Polycystic ovarian syndrome (PCOS)
Polycystic ovarian syndrome is the most common hormonal disorder in women of reproductive age. PCOS can cause various symptoms such as absence or irregular period, increase in facial or body hair (hirsutism), weight gain or being overweight with difficulty of losing weight, oily skin with acne, hair loss (male- pattern baldness) and difficulty to conceive. Depression, anxiety and body perception issues and poor self- esteem are also very common with PCOS. Some women may have very few symptoms while others are more severely affected by a wider range of symptoms.
The exact cause of PCOS is unknown but studies have shown that it is possibly due to a combination of genetics and environment. PCOS often runs in the family and if you have other family members with PCOS, you are at higher risk of developing PCOS in the future.
In PCOS, there is an excessive production of a hormone by the pituitary gland called Luteinising Hormone (LH) in relation to another hormone called Follicle Stimulating Hormone (FHS) by more than thrice. Every once a month, the ovaries are supposed to make a structure called a follicle. As the follicle grows, it produces hormones. Then it releases an egg in the process called ovulation. In women with PCOS, the ovary makes many small follicles instead of one big one and it can disrupt the balance of hormones. Successful ovulation doesn’t happen every month the way it is supposed to. This is why women with PCOS tend to have infrequent or absent menses and can affect fertility. There is also an excessive production of male hormone (androgen) which can result in abnormal hair growth and acne formation.
In PCOS, there is an excessive insulin hormone production which helps to control blood sugar level and can cause the blood sugar level to be high. The body may not respond to insulin known as insulin resistance.
Having multiple cysts in the ovaries ('polycystic') doesn’t mean you have PCOS. A diagnosis is made when you have any of the following; irregular, infrequent periods or no periods at all , an increase in facial or body hair and/or blood tests that show higher testosterone levels than normal and an ultrasound scan that shows polycystic ovaries.
Your will need full check- up of your hormones to exclude other causes of irregular menses such as thyroid disorder, prolactinoma, Cushing and genetic disorders. You also need a check- up of your weight, BMI, blood pressure, waist circumference, glucose tolerance test and lipid check to screen for metabolic disorders.
PCOS is associated with metabolic syndrome. Metabolic syndrome is a group of risk factors for heart disease. You may have metabolic syndrome if you are overweight or obese, having high blood pressure, high blood glucose, high triglyceride (bad cholesterol) and low HDL (good cholesterol). The occurrence of metabolic syndrome in patients with PCOS is as high as 40%. PCOS and metabolic syndrome are interrelated through insulin resistance. Women with PCOS have a 5–10-fold increased risk of developing T2DM, compared to other women without PCOS. With each risk factor you have, your risk for heart disease goes up. If you have all of the risk factors, you are six times as likely to get heart disease.
If you have irregular menses, the lining of your womb (endometrium) will get abnormally thick and can undergo cancerous changes (hyperplasia) which is a precursor for development of endometrial (uterus) cancer.
PCOS with obesity can also increase your getting sleep apnoea which can lead to excessive daytime sleepiness, fatigue and decrease your attention and performance level. Obstructive sleep apnoea increases your risk of getting high blood pressure, heart attack and stroke
The treatment of PCOS is usually individualized to each patient’s presentation and desire to get pregnant. If patient is not keen to conceive, hormonal pills such as Dianette is used. Your doctor will also discuss other options such as use of progesterone pills to induce your period if you have not gotten menses for more than 3 months to prevent from abnormal thickening of the womb walls. Other treatment such as IUCD called Mirena can also be use.
Medication called Metformin is often used to treat PCOS to help with the insulin resistance. It can also help with the menses cycle and fertility issue. For women who keen to get pregnant, referral to a gynaecologist can be made for fertility assessment.
Treatment of acne involve use of topical cream, antibiotic and oral retinoid. Laser treatment and use of hormone pills such as Dianette can also help with the excessive hair growth.
Weight reduction through lifestyle modification have shown that even modest weight loss (10–20%) can help improve symptoms of PCOS such as menstrual irregularities, acne and hirsutism. A balance diet includes fruit and vegetables and whole foods (such as whole meal bread, whole-grain cereals, brown rice and whole-wheat pasta), lean meat, fish and chicken. You should also cut down the amount of sugar, salt and caffeine that you eat and drink. Try reducing the unnecessary calories intake by skipping desserts, snacking or high caloric foods such as fried foods. Try to eat a lot more fish which has a lot more omega 3 fatty acids are healthier than red meat. You can also switch to using olive oil and coconut oil which are healthier alternative.
It is recommended to get at least 150 minutes of exercises every week. Not being active is the biggest risk factor for heart disease. If you don’t already exercise, start by walking for five minutes every day. Once you are walking regularly, you should slowly increase how fast and how far you walk. Eventually you should walk for 30 to 60 minutes at least five days a week. If you already exercise this much, consider adding resistance exercises to build muscle strength.
There is no cure for PCOS. PCOS is a life-long illness. Medical treatments aim is to manage and reduce the symptoms or consequences of having PCOS. Medication alone has not been shown to be any better than healthy lifestyle changes (weight loss and exercise). Many women with PCOS successfully manage their symptoms and long-term health risks without medical intervention. They do this by eating a healthy diet, exercising regularly and maintaining a healthy lifestyle.
if you have any further questions regarding PCOS, talk to our experienced medical doctor for more information.
