Be prepared to tackle Polycystic Ovarian Syndrome

Twenty-one-year-old Riya, an IT professional, was excited to start her newly married life. But, she always had irregular periods.

CHENNAI: Twenty-one-year-old Riya, an IT professional, was excited to start her newly married life. But, she always had irregular periods. What made it worse was her perennial condition of pimples and excessive facial hair growth. Despite trying several treatments, her skin refused to heal. Now her biggest fear is that she may not conceive as she gets her periods only once in four months. 
Riya is one of the many women who are battling the problem of Polycystic Ovarian Syndrome or PCOS. 
Symptoms of PCOS?

• Irregular periods: PCOS is typically earmarked by irregular periods, either infrequently or too frequently, sometimes no periods at all. 
• Infertility: Polycystic ovaries fail to regularly release eggs leading to infertility.
• Obesity: Incidence of obesity is as high as 80% in PCOS-troubled women. 
• Acne: Because it is associated with PCOS, acne does not respond to treatment.
• Excessive unwanted hair: This condition, called hirsutism, is caused by increased androgen levels leading to unwanted hair on face, chest and upper thighs. 
• Acanthosis nigricans: Thickened, velvety, darkened skin is commonly seen around the neck region and is due to insulin resistance.
• Male pattern baldness: Women may typically experience thinning of hair in the frontal region due to androgen excess.
• USG shows multiple small collection of follicles which have failed to ovulate, giving the appearance of polycystic ovaries. 

Blame the lifestyle
Though the disorder is not new, it is increasing at a dizzying rate. Obesity is one of the main reasons that PCOS is on the rise. Most youngsters eat processed and junk food which leads to quick weight gain. Add strenuous academic and working hours to that, and they are left with no time to exercise. 

What is insulin resistance?
Insulin is a hormone produced in the pancreas that allows cells to use sugar, which is the body’s primary energy supply. If cells become resistant to the action of insulin, then the blood sugar levels can rise and the body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation. 

Does a USG showing polycystic ovaries mean I have this disease?
No, a USG finding of polycystic ovaries without other symptoms cannot be labelled as PCOS. A woman with PCOS should have two or more of the following criteria:
Irregular or infrequent periods, but still 20% of PCOS women might have regular cycles. 
Signs of increased androgen in the form of acne, hirsutism or blood tests revealing increased androgen levels. 
Scans showing polycystic ovaries.
Are treatment options available?
Yes. Treatment is tailored to each woman according to her symptoms and whether she wants to become pregnant. Because of the chronic nature of the condition, lifelong management is necessary. Certain drugs aid in weight loss, restore androgen levels and improve sensitivity to fertility drugs. 
How do oral contraceptive pills help?
Contraceptive pills are a combination of estrogen and progesterone and possess anti-androgenic properties. They are used to regulate periods and reduce hirsutism and acne by reducing androgen levels. It should be noted that cycles are regulated for the patient’s sense of well-being and there is no necessity to treat for ‘30 days cycle’ as long as the periods occur sufficiently often.  
Is weight loss the answer?
Yes. For overweight women, weight loss is the most effective method of restoring ovulation and menstruation. Even a small amount of weight loss can be helpful in making your periods more regular. 

Eat the right food
Healthy eating plays a big role in PCOS. Stop radical eating. Include plenty of fruits and vegetables. Cut down on sugar, white bread, maida, potatoes, oily and junk food. Replace them with high fibre-, carbohydrate- and protein-rich foods. 
What if PCOS is not treated?
PCOS can lead to long-time consequences which include increased risk of developing Type II diabetes mellitus, cardiovascular disease and high cholesterol levels. PCOS women tend to have endometrial hyperplasia, a condition in which the inner lining of the uterus is thickened. This can predispose to the development of endometrial cancer. 
Consult your gynaecologist now if you have any of the above symptoms.
(The writer is a consultant endogynaecologist at GEM Hospital, Chennai)