Frequently Asked Questions On Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome or PCOS is a hormonal disorder that commonly affects women of childbearing age. It may result in the development of multiple small cysts located in ovaries. These small cysts are not harmful, however can affect the natural ability of ovaries to release eggs regularly. The release of eggs is a crucial component of the menstrual cycle, and PCOS can influence this process, leading to irregularities and missed periods in women.

There is no clear evidence of the exact causes of PCOS. However, it is estimated that several environmental and genetic factors contribute to PCOS. Insulin resistance plays a crucial role in PCOS. The body’s cells do not respond to insulin effectively in insulin resistance, this ultimately results in higher levels of insulin that may lead to increased production of androgens (male hormones that are present in both men and women) in women. This hormonal imbalance results in PCOS.

There are various manifestations of PCOS, but all women do not experience these symptoms. About 70% of cases remained undiagnosed. Common signs and symptoms of PCOS are described as follows:

• Dysfunction in ovulation
• Irregular menstrual cycle
• Excessive hair growth on the chin and face areas (Hirsutism)
• Oily skin and acne problems
• Fluctuation in weight (Weight gain is a serious concern for women with PCOS, and it is challenging for them to lose weight)
• Thinning of hairs
• Darkening of skin (Darkened and thickened skin in body creases known as Acanthosis nigricans)

Symptoms of PCOS vary from person to person, hence, a thorough evaluation rules out irrelevant conditions and confirms the presence of PCOS in women. Diagnosis by healthcare professionals, common tests, and evaluations of PCOS include:

Medical History and Physical Examination

Discussion on medical history and problems related to menstrual cycles, including changes in weight, hair growth, and irregular periods, immediately in the first instance.

Blood Tests

The analysis of blood hormonal levels provides valuable information for healthcare professionals. The primary focus is on assessing elevated levels of male hormones, particularly androgens such as testosterone, in addition to other pivotal hormones like follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Given the association between insulin resistance and PCOS, there is a necessity to screen blood glucose levels as part of the comprehensive evaluation.

Transvaginal Ultrasound

The diagnostic procedure of transvaginal ultrasound is employed to examine the ovaries, involving the insertion of a small probe into the vagina to capture images. Ultrasound revealing multiple small cysts on the ovaries is a key characteristic of PCOS.

Diagnostic Criteria

Rotterdam criteria is commonly used to diagnose PCOS. According to these criteria, if at least two out of the following three features are present, a diagnosis of PCOS can be establishedfg:

1. Absent or irregular menstrual cycles.
2. Biochemical or clinical signs of hyperandrogenism (higher levels of androgen or symptoms like acne or hirsutism).
3. Ultrasound shows polycystic ovaries.

A common misconception is that women with PCOS cannot get pregnant. While, PCOS can impact fertility through various mechanisms, majority of women can achieve pregnancy with simple lifestyle interventions and medical treatments. Here are some ways in which PCOS affects fertility:

Ovulatory Dysfunction: The complete absence or irregularity of menstrual cycles indicates irregular ovulation, a common occurrence in PCOS. Ovulation dysfunction in PCOS can pose a challenge for estimating the fertile window, as irregular cycles make it difficult to predict when ovulation is likely to occur. Approximately 90–95% of PCOS women seek infertility treatment.

Hormonal Imbalances in PCOS: Women with PCOS often exhibit elevated levels of luteinizing hormone, androgens (including testosterone, dehydroepiandrosterone, and androstenedione) and insulin and reduced levels of follicle-stimulating hormone (FSH).

Menstrual Irregularities: Imbalances in hormones can lead to oligomenorrhea or amenorrhea, characterized by infrequent or absent menstruation.

Pregnancy Risks in PCOS: Women with PCOS who become pregnant face an increased risk of developing gestational diabetes mellitus and experiencing a first-trimester spontaneous abortion.

While there is no definitive method to prevent or completely cure PCOS. However,  adopting simple lifestyle changes can be very effecting in mitigating the symptoms of PCOS. Incorporating a nutritious diet, engaging in regular exercise, and maintaining a healthy body weight can be beneficial in minimizing the impact of PCOS.

PCOS is a multi-systemic health condition that can be managed effectively by available treatment strategies.
Lifestyle Modifications

• Diet and Exercise: Menstrual cycles can be regulated, and reduction in the symptoms of PCOS and improvement in insulin sensitivity can be made by taking a balanced diet along with regular physical activity, ultimately leading to a healthy weight.
• Stress Management: Stress can worsen the symptoms of PCOS. Stress reduction techniques can be helpful in the management of PCOS. Mindfulness and relaxation exercises are beneficial in this regard.

Medications

• Birth Control Pills: Hormonal contraceptives regulate menstrual cycles. These medications reduce the androgen levels and improve the problems like hirsutism and acne.
• Anti-Androgen Medications: These medications help improving the hormonal imbalance. Spironolactone is one of the anti-androgen medications that reduces acne and excessive hair growth.
• Metformin: Metformin is prescribed for women experiencing symptoms of insulin resistance, as it has the potential to enhance insulin sensitivity
• Fertility Medications: Clomiphene may be prescribed to induce ovulation, serving as a fertility drug specifically recommended for women actively seeking to conceive..
  Nutritional Support
  PCOS symptoms can be managed by incorporating a healthy diet plan provided by a registered dietitian. These dietary changes can help to promote hormonal balance and control blood sugar levels.
  Surgical Interventions
  Surgical interventions are seldom considered; however, one such procedure is ovarian drilling, a method that involves inducing ovulation by creating small holes in the ovaries.

Right strategies and support can help women with Polycystic Ovary Syndrome (PCOS) to manage their symptoms effectively, leading to a healthier and more fulfilling life. PCOS is a challenge but can be managed using the correct treatment plans.

Tips for Managing Symptoms and Maintaining a Healthy Lifestyle:

Balanced Diet: Weight management is a critical aspect of PCOS management. A well-balanced diet helps to stabilise sugar levels in the blood. A dietary plan consisting of complete nutrients like whole foods, vegetables, whole grains, lean proteins, and plenty of fruits is the key to managing weight.

Regular Exercise: Exercise promotes weight loss, regulates menstrual cycles, and improves insulin sensitivity. At least 150 minutes of moderate exercise in a whole week must be done to improve the lifestyle with PCOS.

Stress Management: PCOS symptoms can be intensified with chronic stress. Meditation, yoga, or deep breathing exercises are some stress reduction techniques. Incorporation of these techniques into your daily routine can improve stress.

Regular Check-Ups: Monitor your PCOS and overall health condition by scheduling appointments with your healthcare provider. Make sure to complete follow-up visits to your doctor. Early interventions and individualised treatment plans by healthcare providers are essential for managing and treating PCOS.

Medication Adherence: Strict adherence to the prescribed dosage and schedule is essential when your healthcare provider has recommended insulin-sensitizing drugs or birth control pills.

Hair Removal Options: Excessive hair growth can be removed by considering hair removal methods like laser hair removal, shaving, or waxing, according to the consultation provided by your dermatologist.

Skin Care: Seek specialist advice and manage acne problems by following a skincare routine, including non-comedogenic products and gentle cleansing.

Fertility Support: Consulting with a fertility specialist can provide valuable guidance on fertility treatments, such as ovulation induction, especially if you are actively seeking to conceive..