What is PCOS?
Polycystic ovary syndrome (PCOS) is a common condition affecting 6-7% of women in the reproductive age group. This syndrome is often diagnosed if any two of the following three symptoms or signs are present: absence of periods or irregular periods associated infrequent or no release of eggs every cycle or every month (anovulation or oligo-ovulation), a raised level of male hormone (testosterone) with presence or absence of associated symptoms such as acne, oily or greasy skin, excess hair growth and presence of polycystic ovaries (ovaries with many small cysts of 2-9 mm in size) on ultrasound scan. Although polycystic ovaries are seen in 20 – 33% of women, majority of them are healthy, ovulating normally and not having PCOS.
What causes PCOS?
Weight gain or obThe exact cause of PCOS is not yet clear. Whilst PCOS may run in families and several genetic factors have been implicated with its development, not all women with a genetic trait will develop the condition. However, one of the main underlying problems appears to be ‘insulin resistance’. This means that cells in the body such as muscles are resistant to the effect of a normal level of the insulin hormone secreted by the pancreas. Insulin is a hormone that is responsible for control of the blood sugar in your body. The resistance to the insulin effect in these individuals is compensated by an increased production of insulin to keep the level of sugar in the blood normal. The resultant increase in insulin levels in the blood act on the ovaries as well leading to increased production of the male hormone testosterone. A high level of testosterone slows the normal development of follicles or eggs in the ovaries resulting in an abnormally large number of small follicles, which remain immature and subsequent ovulation (release of egg) is hampered.
Short term and long term problems associated with PCOS:
Weight gain or obesity is not a consequence of PCOS however obesity or excess weight gain tends to worsen the manifestation of this syndrome. Excess body fat can also make insulin resistance worse, leading to further elevations in blood insulin concentrations with a progressive burn out of the gland producing the hormone.
Women with PCOS may develop symptoms in their late teens or 20s. Symptoms can vary from mild to severe and may change over the years. Apart from period related problems, which affect 7 in 10 women affected with PCOS, unwanted hair growth may occur over face, lower abdomen or chest depending on the degree of the rise in testosterone levels. Acne and thinning of scalp hair may also occur. 40% of women are obese and this may be secondary to increased insulin levels. Because of the disturbance in ovulation associated with PCOS, most women experience subfertility although majority of them conceive following treatment of stimulation of the ovaries using fertility drugs.
Nearly 10-20% of women with PCOS develop diabetes at some point in their life. The risk is increased if women are obese (body mass index more than 30), have a strong family history of type 2 diabetes or are above 40 years of age. Women who have been diagnosed as having PCOS are more likely to develop diabetes during pregnancy. A sleeping problem called sleep apnoea, a condition associated with snoring, is also more common than average in women with PCOS. They are also at increased risk of having a stroke and heart disease in later life because of the problems described above in addition to other associated conditions such as obesity, raised blood pressure and increased cholesterol levels. If women suffer from infrequent periods particularly with intervals between menstrual cycles of more than three months, the risk of pre-cancerous changes and subsequent cancer of the lining of the womb is higher than women having regular menstrual cycles. Because of these associated risks women having PCOS should have regular checks for blood sugar, cholesterol levels and blood pressure to detect any abnormality as early as possible. They should also be advised to have at least four menstrual cycles, which could be induced by taking either the ordinary contraceptive pills or progesterone tablets as prescribed by a doctor to prevent any changes within the lining of the womb.
Whilst there is no cure for PCOS, life style and dietary modification may alleviate some of the symptoms and long term consequences. Weight loss and regular exercise in obese women have been shown to improve fertility and lowering of androgen levels and associated symptoms of hair growth and acne. It also reduces the long term risk of diabetes, heart disease and even cancer of the lining of the womb. Even a small reduction in weight of about 2-5% has been shown to improve the ovulation and resumption of menses. Dietary modification such as low calorie diet, avoiding sugary drinks and also snacks between meals are useful to complement the efforts to reduce weight. Small frequent low calorie diet may be an alternative to avoid persistent increase in insulin levels, which is the key mechanism for the development of most symptoms of PCOS (make your portions small). Daily moderate sweat inducing exercise lasting for at least 30 minutes is one of the most important lifestyle measures to reduce the risks of both the short term and long term consequence of PCOS.