Today as the lifestyle is getting advanced, we are inviting many of the health-related issues. This is caused due to no physical exercise, yoga, meditation, and no control over diet. In today’s world if estimated is done most of the girls starting from the age of 16 years, suffer from PCOS. In this, article we will discuss Polycystic ovarian syndrome (PCOS) symptoms and treatments. This disease has now become very common or you can say 1 out 10 women are diagnosed with this disease.
What is PCOS?
Polycystic ovarian syndrome (PCOS) is characterized by persistent anovulation (when ovaries do not release an oocyte during the menstrual cycle) that can lead to clinical manifestations, including enlarged polycystic ovaries, secondary amenorrhea (absence of menses) or oligomenorrhea (infrequent menstruation), obesity, hirsutism (unwanted hairs), and infertility.
Stein and Leventhalboth was the first person who has described polycystic ovarian diseases as a syndrome which is manifested by amenorrhea, hirsutism, and obesity which is associated by enlarged polycystic ovaries.
This syndrome is complex of many symptoms which is characterized by excessive androgen hormone production by ovaries which interferes with the growth and function of the ovarian follicles.
PCOS mainly affect the females in teenagers and in young women and childbearing age.
Causes for Polycystic Ovarian Syndrome (PCOS)
Till now no specific cause is found which can be responsible for Polycystic ovarian syndrome (PCOS). But there are many factors that contribute to PCOS, These are
Increased Androgen Production
Androgen hormone is naturally synthesized in the body (in ovaries) which helps in the regulation for the development and maintenance of the male like characteristics in the female.
In PCOS there is an increase in androgen production takes place. As a result, there is increased stimulation for the growth of hairs in the body as well as pubic hair growth, which results in hirsutism and acne on the face.
Increased Production of Insulin
Role of the insulin in the body is to control the blood sugar level. Those females who are suffering from PCOS, their cells become resistant to the action towards the insulin, which results in the increased production of blood glucose in the body.
This increased insulin production triggers the production of androgen hormone which is responsible for the male like characteristic in the female. As well as this increased androgen production also causes difficulty in ovulation.
- Hereditary: Hereditary plays an important role in PCOS.
- Presence of Low-grade inflammation: Those women who are suffering from PCOS have low-grade inflammation in their body which triggers the polycystic ovaries to produce more androgen production.
- Sedentary lifestyle
- Increased prolactin level
Pathophysiology of Polycystic Ovarian Syndrome (PCOS)
The exact pathophysiology of PCOS is still unknown or not clear but it can be discussed under the following
Role of Hypothalamic –Pituitary Pathway in PCOS
Due to increased pulse frequency of Gonadotrophin-releasing hormone (GnRH), this leads to the increased pulse frequency of Luteinizing hormone (LH). This increased LH secretion with decrease Follicle-stimulating hormone (FSH) may stimulate the ovarian follicle.
As well as increased production of insulin also stimulates the ovarian follicle for the production of androgen.
Abnormal regulation of the androgen forming enzyme (P450 C 17) is thought to be the main cause for the excess production of androgen from the ovaries and adrenal glands.
In about 20 percent cases, there may be mild elevation of prolactin level due to increased stimulation of GnRH or due to dopamine deficiency or both. This increased prolactin level further stimulates adrenal gland for increased production of androgen.
Anovulation means when the ovaries do not release the oocyte during the menstrual cycle. This causes irregular menstrual bleeding. This occurs due to low FSH level, which results as arrested follicular growth (arrested ovum growth) at a different phase of maturation.
Due to increased level of LH, there is increased growth of theca cella (cells of the ovary which are made of connective tissue) which leads to the increased production of androgen.
Long Term Consequences of PCOS
- Patients who are at the risk of developing diabetes mellitus due to insulin resistance.
- Those who are at the risk of developing endometrial carcinoma due to persistently increased level of oestrogen.
- Those who are at the risk of hypertension and cardiovascular disease due to abnormal lipid profile.
Signs and Symptoms of PCOS
If PCOS diagnosed at an early stage it can be treated easily, but if diagnosed late than signs and symptoms of PCOS can be worsened.
Here the sign and symptoms:
- Menstrual abnormality in the form of oligomenorrhoea, amenorrhoea or DUB
- Increased weight (Obesity)
- Hirsutism (extra hairs on face and body)
- Acanthosis nigricans. In this, the skin becomes thickened and pigmented. This change in skin is caused due to insulin resistance. It is mostly seen nape of the neck, inner thighs, and axilla.
A few females who are diagnosed with PCOS are often seen with normal weight or with underweight but the size of the ovary is enlarged. Virilism is seen but is very often.
There may be some mental symptoms include
- Mood swings
Headache is often seen in PCOS women with fatigue and low energy level. Sleep disturbance is mostly seen in PCOS women.
These are the common symptoms which are mostly seen in PCOS patient. But symptoms may be varying from individual to individual.
Complications of PCOS
Complications of PCOS are seen in the form of
- DUB (dysfunctional uterine bleeding)
- Endometrial carcinoma
- Pregnancy-induced or gestational diabetes
- Gestational hypertension
- Metabolic syndrome
- Non-alcoholic steatohepatitis
- Sleep apnoea
- Miscarriage or premature birth
- Psychological symptoms like depression and an eating disorder.
How PCOS can be Diagnosed
Along with the signs and symptoms, the doctor advised going with ultra-sonography and investigation to confirm the PCOS and rule out other diseases.
- Sonography: Patient is advised to go with transvaginal sonography especially in those who are an obese person. In sonography ovaries seen are enlarged in volume with an increased number of peripherally arranged cysts are seen.
- Serum values: LH level will be seen elevated/ or the ratio between LH and FSH will be seen >3:1.
- Oestrogen level will be markedly elevated.
- Serum testosterone level will be seen increased.
- Raised insulin level (insulin resistance)/or the ratio of fasting glucose: fasting insulin is <4.5.
- Prolactin level will be seen increased.
Along with this patient is also advised to investigate the thyroid hormone level. As a patient of thyroid diseases also have irregular menses.
On per vaginal (P/V) examination, the presence of cervical mucus indicates the increased level of oestrogen. Most of the PCOS women have founded this on P/V along with other symptoms.
Don’t forget to take these vital signs also
- Blood pressure
- Respiratory rate
General examination of the patient should also be done which include
- Nutritional status
- Extreme emaciation or marked obesity
- Presence of acne or hirsute
- Discharge of milk from the breasts.
Polycystic ovarian syndrome (PCOS) symptoms and treatments: Management of PCOS need individualization of the patient because all the patients will not give all the common symptoms. So it depends upon:-
- Her presenting problems
- Menstrual disorders
- Other combined symptoms.
Presence of at least two symptoms along with irregular menstruation and weight gain will confirm the diagnosis which requires the treatment.
The most important part of the treatment is the counselling of the patient. The treatment is given to the patient keeping in the mind to correct the biochemical abnormalities.
The first-line treatment in PCOS is weight reduction, especially in obese patients. So they are advised to maintain their diet so that their BMI gets <25. This will improve menstrual abnormalities, hirsutism, and infertility.
If fertility is not concerned, then second-line treatment to decrease the androgen excess level. This can be done by prescribing combined oral contraceptive pills as they are effective in decreasing the level.
Progestin suppresses the LH and estrogen level and improves the SHBG (sex hormone-binding globulin), and reduce free testosterone level. Norgestrel containing pill is avoided because of its high androgenic.
For those patients who want pregnancy, the third-line treatment is to correct the ovulation phase in the menstrual cycle of the patient. This can be achieved by prescribing clomiphene citrate medicine to the patient.
For those patient who are having anovulation with PCOS and obesity. Clomiphene with metformin 500mg combination is given which results in satisfactory ovulation.
Metformin should be given thrice a day as it is found to correct the biochemical abnormalities observed in PCOS when given thrice a day.
How Lifestyle Affects the PCOS
Our lifestyle plays an important role in controlling PCOS. Modernization of life is now one of the trigger factors for producing PCOS. So there are some advises which helps in relieving the PCOS symptoms.
Diet plays an important role in controlling PCOS. So patient with diagnosed PCOS should eat a healthy and nutritious diet. Lower down the content of carbohydrate in your diet. As high carbohydrate and fat in your diet increase the insulin level.
Patient with PCOS is firstly advised to decrease their weight. If their weight will be increased it will increase the insulin level which increases the production of androgen in the body.
Exercises help to reduce the glucose and burn the extra calories which in turn reduces the level of insulin in the body.
For Reducing Insulin Level
Foods include whole grains, nuts, legumes, seeds, fruits, starchy vegetables, and other low carbohydrate foods.
For Lowering the Inflammation (Anti-inflammatory)
Foods such as berries, green leafy vegetables, fatty fish, extra virgin olive oil.
For Reducing Hypertension
Food includes fish, poultry, fruits, vegetables whole grains, low-fat dairy products. These foods also reduce the high risk of cardiovascular diseases with PCOS.
Healthy Food for PCOS Must Include
- Natural and unprocessed foods
- Food which contains high-fibers
- Fatty fish which includes salmon, tuna, sardines, and mackerel
- Green vegetables like kale, spinach, and other dark leafy greens
- Fruits include dark red fruits, such as red grapes, blueberries, blackberries, and cherries
- Broccoli and Cauliflower
- Dried beans, lentils, and other legumes
- Olive oil,
- Nuts which includes pine nuts, walnuts, almonds, and pistachios
- Spices include turmeric and cinnamon
With a healthy diet, healthy lifestyle, and proper medication Polycystic ovarian syndrome (PCOS) can be cured without leaving symptoms any complications.