Polycystic Ovarian Syndrome (PCOS)-A Leading Cause of Female Infertility
What is Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is a endocrine system disorder that affects women in their reproductive years. The condition arises due to the imbalance of estrogen and progesterone. This leads to the benign masses or cysts on the ovaries. About 1 in 10 women suffer from this problem.
PCOS is difficult to identify. There are several symptoms and a patient may not have all of them. Though the name 'polycystic' means multiple cysts, not all women with multiple cysts have PCOS and not all PCOS patients have multiple cysts.
Women with PCOS have ovaries that are two to five times the normal size. Ovaries have clusters of small, pearl-sized cysts which contain fluids and immature eggs.
PCOS affects menstrual cycle, ability to conceive, cardiac function and the overall appearance.
Causes of PCOS
PCOS is caused mainly due to the hormonal imbalance.
Ovaries produce a small amount of male sex hormone called androgen. But in case of a patient of PCOS the production of this hormone is slightly higher than normal. This leads to problems in ovulation, formation of acne and growth of unwanted facial and body hair.
Excess Luteinising Hormone (LH)
LH is a ovulation stimulating hormone, but too much of it may have adverse effects on the ovaries.
Reduced Sex Hormone-Binding Globulin (SHBG)
SHBG is a protein that binds androgen and reduces its side effect.
Genetics plays a role. PCOS runs in the family. One is likely to get PCOS if mother, sister or aunt suffer from it.
Insulin is a hormone produced in the pancreas to control the glucose level in the blood. If the body is insulin resistance then glucose cannot be moved from the blood into the tissues. The body responds by producing extra insulin. High level of insulin leads to the production of more androgen.
Insulin resistance also causes weight gain and excess body fat in turn produces more insulin.
Low Grade Inflammation
Many patients of PCOS are found to have low grade inflammation. These stimulate the production of more androgens.
Irregular Menstrual Cycle
Women with PCOS usually have irregular menstrual cycle or the period stops all together. An irregular menstrual cycle is defined as:
This is caused due to the high level of androgen and insulin which interrupt monthly cycle of ovulation and hence the menstruation.
- less than or equal to 8 menstrual cycles per year.
- menstrual cycle longer than 35 days.
Hirsutism is the growth of excess hair in certain body parts where usually men have hair. These regions are sideburns, cheeks, chin, lower abdomen, chest and around the nipple. It occurs due to the raised level of male hormone androgen.
About 60% of women with PCOS have hirsutism, although hirsutism can develop in women without PCOS. The effect of hirsutism is more pronounced in certain ethnic groups than others.
Excess androgen increases the activity of oil producing glands on the skin, leading to increased acne.
Excess level of androgen leads to thinning of hair at the scalp and receding hair line in the front.
Excess level of both androgen and insulin interferes with ovulation. Either it completely stops or becomes irregular. As a result women fail to conceive. Those who conceive have a higher risk of miscarriage. Weight gain also increases the chance of infertility.
Approximately 29% of women with PCOS suffer from depression. It is believed that PCOS related depression is mainly due to hormonal imbalance..
Hirsutism, weight gain, infertility, severe acne and general problem with femininity and sexuality also plays a role in reducing the self-esteem of a woman.
Other symptoms related to PCOS are decreased sex-drive, deepening of voice and decrease in breast size.
PCOS is marked by decrease in female sex hormone and increase in male sex hormone androgen.
Could you be suffering from PCOS
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There is no specific test to diagnose PCOS. The diagnosis is done mainly based on the 'principal of exclusion' i.e. after considering all the symptoms, physicians rule out other disorders.
Height and weight are measured to check for obesity. Pelvic exam is done look for signs of PCOS such as swollen ovaries or swollen clitoris.
Blood tests are done to check the levels of hormones and insulin. Doctors may also want to check for cholesterol and triglyceride which usually are at elevated level with PCOS.
Doctors recommend USG to see the appearance of ovaries and the thickness of uterine lining.
All About PCOS
Treatment of PCOS focuses on controlling the symptom rather than on curing the disease. The type of treatment administered varies from patient to patient and the severity of the symptoms.
Diet and Lifestyle Change
Doctors put emphasis on the need to control the weight through low calorie, healthy diet and regular exercise, Studies have shown that about 5% weight loss can reduce insulin and androgen levels and trigger ovulation and menstrual cycle.
1. Regularizing Periods
Women who don't want to get pregnant may be given birth control pills to regulate the periods. These pills contain a combination of estrogen and progestin (synthetic progesterone) which help reduce the androgen production.
Sometimes skin patches or vaginal rings are given instead of birth control pills to regulate levels of hormone.
2. Regulating Ovulation
If the woman is planning pregnancy she is given medication to help ovulate. Oral anti-estrogen medications are given for the first part of the menstrual cycle. If the patient still fails to become pregnant then follicle stimulating hormone (FSH) and luteinizing hormone (LH) are injected.
3. Unwanted Hair Growth Control
Doctors may prescribe birth control pills to curb the production of androgen. They may also give medication to block the effects of androgen on the skin. But the use of this later drug may cause birth defects. Hence it cannot be given to women who are planning to conceive.
1. Ovarian Wedge Resection
A part of the ovary is surgically removed. It was found that 95% women resumed regular menstrual cycle post surgery. But the technique had some undesirable side effects. It led to tissue adhesion around the ovary and the fallopian tube, affecting the fertility of the patient. The procedure thus fell out of favor.
2. Ovarian Drilling
With the advent of laparoscopy, a technique called ovarian drilling became a popular treatment for women who failed to lose weight or did not respond to fertility medicine.
It works by removing a portion of the central or stroma of the ovary using laser. It was found to trigger ovulation, but again not without side effects. Studies have shown that burning of the ovarian surface with laser leads to tissue adhesion.
3. Robotic Laparoscopic Ovarian Wedge Resection
This is the best possible surgical option for PCOS. Doctors remove a wedge shaped section of each ovary. Edges of the ovary are sewed back together using special micro-surgical techniques to prevent tissue adhesion.
PCOS management places strong emphasis on healthy lifestyle along with targeted medical therapy as required.
Dietary Dos and Don't s of PCOS
Low sugar index food
High sugar index food,
Whole grain foods
Processed or refined food
Foods high in fibre content
High carbohydrate food
Green leafy vegetables like spinach, lettuce
Starchy vegetable like potato
Foods rich in essential fatty acids, unsaturated fats, vitamins,
Saturated fats, transfats
Foods rich in natural protein such as nuts, almonds, beans etc
Fast foods like pastas, chocolates
8-10 glass of water each day
Laparoscopic Ovarian Wedge Resection
- For PCOS patients the entry point to the process of treatment can be through their GP, Dermatologist, Gynecologist or Endocrinologist.
- Between 15% - 30% women with PCOS have regular periods.
- Even a small weightless can trigger ovulation and regularization of menstrual cycle.
- Oral contraceptive pills are the primary method of treatment for those who don't want to conceive.
- Strong emphasis is placed on healthy lifestyle.
Dr Dawn discusses the causes and treatments available for PCOS, as well as casting her medically expert eye over your frequently asked questions.