One in every 10 women in India has polycystic ovary syndrome (PCOS), a common endocrinal system disorder among women of reproductive age, according to a study by PCOS Society. And out of every 10 women diagnosed with PCOS, six are teenage girls.
PCOS was described as early as 1935. However, even today there is a general lack of awareness regarding the condition in India and it often remains undetected for years. This health condition is estimated to affect about 10 million women globally.
WHAT IS PCOS? : Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be.
PCOS can cause missed or irregular menstrual periods. Irregular periods can lead to:
1. Infertility (inability to get pregnant). In fact, PCOS is one of the most common causes of female infertility.
2. Development of cysts (small fluid-filled sacs) in the ovaries
RISK GROUPS : Between 5% and 10% of women of childbearing age (between 15 and 44) have PCOS.1 Most often, women find out they have PCOS in their 20s and 30s, when they have problems getting pregnant and see their doctor. But PCOS can happen at any age after puberty.2
Women of all races and ethnicities are at risk for PCOS, but your risk for PCOS may be higher if you are obese or if you have a mother, sister, or aunt with PCOS.
SYMPTOMS OF PCOS : Some of the symptoms of PCOS include:
1. Irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods.
2. Too much hair on the face, chin, or parts of the body where men usually have hair. This is called “hirsutism.” Hirsutism affects up to 70% of women with PCOS.
3. Acne on the face, chest, and upper back
4. Thinning hair or hair loss on the scalp; male-pattern baldness
5. Weight gain or difficulty losing weight
Darkening of skin, particularly along neck creases, in the groin, and underneath breasts
6. Skin tags, which are small excess flaps of skin in the armpits or neck area
CAUSE OF PCOS : The exact cause of PCOS is not known. Most experts think that several factors, including genetics, play a role:
1. High levels of androgens. Androgens are sometimes called “male hormones,” although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness. Women with PCOS have more androgens than estrogens. Estrogens are also called “female hormones.” Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS.
- High levels of insulin. Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who are overweight or obese, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.
MEDICINES FOR PCOS : There is no permanent cure for PCOS. However, its symptoms are manageable. The types of medicines that treat PCOS and its symptoms include:
1. Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormone intrauterine device (IUD). For women who don’t want to get pregnant, hormonal birth control can:
- Make your menstrual cycle more regular
- Lower your risk of endometrial cancer
- Help improve acne and reduce extra hair on the face and body (Ask your doctor about birth control with both estrogen and progesterone.)
- Anti-androgen medicines. These medicines block the effect of androgens and can help reduce scalp hair loss, facial and body hair growth, and acne. They are not approved by the Food and Drug Administration (FDA) to treat PCOS symptoms. These medicines can also cause problems during pregnancy.
- Metformin. Metformin is often used to treat type 2 diabetes and may help some women with PCOS symptoms. It is not approved by the FDA to treat PCOS symptoms. Metformin improves insulin’s ability to lower your blood sugar and can lower both insulin and androgen levels. After a few months of use, metformin may help restart ovulation, but it usually has little effect on acne and extra hair on the face or body. Recent research shows that metformin may have other positive effects, including lowering body mass and improving cholesterol levels.
RECENT STUDIES :
- The Endocrine Society issued a Clinical Practice Guideline (CPG) for the diagnosis and treatment of polycystic ovary syndrome, the most common hormone disorder in women of reproductive age and a leading cause of infertility. In the CPG, The Endocrine Society recommends that a diagnosis be made if adult women have two of the three cardinal features of PCOS (diagnostic criteria supported by the NIH panel):
• Excess production of male hormones called androgens.
• Anovulation, a condition where the ovary does not release a mature egg each month. This causes irregular menstrual cycles.
• The formation of clusters of pearl-size cysts containing immature eggs in the ovaries, which is called polycystic ovaries.
- Women with PCOS are at increased risk for endometrial cancer, whereas their risks for breast and ovarian cancer are similar to those of women in the general population. Our finding that women with PCOS also are at increased risk for cancers of the kidney, colon and brain requires further study.
- Vitamin D and calcium supplementation in addition to metformin therapy in women with PCOS could result in a better outcome in a variety of PCOS symptoms including menstrual regularity, and ovulation.
- As the prevalence of these endocrine dysfunctions increases, the association of polycystic ovary syndrome (PCOS) and autoimmune thyroid disease is increasingly being recognised. While the causality of this association is still uncertain, the two conditions share a bidirectional relationship. The exact nature of this link has not been elucidated yet.
LONG TERM HEALTH RISKS : PCOS affects all areas of the body and not just the reproductive systems. Insulin resistance increases the chance of the metabolic syndrome, which means that there is a much higher chance of developing diabetes mellitus, heart disease, obesity, hypertension and increased levels of cholesterol. The lining of the uterus (lining of the womb), called the endometrium tends to become thicker with time. This is called hyperplasia and can lead to cancer of the endometrium. Depression, mood swings, day time drowsiness and snoring are also linked to the effects of PCOS.
EATING RIGHT : Experts agree that eating right can help control insulin levels, make one feel better, keep the heart healthy, lower the risk of getting diabetes and help losing weight. Include fruits, vegetables and whole foods (like whole meal bread, whole grain cereals, brown rice etc) in your diet. Choose lean meat, chicken and fish over red meat. Avoid excess sugar, salt, caffeine, alcohol and smoking. Have regular meals.