An established reproductive disorder

PCOS is a gynaecological hormonal disorder, which affects around 10% of women in their reproductive age

KOCHI: Medical science is still unsure as to what causes Polycystic Ovarian Syndrome (PCOS). But we do know that PCOS is a hormonal disorder that is genetically determined and environmentally controlled. It is associated with irregular periods, leading to infertility and raised androgen levels (male hormone), leading to acne, facial hair, loss of scalp hair and enlarged ovaries with multiple follicles. Around 80 per cent of women suffering from PCOS are obese and are known to have Insulin Resistance (IR) (lack of insulin hormone), which manifests as diabetes, hypertension, high cholesterol and obesity. IR is also known to be present in 25 per cent of lean PCOS women. It is an incurable, life-long condition, but can be definitely kept under check.

Treatment

Lifestyle modification is the first-line treatment for PCOS. A low-calorie diet and regular exercise is key to weight loss, which can improve fertility, regularise periods and reduce insulin and androgen levels. A weight control program with regular aerobic exercises, preferably under a nutritionist’s guidance, is recommended.

Birth control pills: These can be used in women who don’t want to get pregnant. The pills regulate periods and correct excessive hair growth and acne by reducing the male hormone. They also help to reduce excessive blood loss in women who bleed heavily after two to three months of no period.

Insulin sensitizing drugs: Drugs that lower insulin levels include metformin and inositols. Metformin promotes fertility and regularises periods promotes weight loss with exercise and improves insulin sensitivity. It can be safely used in women desirous of childbearing as it prevents miscarriages, gestational diabetes and high blood pressure during pregnancy.

Ovulation inducing drugs: These are the medications that help infertile women release an egg every month, especially in those who have irregular periods. Anti-male hormones drugs/ anti-androgens: These are used when the androgen levels are high or women have symptoms of excessive facial hair or loss of scalp hair or excessive acne.

The author is the director of Gynaecworld the Center for Women’s Health & Fertility, Consultant, Breach Candy Hospital, Jaslok Hospital

Diagnosis

• A detailed history of periods, weight gain, hair growth, acne, hair loss on the scalp and pigmentation reveals PCOS. Blood investigations and ultrasound is also conducted. If a woman above 18 years of age has at least two of the following criteria present, then she is diagnosed as having PCOS.
• Less than eight menstruation cycles annually
• Lab evidence of increased male hormones
• Polycystic or enlarged ovaries above 10ml each on ultrasound.