A Guide to PCOS
Polycystic Ovarian Syndrome (PCOS) is a disorder that mainly affects women of reproductive age. In India, it has a prevalence rate of 3.7 to 22.5 percent. Menstrual abnormalities and excess androgen are the hallmarks of this condition. Women with PCOS are at risk of obesity, type II diabetes mellitus, insulin resistance, cardiovascular diseases, cancer, infertility, and psychological disorders. Polycystic ovaries contain several follicles which are 8 mm in size contained in underdeveloped sacs, which are unable to release an egg, resulting in lack of ovulation and infertility. This guide will shed light on what this disorder is, and what an individual can do to prevent, treat and live with it, with the help of the Zury app, without affecting the quality of one’s life.
Causes and risk factors
PCOS typically affects women in the age group of 15 to 44 years, though it mainly affects women in the second and third decades of their life. Race or ethnicity are not related with an increased risk of PCOS. The risk of PCOS is higher in those individuals who have someone in the family with PCOS or are obese. There is no clear cause for PCOS. Abnormal hormonal levels like insulin and androgen (male hormones) can result in PCOS.
Nature of PCOS
The female hormones estrogen and progesterone, produced by the ovaries, are vital for follicular development. Follicles are nothing but eggs contained within a fluid-filled pocket inside the ovaries. Androgen testosterone is also produced in small quantities by the ovaries. In women with PCOS, testosterone is produced in higher quantities, failing the release of the egg. These follicles multiply with the eggs, due to failure of releasing them, which results in multiple cysts (polycystic). This also results in problems with fertility. As the lining of the uterus is not shed, due to this hormonal change, the risk of development of cancer can arise. Due to the rise in androgen levels, an increase in masculine features like acne and increased growth of hair at unusual regions like the upper lip, jawline, armpits etc. are seen. Along with increased androgen levels, insulin levels are also high. This results in the risk of developing obesity, heart diseases, diabetes, and high blood pressure.
PCOS will be diagnosed with a history taking, physical examination, and other investigations.
- Physical exam- In this, the physician will inspect for any changes in blood pressure, weight, skin(acne), hair growth, and an enlarged thyroid.
- Pelvic exam- This will be done to rule out signs like enlargement of ovaries or enlarged clitoris.
- Pelvic ultrasound (sonogram)- This test checks ovaries for the presence of cysts and the thickening of the endometrium.
- Blood tests- These will be done to check androgen, insulin, cholesterol levels and thyroid test to rule out any thyroid disease which may mimic PCOS symptoms.
- Irregular periods
- Increased androgen levels like extra hair growth (hirsutism), acne or thinning of scalp hair
- Presence of several cysts in the ovaries.
Symptoms of PCOS vary in women. They are as follows:
- Irregular periods
- Increased facial and body hair (hirsutism)
- Thinning of hair on the head
- Issues with fertility
PCOS is not curable. However, managing its symptoms and preventing complications are the mainstay treatment.
- Normalization of menstrual cycle (Hormonal treatment): Treatment varies whether the individual wishes to get pregnant. Restoration of the menstrual cycle can reduce cancer risk. This can be done by supplementations of progesterone or birth control pills containing both estrogen and progesterone. These hormones help reduce the workload of the ovaries and decrease androgen production.
- Treatment of fertility issues: Clomiphene citrate is paramount in assisting the ovary in releasing eggs.
- Cosmetic treatment: Physical features of excessive hair growth and acne can be reduced with this treatment. Cosmetic surgery or anti-androgen medication can be employed by some women to get rid of unwanted hair.
- Prevention of complications: Prevention of obesity, diabetes, and heart disease need to be done via weight loss, exercise, and diet. Oral blood sugar lowering medications may also be prescribed to combat diabetes and reduce testosterone levels and return normal menstrual cycles and fertility. Other conditions like high blood pressure, high cholesterol, or diabetes should be treated, if present.
- Surgical management: Surgery, involving removal of a section of the ovary (wedge resection), or ovarian drilling, maybe rarely done to reduce the number of androgen hormones.
Screening recommendations with PCOS
Screening recommendations as per the Royal College of Obstetricians and for individuals with PCOS are as follows. These are essential to identify morbidities.
- Type II diabetes mellitus: Women with PCOS should be screened for type II diabetes mellitus every 3-5 years or once a year if risk factors are present.
- Cardiovascular diseases (CVD): To avoid CVD complications assessment of body weight, BMI, blood pressure, cigarette smoking, and lipid profile which includes testing for cholesterol is essential for hypertension (high blood pressure) and dyslipidemia (abnormal cholesterol and lipid levels) evaluation.
- Psychological Well-being: For women with PCOS, psychological screening will include screening for depression, anxiety, eating disorders, negative body image, and psychosexual dysfunction.
- Cancer: In cases of irregular menstruation, an ultrasound scan of the uterus may be advised to rule out cancer of the uterus.
Complications of PCOS
Women with PCOS are at risk for developing other disease conditions which are as follows.
- Diabetes- Almost half of the women with PCOS will develop type 2 diabetes before the age of 40. Gestational diabetes (diabetes during pregnancy) may risk both the mother and child.
- Cardiovascular diseases (CVD)- This is more common in women with PCOS and their risk for stroke and other heart diseases increases manifold due to PCOS. High blood pressure, which is also seen in PCOS, can further increase the chance of CVD.
- Sleep Apnoea -
- Depression and anxiety- These are commonly seen in women with PCOS.
Endometrial cancer- Women with PCOS have an increased risk of developing cancer of the lining of the uterus (endometrium), due to complications with obesity, insulin resistance, ovulation, and diabetes.
Lifestyle changes to manage PCOS
Lifestyle changes are essential to manage one’s weight and keep complications of PCOS at bay. The Zury app plays an essential role in this, especially for women who want to talk about what they are going through during their PCOS journey. This app lends a platform to women with PCOS to access diet plans, workout regimes, period trackers, and logs to body transformation, which helps women keep track of their progress. As insulin resistance is commonly seen in women with PCOS, it is recommended to avoid sugars and simple carbohydrates.
Lifestyle changes beyond working out and mindful eating
Weight management plays an essential part in PCOS. Apart from diet and exercise, it is vital to remember that our mind plays an important part in making us feel good about ourselves. Cultivating mindfulness can be done in the following ways.
- Practicing positive self-talk- This will aid to a happier you and a positive self-image.
- Listening to one’s body- Know when to take a break to prevent burnout.
- Awareness of the digital world- Do not be sucked into marketing strategies of body shaming and be mindful of what you watch and follow.
- Pampering oneself- will help improve one’s morale.
- Communicating- about our self-image, expectations, and feelings. Support groups can help.
Alternative medicine in PCOS
Alternative or complementary medicine has been seen to have a role in PCOS. Acupuncture which involves the insertion of fine needles into specific areas on the skin helps in regulation and normalizing periods. Along with this, reduction of weight, headaches, improvement of mood, and outlook of the patient has been seen to occur in women with PCOS, after acupuncture.
Symptoms of PCOS may improve with appropriate treatment. This condition will last till menopause. However, it is essential to keep complications of diabetes, heart disease at bay by taking necessary precautions throughout one’s life.
PCOS is a conundrum due to its enigmatic nature. As most treatments have been directed towards its symptoms and not the syndrome per se, no treatment can be considered as an answer. It is vital to remember that you are not alone in this and with the right blend of diet, exercise, screening, and treatment, available on the Zury app, you can live a normal life with an improved quality of living.
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