The full form of PCOS is Polycystic Ovarian Syndrome. It is the most common endocrine problem faced by women all over the world. However, many women do not wish to talk about this PCOS problem and so awareness becomes a major concern. Many women have questions about this syndrome, like - what exactly is PCOS? Can women with PCOS get pregnant? Is PCOS a serious problem? Is PCOS curable? These are all pertinent questions and awareness can help people, especially women, to take care of their health and seek treatment when necessary. In India, 9.13% to 36% of women of reproductive ages suffer from PCOS.
PCOS is not just a condition of the ovaries, it also has an effect on many hormones of the body. In this article, we try to answer the main questions about PCOS and try to create awareness among the general population about this common syndrome.
This disease is not as dangerous as it sounds if you follow the recommended treatment of PCOS properly. Let us first understand the female hormonal system.
PCOS is said to be present if any two of the following three criteria are fulfilled:
â— Irregular periods
â— Symptoms or blood tests showing an excess of male hormones
â— Polycystic ovaries
The ovary releases the hormones Estrogen and Progesterone in response to the hormones released by the anterior pituitary gland - follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The hypothalamus releases the hormone gonadotropin-releasing hormone (GnRH), which stimulates the anterior pituitary gland to release the two female sex hormones.
Females, too, have male sex hormones. The ovary secretes a lot of testosterone, actually more than oestrogen. However, it then converts this testosterone to oestrogen. Hence, it is safe to say that women have to be able to make testosterone since, without that, they would not have any oestrogen.
The levels of all these hormones have to be well regulated to form a balance for the body to function properly. PCOS is a condition affected by multiple factors and depends on the presence of various genes. It is essential to know that there is a difference between having a Polycystic Ovary and being affected by the PCOS.
PCOS is said to be present if any two of the following three criteria are fulfilled:
â— Irregular periods
â— Symptoms or blood tests showing an excess of male hormones
â— Polycystic ovaries
It is seen that one in four women have a polycystic ovary. If there are no symptoms of PCOS, then this condition of Polycystic Ovaries is considered normal.
History of PCOS -
PCOS is also known as the Stein-Leventhal syndrome as the Stein and Leventhal are believed to have discovered this syndrome. However, there is evidence of scientists before them describing clinical situations resembling those of PCOS. It can be safely said that PCOS is not a new disease, though it is true that its incidence among the population is increasing with passing years.
PCOS has continued to puzzle researchers and scientists for years now, and yet no particular cause(s) or factor(s) has been proven to cause this syndrome. Research still continues to search for an absolute treatment of PCOS.
Types -
There are four types of PCOS:-
â— Insulin-resistant PCOS
â—‹ This is one of the most common types of PCOS problems faced by women
â—‹ Its development is linked to smoking, pollution, excess consumption of sugar and trans fat in the diet
â—‹ Increased amounts of sugar in the body leads to increased levels of insulin and also adds to your weight
â—‹ In this type of PCOS, insulin blocks the ovaries from producing eggs and, in turn, stimulates them to secrete androgens
â— Pill-induced PCOS
â—‹ This is the second most common type of PCOS
â—‹ It results from taking contraceptive pills that suppress ovulation
â—‹ In most women, this effect lasts for as long as the pill works on the ovaries, after which they can go back to ovulating normally. However, some women cannot revert to their normal functioning of ovaries even after the pills have lost their effect
â—‹ Irregular periods before consumption of any contraceptive pills is a sure sign of pill-induced PCOS
â— Inflammatory PCOS
â—‹ Stress is a huge factor in inflammatory PCOS along with other causes like environmental toxins and dietary inflammatory agents like gluten
â—‹ Due to inflammation, the ovaries are unable to produce eggs and start secreting excess amount of androgens
â— Hidden PCOS
â—‹ This occurs as a result of other diseases such as thyroid diseases, iodine deficiency, vegetarian diet, and artificial sweeteners.
â—‹ The cause is not well established and hence is named hidden PCOS
â—‹ It is diagnosed once all other forms of PCOS are excluded from the diagnosis
There are several symptoms -
Menstrual abnormalities - It is said that a girl becomes a woman when she starts getting her periods. It marks the start of her ovaries producing eggs, a potential life-form. Ovulation is the process of production of an egg by a mature follicle in the ovary. After releasing the egg, this follicle remains in the ovary as “corpus luteum” which produces the hormones - estrogen, and progesterone to prepare her uterus for a baby. If pregnancy does not occur, this follicle dies after 14 days. This entire process is called a menstrual cycle, which is usually 28 days but can vary from 21 to 35, sometimes even 45 days.
Increasing Obesity - Obesity is interconnected with PCOS in a way that acts as a factor for its development and is a result of the syndrome itself. Since PCOS is strongly related to insulin resistance, the effects of the latter cannot be ignored. Insulin helps the body absorb glucose for the production of energy and its failure to do so results in high levels of glucose in the blood. This makes it easy for a woman with PCOS to gain weight and difficult to lose it. Insulin resistance is characterized by a high Body Mass Index (BMI) (<25 kg/ sq.m) and a waist:hip ratio >0.85.
Infertility - Fertility is the ability to be able to reproduce; that is, bring your own baby into this world. Ovaries play a massive role in this since they produce the egg, which in turn produces the baby when fused with the sperm from a male.
In PCOS, it is quite rare for only one ovary to be affected. With both ovaries being unable to produce eggs, women affected with PCOS have a tendency to be infertile.
Increased hair growth on the body - Hirsutism is a condition in women where thick hair grows in areas like the face, shoulders, chest, and back. Such areas are supposed to be reserved for the males to grow their beards or flaunt their chest hair! However, women with PCOS have a hormonal imbalance in their bodies, which makes the receptors on these hair follicles sensitive to potent male hormones.
Weight Loss
The method of choice for the treatment of PCOS and the resulting infertility is weight loss. Excess body fat in women with PCOS increases the chances of complications by increasing insulin and androgen levels in the body. Increased levels of insulin increase the production of LH from the pituitary gland and Androgen from the ovaries. Leptin is a hormone produced by fatty tissue that is related to elevated testosterone levels. Hence, just as an increase in weight enhances every symptom of insulin resistance, loss of weight can improve the hormonal imbalance. It is a fact that a reduction in body weight by 5 to 10% reduces visceral fat (that is fat stored in the abdomen) by 30%, which is mostly enough to improve ovulation and reduce the chances of other complications.
Oral contraceptives
Oral Contraceptives work by suppressing the production of androgen, which reduces testosterone levels in the blood. This gradually helps cure hair loss, acne, and is also used as pre-medication before treatment of PCOS with GnRH antagonists
Progestin
Progestin used to be the first drug that was prescribed as a treatment of PCOS. However, recent studies show that progestin might lead to reduced chances of pregnancy.
Clomiphene
Clomiphene citrate is a medication that stimulates the pituitary gland to secrete Follicle Stimulating Hormone (FSH). This treats infertility by stimulating the growth of ovarian follicles inside the ovary, which produces a healthy ovum for fertilization. This medication is usually given for 5 days, starting from day 2 to 5 of spontaneous or induced bleeding at a low dose. If the ovary responds to that dose, then lowering the dose may also be considered. However, if the ovary does not seem to show any effect on the starting dose, the medication can be increased gradually up to 100mg/d beyond which there would be no additional effect to the extra dose. Clomiphene citrate should be successful in producing fertility when taken through 3 to 6 ovulatory cycles. Other medications such as Metformin or Dexamethasone can be used along with Clomiphene citrate to improve response. If it fails to do so within 10 to 12 ovulatory cycles, alternate options of treatment must be explored.
Metformin
It has been shown in studies that raised insulin levels have a strong association with the absence of ovulation. Hence reducing the insulin levels can have a positive effect on ovulation. This positive effect is also seen on losing a certain amount of weight; however, for those who are unable to lose their weight or have difficulty in doing so, metformin can be quite helpful for PCOS-affected women. Decreasing insulin levels can also decrease androgen levels in the blood, which can lead to the reversal of infertility and control of the skin and hair symptoms resulting from excess androgens.
Common medical treatment
An absolute treatment of PCOS is yet to be found. The treatments at present aim at relieving the woman suffering from the symptoms that come with the syndrome. Clomiphene citrate and Metformin are the most common medical methods for the induction of ovulation. Gonadotropins and other hormonal pills can be given to suppress the androgenic effects of male sex hormones.
The following homeopathic treatment for PCOS have shown some success:-
â— Hair loss and Acne can be treated with Wiesbaden and Arnica
â— Acne and PCOS can be treated with Sulphur and Phosphorus
â— Infertility can be treated with Pulsatilla and sepia
Diet & lifestyle tips for treating PCOS
Maintaining a proper diet and healthy lifestyle are the main treatments of PCOS
â— Less junk food
â— More dietary fibres
â— Adequate proteins
â— No restrictive eating
â— Mindful eating
â— Supplements (as advised by your doctor)
â— Regular physical exercise
â— Yoga for PCOS and meditation
â— Adequate sleep
â— Stressless
How to cure PCOS permanently?
Unfortunately, there is still no permanent cure for PCOS. There are several ways of decreasing or eliminating the symptoms that arise due to it that have been mentioned earlier, which are considered as symptomatic treatment of PCOS.