What Is Polycystic Ovarian Syndrome? Common Symptoms of PCOS And How It Affects Pregnancy?

What Is Polycystic Ovarian Syndrome? Common Symptoms of PCOS And How It Affects Pregnancy?

Some conditions related to women can pose potential long-term health risks. This is especially important when it comes to pregnancy as infertility is the biggest problem a woman could face in her reproductive life cycle. After all, who doesn’t want to become a mother of a healthy baby? One such common disorder we are discussing is PCOS or Polycystic Ovarian Syndrome.

Highlights -

    PCOS is one of the common disorders of the women which can result in infrequent menstrual cycle
•    Insulin resistance, inflammation and family history are some of the risk factors related to this condition
•    With proper medication and changes in lifestyle, PCOS can be effectively managed

Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome or PCOS is a hormonal disorder of the women that interfere with the normal menstrual cycle. In PCOS, the women produce more than normal male hormone (androgen) that causes infrequent or prolonged menstrual cycle. This eventually makes harder for them to get pregnant.

PCOS affects ovaries of the women from where estrogen and progesterone hormones are released. These hormones play an important role in regulating the menstrual cycle. Women with Polycystic Ovarian Syndrome often also have high insulin levels. Higher insulin levels can force ovaries to produce more androgen hormones such as testosterone.

How common is PCOS?

PCOS strikes women in their reproductive or childbearing age in between 15-44 years. According to an estimate, 2.2 to 26.7 percent women in this age bracket can have PCOS. Moreover, many of the women with PCOS don’t know they are actually suffering from the disease. According to a study, 70 percent of women suffering from PCOS had not been diagnosed in their life.

As per endocrinologist Dr. Mohammad Ashraf Gani, AIIMS, the data on PCOS shows 20-25 percent women in India of reproductive age are suffering from the condition. This is high as compared to 4-10 percent and 2 percent of cases in USA and European countries respectively.

Globally, estimates may vary depending on several factors, but below numbers are shocking.

  • PCOS is estimated to affect over 116 million women globally in 2012 (WHO)
  • In India, 1 in 10 women suffer from PCOS.
  • According to AIIMS, 20-25 percent of women in India suffers from PCOS
  • About 60 percent of women with PCOS are suffering from obesity
  • About 30-35 percent of women with PCOS have fatty liver while 60-70 percent of them have high level of androgen

What causes PCOS?

The exact cause of the PCOS is still unknown but there are some factors that might play a role in developing this condition:

  1. Insulin resistance - Insulin is a hormone that is produced by the pancreas allowing the cells to use sugar from foods for energy. When the cells become resistant to insulin or can’t use insulin properly, the body’s demand for insulin rises. To supply body’s extra demand of insulin, pancreas makes more insulin. This extra effort of pancreas causes ovaries to produce more male (androgen) hormones. This can impact ovulation.
  2. Inflammation - Some researches have shown that women with PCOS have certain type of low-grade inflammation. This stimulates ovaries to produce more androgen hormone which can result in heart and blood vessel problems.
  3. Genetic - Studies suggests that certain genes are linked to PCOS that causes it to run in families. It’s likely that more than one gene is involved in contributing to the condition.

Complications of PCOS

PCOS can lead to several complications such as:

  • Gestational diabetes or high blood pressure in pregnancy
  • Infertility
  • Miscarriage
  • Premature birth
  • Fatty liver caused by accumulation of fat in the liver (Non-alcoholic steatohepatitis)
  • Prediabetes or type 2 diabetes
  • Depression and anxiety
  • Sleeping disorder (Sleep apnea)
  • Abnormal uterine bleeding
  • Low HDL (good cholesterol) and high LDL (bad cholesterol)
  • Endometrial Cancer

Symptoms of PCOS - Check for these signs

A woman starts experiencing symptoms at around their first period. Other women only start seeing the symptoms either when they have gained a lot of weight or when they are finding difficulty in getting pregnant. Also, symptoms may vary from woman to woman. Some of the common symptoms of PCOS are:

  1. Irregular periods - Irregular or infrequent periods is the most classic sign of PCOS. Some women might experience less than 8 periods a year.
  2. Abnormal hair growth - Women with PCOS would experience abnormal hair growth (hirsutism) on the chin, upper lip, around the nipples, back and the abdomen. This happens in 70 percent of the cases.
  3. Weight gain - More than 80 percent women with this condition are obese.
  4. Acne - Excess production of male hormone testosterone can make the skin oilier than normal and cause breakouts on the face, back and upper chest.
  5. Male pattern baldness - Hair loss from the scalp is a common symptom in women with PCOS.
  6. Fertility problems - Women suffering from PCOS will experience fertility problems such as not releasing egg (ovulation) and repeated miscarriages. Studies have shown miscarriage rates may be as high as 20-40 percent.
  7. Heavy bleeding - As uterine lining builds up again after a long gap, so one can experience bleeding heavier than normal.
  8. Headaches - Changes in hormone levels can trigger headaches in some women.
  9. Darkening of the skin - PCOS can result in dark patches on the skin such as body creases on the neck and under the breasts.

How PCOS is diagnosed?

There is no definitive test to diagnose PCOS. Your gynecologist will first discuss your medical history and then move on to perform a physical examination. The doctor would be searching for at least two symptoms out of these three:

  • Irregular menstrual cycles
  • High androgen levels
  • Cysts in ovaries

Mainly three tests are performed for diagnosing PCOS:

  1. Pelvic examination - Visual inspection of reproductive organs will be performed for any unusual growth or abnormalities.
  2. Blood Tests - Blood test will check hormone levels, blood sugar levels as well as high triglyceride levels (high cholesterol)
  3. Ultrasound - Transvaginal ultrasound will check the appearance of the ovaries and abnormal follicles.

Your doctor might recommend additional tests to check blood pressure, screening for sleep apnea and depression.

Is there any cure for PCOS?

Unfortunately, PCOS cannot be cured however, it can be managed effectively. Generally, treatment of PCOS focuses on managing individual concerns. They can be basically divided into three categories:

Medication -

  1. Birth Control - Having doses of estrogen and progesterone on a daily basis can help regulate your menstrual cycles. It can also reduce unwanted hair growth, acne and act as a protective shield against endometrial cancer. These hormones can be taken in the form of pills, patch or vaginal ring.
  2. Metformin - It can help you restore regular ovulation process. Metformin is safe to be used in pregnancy and it is often recommended for managing insulin levels in women with PCOS. Some study also suggests that it can lower blood sugar as well.
  3. Clomiphene - This is an oral anti-estrogen medicine that can help a woman get pregnant. However, there is a risk of getting twin pregnancy and multiple births.
  4. Letrozole (Femara) - This medication is used to treat certain types of breast cancer. It can also stimulate ovaries for producing eggs.
  5. Hair removal medicines - Electrolysis is a process that can remove unwanted hair from the face and body. A tiny needle is inserted into each hair follicle. This needle passes a pulse of electric current that destroys the follicles. Laser hair removal can also help get rid of unwanted hairs.

Surgery -

If nothing works to improve the ovulation and fertility, you can choose ovarian drilling. In this surgical process, tiny holes are made into the ovaries via thin heated needle or laser to fix ovulation problem.

Lifestyle changes -

Your doctor might recommend you doing some diet and lifestyle changes to treat PCOS. Losing 5-10 percent of the total body weight can be helpful in regulating the menstrual cycle. Losing weight has several other benefits such as improvements in cholesterol level, diabetes and heart disease. All these conditions can act as a precursor to PCOS. So most of the tips you would be getting are related to weight loss:

  • Take a low carb diet that is effective in improving insulin levels as well as weight loss. There are some myths related to low carb diets that should be taken into consideration.
  • Do moderate intensity exercise. Some studies showed that 30 minutes of moderate intensity exercise thrice a week can help women with PCOS lose a considerable amount of weight. Losing weight improves ovulation and insulin level.
  • Eat balanced diet full of fruits and vegetables.
  • Eat low-fat dairy.
  • Stop smoking as women who smoke can have higher levels of androgen hormones as compared to the non-smokers.

Bottom Line

PCOS is a condition that has the potential to disturb regular menstrual cycles, making it difficult to get pregnant. Weight loss regime can improve the PCOS symptoms drastically and help you fight the odds of getting pregnant. Medication and surgery is the option if nothing works. So get regular check-up and meet with your gynecologist if you experience symptoms of PCOS.