Polycystic Ovarian Syndrome (PCOS/PCOD)

PCOS- what is it?

PCOS stands for Polycystic ovary syndrome.  It is one of the most common hormonal disorders in women of child bearing age.

Cause:

PCOS occurs in women only and generally starts at around puberty. It occurs in upto 10% of all women. The exact cause of PCOS is not yet known but it occurs due to a combination of genetic and environmental factors. It is thought to develop due to hormonal imbalance- high male hormone levels, insulin resistance and raised insulin level.

What are its symptoms?

  • Menstrual problems- Periods are irregular or sometimes absent. Some patients get heavy bleeding.
  • Acne- PCOS patients get severe acne on face (especially jawline and lower half of face), chest, shoulders, back. These often do not respond to the conventional acne treatments and have to be given hormonal treatment.
  • Hirsutism- the hormone imbalance in PCOS causes excess hair growth leading to thicker and darker facial hair and more hair on the chest, belly, and back.
  • Alopecia- PCOS patients often develop female pattern hairloss.
  • Skin tags
  • Cysts in ovaries detectable by ultrasound of pelvis.
  • Infertility due to decreased or no egg production by ovaries. The rate of miscarriage is also higher in PCOS cases.
  • Obesity– Nearly half of all women with PCOS are clinically obese.
  • Increased muscle mass, voice deepening in severe cases.
  • Diabetes, Hypertension (High blood pressure), Elevated blood fats (hyperlipidaemia), Cardiovascular disease especially coronary artery disease.

 It was once thought to be only due to an ovarian defect as it was associated with enlarged polycystic ovaries, hence its name polycystic ovary syndrome. However, it is now known that PCOS may occur in women with normal sized ovaries and polycystic ovarian changes can be found in women with normal menstrual cycles.

How is it diagnosed?

If the doctor is suspicious of PCOS, certain tests have to be done. These include Hormone levels (FSH, LH, Prolactin, Testesterone, 17 hydoxyprogesterone, DHEAS, Insulin level, cortisol, thyroid hormones), Blood sugar, Ultrasonography of pelvis, Lipid profile. These tests help doctor to rule out other causes of hormonal imbalance which can mimic PCOS. They also help in the line of treatment and its monitoring.

How is PCOS treated?

The management of PCOS has to be tailor made for each patient according to the symptoms the patient exhibits and the results of the test.

Lifestyle modification:-

 Weight loss through a low-calorie diet combined with moderate exercise activities is the first recommendation of the doctor. This helps in decreasing the insulin resistance and also reduces the cardiac and diabetic complications.

Drugs:-

The drugs prescribed will depend on the test results and the symptoms of patient.

Oral contraceptive pills (OCP) are often prescribed to PCOS patients for about 6-12 cycles. These are given not to prevent pregnancy but to streamline menstrual periods and hormone levels.

Metformin is prescribed to decrease insulin resistance.

Other commonly prescribed drugs to control the effects of hormone imbalance include Spironolactone, Cyproterone acetate etc. Any hormone deficiency or excess are controlled with drugs.

Acne is treated with regular acne medications in addition to the hormonal treatment.

Laser hair reduction to reduce unwanted hair is often required.

Drugs may also have to be given to treat infertility.

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