Q: what is polycystic ovarian syndrome(PCOS)?
A : The ovaries are responsible for producing eggs (oocytes) and the female hormones (estrogen, progesterone and androgens) . In a normal ovary, ovulation (release of a mature egg) is a regular feature which takes place in a cyclical manner. Polycystic ovarian syndrome is an endocrine disorder with heterogeneous features , wherein there is absence or infrequent ovulation associated with various hormonal imbalance . Polycystic ovaries are larger than normal ovaries with increased stroma and multiple small follicles filled with fluid, which fail to ovulate.

Q:  Why is PCOS so commonly heard of lately?

A: Approximately 10 to 20 % of women in the age group of 15 to 45 years, have PCOS.

Its incidence is on a rise due to change in lifestyle, food habits, increasing obesity and environmental factors.

Q: what are symptoms of polycystic ovaries?

A: The symptoms include

• Menstrual irregularities:

No  menstrual  periods

 Frequently missed periods

Very heavy periods or prolonged periods

• Increase in body hair especially on face, chest, belly and upper thigh ( hirsutism )
• Loss of hair on scalp
• Being overweight, experiencing a rapid increase in weight or having difficulty losing weight
• Oily skin, pimples (acne)
• Difficulty becoming pregnant
• Patches of thickened ,dark skin over neck , axilla, groin ( acanthosis nigricans)
• Depression and psychological problems

Symptoms vary from woman to woman. Some women may have very few mild symptoms, while others are affected severely.

Q. What causes polycystic ovaries?

A: The cause is multifactorial

• Androgen excess seen in almost 60 to 80 % of women
• Insulin resistance or elevated insulin levels
• Family history in mother, sister, aunt
• Epigenetics : environmental factors like obesity, unhealthy lifestyle, low birth weight etc, can interact with genes to lead to PCOS

Q: How do I know if I have PCOS?

A:  There is no single test to definitely diagnose PCOS.

A diagnosis is made when you have any two of the following:

1. Irregular, infrequent periods, or no periods at all
2. An increase in facial or body hair and /or blood tests that show higher testosterone levels than normal.
3. An ultrasound scan that shows polycystic ovaries.

It is important to note that ONLY polycystic ovaries on ultrasound, in the absence of any of the above mentioned signs or symptoms,  is NOT PCOS.

Q: If I have PCOS, will I have difficulty getting pregnant?

A: PCOS is one of the most common but treatable causes of infertility. The hormonal imbalance interferes with the growth and release of eggs from ovaries, thus making it difficult to conceive.

Q: What are the treatment options to get pregnant if I have PCOS?

A:

1. Weight loss

If a patient is overweight, losing weight through healthy eating and regular physical activity can help to regularize periods in majority of women. Even 10% weight loss helps to restore ovulation.

• Medicines to induce ovulation like clomiphene citrate and letrozole
• Some women may need intra uterine insemination (IUI) or in vitro fertilization(IVF),  if the infertility is of long duration ,or if there are other factors of infertility associated.

Q: Can PCOS cause complications in pregnancy?

A: Yes.

Women with PCOS can have

• Miscarriage (especially in first trimester)
• Gestational diabetes
• Preeclampsia( high blood pressure)
• Macrosomia (large weight babies)
• Increased incidence of cesarean section.

Babies can also have increased risk of developing hypoglycemia (low blood glucose) and hypocalcemia (low calcium), in the immediate post natal period and can have long term risk of developing obesity and metabolic syndrome.

Q: Is there a cure for PCOS?

A: There is currently no cure for PCOS. Even after menopause, women with PCOS often have high levels of androgens as well as insulin resistance. Medical treatments aim to manage and reduce the symptoms or consequences of having PCOS. Medication alone has not been shown to be any better than healthy lifestyle changes.

Q: What are the various treatment options available?

A: PCOS treatment is tailored to each woman according to symptoms, existing health problems and whether she wants to become pregnant.

1. Exercise

• At least 150 min/week of moderate intensity exercises like brisk walking, playing light sports etc. OR
• At least 75 min/week of vigorous intensity activities like running, field sports, swimming, jumping rope,etc. OR
• Weight training  helps to strengthen the muscle and increase bone density
• Medications
• Combination birth control pills
• Progestins
• Metformin
• Myoinositols
• Healthy food
• Balance carbohydrates with protein and healthy fats
• Choose nutritious or high fibre carbohydrates instead of sugary or refined carbohydrates
• Eat small frequent meals instead of large meals
• Do not skip breakfast

Q:  Why have I been prescribed Metformin although my blood sugar is normal?

A: Hyper insulinemia or insulin resistance is seen in almost 80% patients of PCOS. In hyper insulinemia , the cells can’t utilize insulin properly,  thus the pancreas makes more insulin to compensate.

High levels of insulin trigger the production of androgens by the ovaries and causes the arrest of normal follicle development.

Metformin is an insulin sensitizer, which helps to increase uptake of insulin. Moreover it helps to lose weight in obese patients.

Q: What could PCOS mean for my long term health?

A: Women with PCOS  are at greater risk of developing long term health problems, as:

1.  Diabetes

In view of insulin resistance, majority of patients with PCOS develop diabetes , especially if obese and over age of 40 years.

• Metabolic syndrome ( obesity+ hypertension+ diabetes+ high cholesterol)
• Sleep apnea (snoring) and day time drowsiness
• Depression and mood swings
• Endometrial cancer

Since women with PCOS do not ovulate, the lining of the womb (endometrium) may thicken, leading to increased risk of developing cancer of endometrium in few women.