Living with PCOS

Polycystic ovarian syndrome is a common condition affecting women of reproductive age in India. Here’s all you should know about it

BENGALURU: Polycystic ovarian syndrome (PCOS) is an imbalance in metabolism of androgens and estrogen. It is one of the most common endocrine disorders in women of reproductive age (15-44 years) in India. The incidence is 9–22 per cent in young women and more so among urban residents than rural ones. While the exact cause is unknown, it is known to run in families.  It appears to be have an autosomal dominant mode of inheritance.  

A genetic predisposition is difficult to prove as there is not enough evidence. Obesity is also associated with PCOS and there is some evidence that women who are obese are at a higher risk of PCOS. Stress, diet, exercise and pollution may also play a role. Women with PCOS have abnormalities in the metabolism and production of certain hormones like androgens, estrogens and luteinising hormone. PCOS is associated with higher levels of insulin in the blood and insulin resistance.

Symptoms
Irregular  menstrual cycles
Periods can occur once in two to six months as opposed to a regular cycle of 28-30 days. A small percentage may have no periods at all and will need medication to induce them. They may have prolonged heavy periods, scanty flow or irregular flow.

Cosmetic problems
Girls face acne (20 per cent), hirsutism or increased hair growth (45– 70 per cent) and more rarely, male pattern hair loss.
Fertility issues
Women can present with difficulty in conceiving and an increase risk of miscarriages. Apart from this, they are also at risk of obesity, early diabetes (insulin resistance), high blood pressure, fatty liver, increased risk for cerebrovascular disease (strokes etc).  The lesser known associations are eating disorders, depression, endometrial cancer and sleep disorders.

Treatment
There is no cure but the symptoms can be treated. The mainstay of treatment is lifestyle changes. Regular moderate exercise and weight loss has been shown to improve the symptoms. Even a five percent weight reduction will help relieve symptoms.  Eating a healthy high fibre carbohydrate diet is recommended. Exercise and diet also lower the blood sugar levels and help to reduce the risk of diabetes. Smoking increases the androgen levels, so quitting smoking is important.

Drugs that are used in the treatment PCOS are the contraceptive pill to regularise periods and treat acne and hirsutism.  Fertility pills may have to be used to induce ovulation and assist reproduction. Metformin is used in women with insulin resistance and can also assist in weight loss.

Busting myths

• Women with PCOS cannot lose weight: Not entirely true. Weight loss may be harder for women with PCOS, but it’s not impossible. Many women with PCOS have a lowered sensitivity to insulin, a hormone that regulates sugar in the blood. This is known as insulin resistance, which is a risk factor for type 2 diabetes and may make it difficult to lose weight, even if you are following a healthy lifestyle. Seeking the help of a dietician and endocrinologist can help.
• You have to have ovarian cysts to have PCOS: Wrong.  It is a hormone imbalance which may or may not be associated with tiny follicles in the ovaries. 
• Irregular periods are caused by PCOS: Not true. PCOS is one cause of an irregular menstrual cycle, but there are other reasons.  A normal cycle ranges from 21–34 days.  Factors such as stress, thyroid disorders or other endocrine conditions, fibroids, or extreme dieting can also lead to an irregular cycle.
• You cannot get pregnant if you have PCOS: Not entirely true. Many women with PCOS can conceive on their own or with help from fertility treatments. Lifestyle changes and a healthier diet can improve chances of conceiving.

(The author is the director,  senior obstetrician and gynaecologist, Fortis La Femme Hospital, Richmond Road )