higher-than-normal level.
- Human chorionic gonadotropin (hCG): This is a hormone test that can check to see for pregnancy.
- Anti-Mullerian hormone (AMH): This test can check how well the ovaries are working and to help estimate how far off menopause may be. The levels would be higher with PCOS.
The doctor may recommend a few more tests to rule out other conditions such as thyroid problems, tumors, and hyperplasia (organ-swelling due to too many cells) that have similar symptoms to PCOS.
After Diagnosis of PCOS is established few other tests may be done to check on overall health and chance of having other conditions:
- Lipid profiles to check cholesterol and triglycerides.
- Glucose test to look for diabetes. More than half of women who have PCOS get this disease.
- Tests to look for insulin resistance, as It’s common among women with PCOS and can lead to diabetes.
How is PCOS treated?
There is no cure for PCOS, but the symptoms of PCOS can be managed. The doctor will work on a treatment plan based on symptoms, plans for having children, and risk of long-term health problems such as diabetes and heart disease. Many women will need a combination of treatments, including- steps taken at home to help relieve symptoms and medicines.
Losing weight- Healthy eating habits and regular physical activity can help relieve PCOS-related symptoms. Losing weight may help to lower blood glucose levels, improving the way body uses insulin, and help body hormones reach normal levels. Even a 10% loss in body weight (for example, a 80 kg woman losing 8 kg) can help make the menstrual cycle more regular and improve chances of getting pregnant.
- Removing hair- Facial hair removal creams, laser hair removal, or electrolysis are some methods available to remove excess hair.
Slowing hair growth. Prescription skin treatment can help slow down the growth rate of new hair in unwanted places.
What types of medicines treat PCOS?
The medicines that help treat PCOS and its symptoms include:
- Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormone intrauterine device (IUD) can be used for women who don’t want to get pregnant. These can:
Make the menstrual cycle more regular
Lower risk of endometrial cancer
Help improve acne and reduce extra hair on the face and body.
- Anti-androgen medicines block the effect of androgens and can help reduce scalp hair loss, facial and body hair growth, and acne. These medicines can cause problems during pregnancy and hence one should use these with caution and discuss with the Doctor.
- Metformin is often used to treat type 2 diabetes and may help some women with PCOS symptoms. It improves insulin’s ability to lower blood sugar and can lower both insulin and androgen levels. After a few months of use, metformin may help restart ovulation, but it usually has little effect on acne and extra hair on the face or body. Recent research shows that it may have other positive effects, including lowering body mass and improving cholesterol levels.
What are the treatment options for someone with PCOS who wants to get pregnant?
The several options to help chances of getting pregnant when suffering from PCOS include:
- Losing weight through healthy eating and regular physical activity can help make the menstrual cycle more regular and improve fertility.
- After ruling out other causes of infertility in both partners, the doctor may prescribe medicine to help with ovulation.
- In vitro fertilization (IVF). IVF may be an option if the medicine does not work. In IVF, the egg is fertilized with the partner’s sperm in a laboratory and then placed in the uterus to implant and develop. Compared to medicine alone, IVF has higher pregnancy rates and better control over the risk of having twins and triplets.
- Surgery is also an option, usually 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 the ovary using lasers or a fine needle heated with electricity. Surgery usually restores ovulation, but only for 6 to 8 months.
How does PCOS affect pregnancy?
PCOS can cause problems during pregnancy for both the mother and baby. Women with PCOS have higher rates of:
- Gestational diabetes
- Cesarean section (C-section)
The baby also has a higher risk of being heavy in weight (macrosomia) and spending more time in a neonatal intensive care unit (NICU).
How to prevent problems from PCOS during pregnancy?
The risk of problems during pregnancy can be reduced by:
- Reaching a healthy weight before getting.
- Reaching healthy blood sugar levels before getting pregnant, through a combination of healthy eating habits, regular physical activity, weight loss, and medicines such as metformin.
- Taking folic acid under the guidance of a doctor.
Is there any online ovulation calculator available to help plan pregnancy with PCOS?
Yes, there are many such tools available. It can help in knowing the days you are most likely to be fertile during your menstrual cycle and can increase your chance of getting pregnant. The typical menstrual cycle is 28 days long, but each woman is different. There are about 6 days during each menstrual cycle when you can get pregnant. This is called your fertile window. Use the calculator to see which days you are most likely to be fertile.
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This information is for general guidance and reflects the opinions and experience of the author. It is not intended to replace specialist consultation or provide treatment advice for specific cases.