Polycystic Ovary Syndrome (PCOS)

Dr. Renu Jain(Medical Director, M.B.B.S., M.S.,(Obs. & Gyane), IVF – Specialist GP Shekhawati Hospital And Research Center)
Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (say "pah-lee-SIS-tik OH-vuh-ree SIN-drohm") is a problem in which a woman's hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS also may cause unwanted changes in the way you look. If it isn't treated, over time it can lead to serious health problems, such as diabetes and heart disease.

Most women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. The cysts are not harmful but lead to hormone imbalances.

Early diagnosis and treatment can help control the symptoms and prevent long-term problems.

Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone.

For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another. For example:

The sex hormones get out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more androgens. This may cause you to stop ovulating, get acne, and grow extra facial and body hair.

The body may have a problem using insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar levels go up. Over time, this increases your chance of getting diabetes.

The cause of PCOS is not fully understood, but genetics may be a factor. PCOS seems to run in families, so your chance of having it is higher if other women in your family have it or have irregular periods or diabetes. PCOS can be passed down from either your mother's or father's side.

Symptoms tend to be mild at first. You may have only a few symptoms or a lot of them. The most common symptoms are:

1.     Acne.

2.     Weight gain and trouble losing weight.

3.     Extra hair on the face and body. Often women get thicker and darker facial hair and more hair on the chest, belly, and back.

4.     Thinning hair on the scalp.

Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods. Others have very heavy bleeding.

Fertility problems. Many women who have PCOS have trouble getting pregnant (infertility).

Depression.

TREATMENT AND PRECAUSTION-

Polycystic ovary syndrome treatment generally focuses on management of your individual main concerns, such as infertility, hirsutism, acne or obesity.

As a first step, your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — for instance, losing 5 percent of your body weight — might improve your condition.

Medications

Your doctor may prescribe a medication to:

Regulate your menstrual cycle. To regulate your menstrual cycle, your doctor may recommend combination birth control pills — pills that contain both estrogen and progestin. These birth control pills decrease androgen production and give your body a break from the effects of continuous estrogen, lowering your risk of endometrial cancer and correcting abnormal bleeding. As an alternative to birth control pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin. During the time that you take this medication to relieve your symptoms, you won't be able to conceive.

If you're not a good candidate for combination birth control pills, an alternative approach is to take progesterone for 10 to 14 days every one to two months. This type of progesterone therapy regulates your periods and offers protection against endometrial cancer, but it doesn't improve androgen levels and it won't prevent pregnancy. The progestin-only mini pill or progestin-containing intrauterine devices are better choices if you also wish to avoid pregnancy.

Your doctor also may prescribe metformin (Glucophage, Fortamet, others), an oral medication for type 2 diabetes that improves insulin resistance and lowers insulin levels. This drug may help with ovulation and lead to regular menstrual cycles. Metformin also slows the progression to type 2diabetes if you already have prediabetes and aids in weight loss if you also follow a diet and an exercise program.

Help you ovulate. If you're trying to become pregnant, you may need a medication to help you ovulate. Clomiphene (Clomid, Serophene) is an oral anti-estrogen medication that you take in the first part of your menstrual cycle. If clomiphene alone isn't effective, your doctor may add metformin to help induce ovulation.

If you don't become pregnant using clomiphene and metformin, your doctor may recommend using gonadotropins — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications that are administered by injection. Another medication that your doctor may have you try is letrozole (Femara). Doctors don't know exactly how letrozole works to stimulate the ovaries, but it may help with ovulation when other medications fail.

When taking any type of medication to help you ovulate, it's important that you work with a reproductive specialist and have regular ultrasounds to monitor your progress and avoid problems.

Reduce excessive hair growth. Your doctor may recommend birth control pills to decrease androgen production, or another medication called spironolactone (Aldactone) that blocks the effects of androgens on the skin. Because spironolactone can cause birth defects, effective contraception is required when using the drug, and it's not recommended if you're pregnant or planning to become pregnant. Eflornithine (Vaniqa) is another medication possibility; the cream slows facial hair growth in women.

Lifestyle and home remedies

To help offset the effects of PCOS:

Keep your weight in check.

Obesity makes insulin resistance worse. Weight loss can reduce both insulin and androgen levels and may restore ovulation. No single specific dietary approach is best, but losing weight by reducing how many calories you consume each day may help with polycystic ovary syndrome, especially if you're overweight or obese. Use smaller plates, reduce portion sizes and resist the urge for seconds to help with weight loss. Ask your doctor to recommend a weight-control program, and meet regularly with a dietitian for help in reaching weight-loss goals.

Consider dietary changes.

 Low-fat, high-carbohydrate diets may increase insulin levels, so you may want to consider a low-carbohydrate diet if you have PCOS — and if your doctor recommends it. Don't severely restrict carbohydrates; instead, choose complex carbohydrates, which are high in fiber. The more fiber in a food, the more slowly it's digested and the more slowly your blood sugar levels rise. High-fiber carbohydrates include whole-grain breads and cereals, whole-wheat pasta, bulgur wheat, barley, brown rice, and beans. Limit less healthy, simple carbohydrates such as soda, excess fruit juice, cake, candy, ice cream, pies, cookies and doughnuts.

Be active.

Exercise helps lower blood sugar levels. If you have PCOS, increasing your daily activity and participating in a regular exercise program may treat or even prevent insulin resistance and help you keep your weight under control.