Polycystic Ovary Syndrome (PCOS)

Introduction

The extra male hormones disrupt the menstrual cycle of a women, hence, women with PCOS get fewer periods than usual. This hormone imbalance can affect your ability to have a child.

What is PCOS?

PCOS affects a woman’s ovaries and ovulation. Ovulation occurs when a mature egg is released from an ovary. This happens so it can be fertilized by a male sperm.

But in PCOS, many small cysts (fluid-filled sacs) can develop inside the ovaries. These sacs are actually follicles, each one containing an immature egg. The eggs never mature enough to trigger ovulation. Due to lack of ovulation, the androgen (male hormone) levels are higher than normal in women with PCOS.

Furthermore, the excess male hormone levels can cause more problems with a woman’s menstrual cycle and makes it harder for them to get pregnant.

Please note, the word “polycystic” means “many cysts.”

The 3 main features of Polycystic ovary syndrome (PCOS) are:

• Irregular Periods: which means your ovaries do not regularly release eggs (ovulation).
  
• Excess male hormone (Androgen): Excess levels of male hormones may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne.
  
• Polycystic ovaries: Your ovaries contain many fluid-filled sacs (follicles) that surround the eggs. As a result, your ovaries might fail to function regularly.

Please note, if you have at least 2 of these features, you may be diagnosed with Polycystic ovary syndrome (PCOS).

Furthermore, PCOS also cause hair growth on the face and body and it can contribute to long-term health problems like diabetes and heart disease.

Who gets Polycystic ovary syndrome (PCOS)?

Most women find out they have Polycystic ovary syndrome (PCOS) in their 20s and 30s, when they have problems getting pregnant and see their doctor. But PCOS can happen at any age after puberty.

You may be more likely to have PCOS if you have obesity or if you have a mother or sister with PCOS.

What Causes PCOS?

The exact cause of Polycystic ovary syndrome (PCOS) is not clear. Most experts think that several factors play a role include:

1. Insulin resistance: Insulin is the hormone produced in the pancreas that allows cells to use sugar from foods for energy. But many women with PCOS have insulin resistance, meaning that their body’s cells can’t use insulin properly.
   
   When cells can’t use insulin properly, the body demand for insulin increases. As a result, your insulin levels become higher than normal. Further, excess insulin might increase androgen (male hormone) production, causing difficulty with ovulation.
   
   Kindly note, Overweight or Obesity are major causes of insulin resistance in a woman. Over time, both obesity and insulin resistance can increase your risk to type 2 diabetes.
   
   
2. Excess androgens: Women with PCOS have high level of androgens (male hormone) than normal. Higher androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle and can cause extra hair growth and acne.
   
   
3. Inflammation: Research has shown that women with PCOS often have an increased levels inflammation in their body, that stimulates polycystic ovaries to produce androgens (male hormone).
   
   
4. Family History: PCOS may also run in families. You might be more likely to have PCOS if your sister or mother also has it.

Symptoms of PCOS

Symptoms of PCOS often develop around the time of the first period. But some women discover they have PCOS, when they have gained a lot of weight or when they have trouble in getting pregnant.

The symptoms of PCOS may include:

• Irregular periods: The most common PCOS symptoms are missed, irregular, infrequent or very light periods. Some women with PCOS get fewer than eight periods a year.
  
• Infertility: Difficulty getting pregnant as a result of irregular ovulation or failure to ovulate.
  
• Too much hair: More than 70 percent of women with PCOS grow hair on their face and parts of their body. Excess hair growth is called hirsutism.
  
• Acne or oily skin.
  
• Weight gain, especially around the belly.
  
• Darkening of the skin: Dark or thick patches of skin can form on the back of the neck, in the groin and under the breasts.
  
• Male pattern baldness: Thinning hair or hair loss on the scalp.

Effects of PCOS

Women with Polycystic ovary syndrome (PCOS) are more likely to develop certain serious health problems. These include:

• Infertility: To get pregnant, you have to ovulate. Women who don’t ovulate regularly don’t release as many eggs to be fertilized. Therefore, PCOS is one of the leading causes of infertility in women.

• Pregnancy complications: PCOS can also cause problems during pregnancy for you and for your baby. Women with PCOS have higher chance of miscarriage and premature birth.

• Metabolic syndrome: It is a group of health issues including high blood pressure, high blood sugar and abnormal cholesterol level. Together, these factors are called metabolic syndrome and they increase your risk of heart disease, diabetes, and stroke.

• Sleep apnea: Women with PCOS, particularly when they are overweight, can be at an increased risk of developing sleep apnea. In this condition your upper airway is obstructed during sleep. This leads to repeated pauses in breathing during the night, which interrupt sleep.

• Endometrial cancer: Regular periods help to prevent excess thickening of the lining of the uterus. Not having regular periods can lead to abnormal cells building up inside the womb.
  
  Women who have had absent or very irregular periods (fewer than 4 periods a year) have a higher risk of developing cancer of the womb lining (endometrial cancer).

• Gestational diabetes: It is a type of diabetes that happens only during pregnancy. Women with PCOS are at greater risk for developing gestational diabetes. This risk increases if you are overweight.
  
  Usually gestational diabetes goes away after your baby is born. However, you still remain at a higher risk of developing type 2 diabetes after pregnancy, so monitoring and prevention are very important.

• Depression and Anxiety: The symptoms of PCOS like unwanted hair growth can negatively affect your emotions and confidence. Many women with PCOS end up experiencing depression and anxiety.

How is PCOS diagnosed?

There is no single test to diagnose PCOS. Your doctor will start by asking about your medical history and symptoms. You may be diagnosed with PCOS if you have at least two of the following symptoms:

1. Irregular periods: Including periods that come too often, not often enough, or not at all.
2. High androgen levels: Higher than normal levels of androgens in blood.
3. Cysts in the ovaries: Multiple cysts on one or both ovaries.

In addition, your doctor may also ask whether you have symptoms like:

• Extra hair growth on your face, chin, and body.
• Acne.
• Weight gain.

Apart from your symptoms, your doctor may recommend below mentioned different tests to diagnose PCOS:

• Blood Tests:  Your blood may be analyzed to measure the levels of Androgens Hormone (Male Hormones). Your doctor may also check your blood glucose levels and cholesterol levels.

How is PCOS treated?

There is no cure for PCOS, but the symptoms can be treated. Treating symptoms of PCOS depends on a number of factors such as your age, how severe your symptoms are, and your overall health. The type of treatment may also depend on whether you want to become pregnant in the future. Therefore, speak to your doctor or health care provider about medications for the treatment.

Furthermore, treatment for PCOS usually starts with lifestyle changes like weight loss, diet plan and exercise.

Healthy eating habits and regular physical activity can help relieve PCOS related symptoms. Losing just 5 to 10 percent of your body weight can help regulate your menstrual cycle and improve your chances of getting pregnant. Moreover, losing weight may also help to improve your cholesterol levels, lower your blood glucose levels and help your hormones reach normal levels.

A few studies have found that 30 minutes of moderate intensity exercise at least 4 days a week can help women with PCOS lose weight. Losing weight with exercise also improves ovulation and insulin levels.

Please Note, exercise is even more beneficial when combined with a healthy diet.

PCOS and Pregnancy

If you have PCOS, you might struggle to get pregnant. Between 70 and 80 percent of women with PCOS have fertility problems.

Moreover, once you become pregnant with PCOS, it can cause problems during pregnancy for you and for your baby. Babies born to mothers with PCOS have a higher chance of being admitted to a newborn intensive care unit or dying before, during, or right after birth. 

Pregnancy complications related to PCOS include:

• Miscarriage: Pregnant women with PCOS may have a higher risk of miscarriage in the early months of pregnancy as compared to women without PCOS.

• Gestational diabetes (Diabetes during pregnancy): This is a type of diabetes that starts during pregnancy. If you have gestational diabetes, your body can’t use sugar (glucose) properly. This leads to higher-than-normal levels of sugar in your blood, which can be unhealthy for you and the fetus. In most cases, the condition goes away after the baby is born. 
  
  Furthermore, if you have gestational diabetes, you are also at increased risk of having a baby larger than expected for their gestational age. Gestational age is length of time that a baby grows and develops inside the mother’s uterus. Therefore, having a large baby can lead to cesarean delivery.
  
  In addition, women with gestational diabetes as well as their children are at higher risk of developing type 2 diabetes in the future.

• Preeclampsia: Preeclampsia is a dangerous rise in blood pressure during pregnancy. Pregnant women with preeclampsia often have high blood pressure, high levels of protein in their urine and swelling in their legs, feet and hands. Preeclampsia generally happens after 20 weeks of pregnancy. However, in some cases, it occurs earlier or after delivery.
  
  If you develop preeclampsia during your pregnancy, you will have to be monitored extremely closely by doctor because your high blood pressure prevents the fetus from getting enough oxygen and nutrients due to reduced blood flow. Moreover, preeclampsia can harm the mother’s kidneys, liver and brain. If left untreated, preeclampsia can lead to eclampsia, a serious condition that can have health risks for both the mother and baby. Eclampsia can cause organ damage, seizures, and even death.
  
  Currently, the only cure for preeclampsia is to deliver the baby, even preterm if necessary. The timing of delivery depends on how severe the preeclampsia is and how many weeks pregnant you are.

• Preterm birth: Infants are considered preterm if they are delivered before 37 weeks of pregnancy. Research has shown that people with PCOS are at a higher risk of having a premature birth. The most common reason for preterm birth is preeclampsia. Furthermore, preterm infants may suffer from many health problems, both right after birth and later in life, 

• Cesarean Delivery: The risk of pregnancy complications are high in women with PCOS, which often leads to cesarean delivery. As cesarean delivery is a surgical procedure, recovery can take longer than recovery from vaginal birth. Moreover, birth through Cesarean delivery has its own risks for both the mother and baby.

Please note, if you have PCOS and are pregnant, it is important you talk with your doctor. The risk of these complications can be reduced by monitoring your PCOS symptoms and taking extra care during your pregnancy.

Difference between PCOS and PCOD?

Both PCOS and PCOD may sound similar enough, however, PCOS (Polycystic Ovary Syndrome) is different from PCOD (Polycystic Ovarian Disease). Following are the difference between PCOS and PCOD.

• PCOS is a hormonal disorder which cause the ovaries to produce excess amount of male hormone (androgens), as a result, ovaries stop releasing eggs. However, in PCOD, the ovaries start releasing abnormally high number immature eggs that lead to hormonal imbalance and swollen ovaries.

• Women with PCOS struggle with infertility issues, making them hard to get pregnant. Further, if become pregnant, risks of miscarriage and premature birth is high in PCOS. However, in PCOD, woman still can conceive and become pregnant with minimal medical help.

• In PCOS, periods are always delayed or stopped. However, in PCOD, periods may be regular or delayed.

• In PCOS, women are at a higher risk of developing heart disease, diabetes, obesity and endometrial cancer. On the other hand, there are no such complications with PCOD.

• PCOS is a serious medical condition and it cannot be cured completely. However, PCOD can be managed just by making lifestyle changes and medications as advised by the doctor.

Diet in PCOS

PCOS is a hormonal condition which cause several health issues such as weight gain, Obesity, Heart disease, Inflammation and insulin resistance in your body. Researches have shown that there is no permanent cure for PCOS and its symptoms. However some changes in diet can help to manage PCOS.

The nutrients you consume through your diet may have a direct impact on your hormone production. Therefore, It is important to pay a closer attention to what you eat.

Foods to Eat

• High Fiber Diet: Fiber has several health benefits for women with PCOS. It helps to control insulin levels in the body. Along with this, a high fiber diet may lower androgen(male hormones) levels in your body, which is one of the complex symptoms of PCOS.

15 Sources

• www.mayoclinic.org
• www.healthline.com/health
• www.webmd.com
• www.womenshealth.gov
• www.hopkinsmedicine.org
• www.nhs.uk
• www.cdc.gov
• www.jeanhailes.org.au
• www.verywellfamily.com
• www.nichd.nih.gov
• www.my.clevelandclinic.org
• www.pregnancybirthbaby.org.au
• www.perlahealth.com
• www.pollie.com
• www.pcosaa.org