Polycystic ovary syndrome (PCOS)

June 29, 2020by Health Desk

Learning that you have a diagnosis of a chronic condition like PCOS can never be easy. There may be many changes in your daily life owing to overwhelming symptoms of the condition. The psychological impact of PCOS can have decreased health-related quality of life, in part related to depression and anxiety. 

You are not alone on this journey. As many as 5 million to 12 of US women of reproductive age are affected with PCOS and it is estimated by WHO that PCOS has affected 116 million women worldwide in 2012.

PCOS is a complex condition arising from the interaction of genetic and environmental factors. Women with PCOS have hormonal imbalance and metabolism. The symptoms experienced are irregular menstrual cycles, acne, overweight or obesity, excessive hair growth on unexpected areas of the body, loss of scalp hair, abnormal bleeding such as heavy bleeding during periods or bleeding in between monthly periods.

The diagnosis of PCOS also has lifelong implications with increased risk for metabolic syndrome, type 2 diabetes mellitus, cardiovascular disease, uterine cancer, sleep apnea, depression, and anxiety. Women with PCOS have infrequent ovulation and, therefore, take longer to conceive. 

Normally androgens or male hormones are produced in women’s ovaries in small amounts. In PCOS the ovaries produce an excess amount of androgens that cause infrequent or irregular ovulation, excessive hair growth on unexpected areas of the body. This also causes multiple small cysts on the ovaries, hence the name polycystic ovary syndrome.

About one-half of women with PCOS have insulin resistance which not only leads to diabetes mellitus but stimulates the excess secretion of androgens, and fat accumulation.

The mainstay of treatment for women with PCOS who are not pursuing pregnancy is combined estrogen-progestin contraceptives. Combined estrogen-progestin contraceptives manage excess androgen, menstrual dysfunction and provide contraception. These combination contraceptives come as pills, skin patches, or vaginal rings. The alternative treatment for women who choose not to or cannot take combination contraceptives is progestin therapy.

The ovulation induction treatment options for women pursuing pregnancy are clomiphene, letrozole, gonadotropins. Metformin is added if you don’t become pregnant using clomiphene alone.

Spironolactone, eflornithine, electrolysis are also used for excessive hair growth.

Weight reduction through lifestyle interventions such as diet, exercise, and behavioral interventions improves insulin resistance, androgen levels and also appears to have reproductive benefits. With the advice from your doctor/dietitian, choose a low-carbohydrate diet.

Despite the increased risks for complications in PCOS, they are preventable with positive changes in your diet, exercise plans and adhering to the treatment regimen as prescribed by your doctor.