What is Polycystic Ovarian Syndrome (PCOS)?

What is PCOS?

Polycystic ovary syndrome (PCOS) is a complex disorder of the reproductive hormones and metabolism in women. It is very common, occurring in 7-10% or reproductive age women, and it is the most common cause of irregular menstrual cycles and infertility in women in their reproductive years.

 

What are polycystic ovaries?

 

 

Polycystic ovaries are slightly larger than normal ovaries and have twice the number of follicles (fluid-filled spaces within the ovary that release the eggs when you ovulate).

 

 

 

What causes PCOS?

 

The precise cause of PCOS is unknown, and likely there are multiple factors involved.

A key feature of PCOS is insulin resistance. Insulin is a hormone secreted by the pancreas and is involved in the metabolism of sugar and fat. Specifically, insulin signals the fat cells and muscle cells in the body to take sugar (and fat) out of the blood. When insulin resistance develops, these cells stop responding normally to the insulin signal. The body tries to overcome this resistance by making more insulin. As long as the body can make enough insulin, the blood sugar stays normal and diabetes does not develop. However, the high insulin level has adverse effects on the ovaries and disrupts the menstrual cycle.

 

What are the symptoms of PCOS?

 

PCOS can have three general types of effects:

• Cosmetic – acne, hirsutism or hair growth on the face, chest, and abdomen, skin darkening over the neck and arm pits (Acanthosis Nigricans).
• Reproductive – irregular or absent menstrual cycles, infertility
• Metabolic – obesity, changes in blood pressure, blood cholesterol, and glucose (sugar) metabolism that may predispose to problems like heart disease, stroke, and diabet

 

How is PCOS diagnosed?

Like any medical condition, the first step in checking for PCOS is to see your health care provider. He or she will take a detailed health history with emphasis on menstrual history, obstetric history and family history.

The physical examination will include checking your height, weight, blood pressure, performing a pelvic exam, and, possibly taking a measurement of your waist circumference. Some of the tests that may be ordered are:

• A pelvic ultrasound to check the ovaries for cysts. The ultrasound may be done either by placing a probe on your lower stomach when your bladder is full, or with a probe inserted inside the vagina, like a speculum during a regular pelvic exam. Either method can be a little uncomfortable, but should not be painful.
• Blood tests to check hormone levels. Hormonal blood tests can help determine if you have PCOS or if other hormone abnormalities are causing your symptoms.
• Blood test to check cholesterol and triglyceride levels. Since triglycerides go up after you eat, this test should be done after you have been fasting for 12 hours.
• Blood sugar test to check for diabetes. Because of the association between PCOS and diabetes, women with PCOS should have their blood sugar levels tested regularly. Early detection of diabetes is particularly important if you are thinking about becoming pregnant.

 

 

How is PCOS treated?

There is no cure for PCOS, but you can manage the symptoms of PCOS. You and your doctor will work on a treatment plan based on your symptoms, your plans for children, and your risk for long-term health problems such as diabetes and heart disease. Many women will need a combination of treatments, including:

 

• Weight loss and lifestyle modifications– Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a 10 percent loss in body weight (for example, a 150-pound woman losing 15 pounds) can help make your menstrual cycle more regular and improve your chances of getting pregnant.
  1. Healthy eating– The diet should be adjusted to provide good nutrition and to limit saturated fat. For women who are overweight, portion sizes and calories should be restricted to help promote weight loss.
  2. Exercise-Regular aerobic exercise can reduce insulin resistance and help promote normal metabolism and menstrual cycles. Ideally you should obtain 30 minutes of exercise on most days of the week
• Prescription medicines-Your doctor may prescribe hormonal birth control to regularise menstrual cycle and to improve acne and reduce unwanted hair. Other medicines can block the effect of androgens or reduce insulin resistance such as metformin.
• Hair removal– You can try facial hair removal creams, laser hair removal, or electrolysis to remove excess hair.

 

 

 

What if I become pregnant while on medication?

If you become pregnant while taking medication to treat PCOS, please notify your doctor to discuss your medications. You should immediately stop birth control pills, spironolactone, and finasteride if you are on any of these or other drugs, as they may adversely affect the developing baby.

 

Many women with PCOS successfully manage their symptoms and long-term health risks without medical intervention. They do this by eating a healthy diet, exercising regularly and maintaining a healthy lifestyle.