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What is PCOS?
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The facts about polycystic ovary syndrome, the most common endocrine disturbance in Indian women
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Smita is distraught. Her 17-year-old daughter has irregular periods. Her family physician ordered an ultrasound and she has been diagnosed as having polycystic ovary syndrome. Her mind is whirling with questions. Will her daughter need surgery? Can she ever have children?
Polycystic ovary syndrome (PCOS) is the most common endocrine disturbance in women of reproductive age. It affects an estimated five per cent to 10 per cent of women. PCOS is a common cause of irregular periods and infertility. Like the other metabolic disease, diabetes, there is a sharp increase in the incidence of PCOS in Indian women.
What does polycystic ovary mean?
During a normal menstrual cycle, a small number of follicles begin to grow. One becomes the biggest, outgrowing the rest. This dominant follicle then ruptures and releases the egg. In women with PCOS, high levels of hormones called androgens halt the normal hormonal process and the egg's development. These immature or underdeveloped follicles are what are called `cysts' in PCOS. A `polycystic' ovary generally is defined as having more than 10 follicles, and the ovary by itself may be larger than normal. Note that the name is a bit misleading. Up to 30 per cent of women with PCOS do not have polycystic-looking ovaries and many women who have polycystic ovaries do not have PCOS.
Why does PCOS occur?
Researchers suspect that a genetic predisposition plays a role. The biochemical imbalances that cause symptoms are becoming better understood. One of the trigger points maybe excess insulin production, which can result from insulin resistance. This stimulates testosterone production (a type of male hormone or androgen). Insulin resistance is also a precursor to Type II diabetes (diabetes which may not require insulin for treatment).
What are the symptoms of PCOS?
The most visible symptoms of PCOS stem from excessive levels of androgens, such as testosterone, which are produced in the ovaries. Excessive levels of these hormones, a condition called "hyperandrogenism" in women, can lead to some of the most common symptoms of PCOS, including: excess body or facial hair; oily skin and acne; irregular ovulation leading to irregular periods; weight gain, specially around the waist; darkened colour and change in texture of the skin along the neck and armpits and on the groin and inner thighs.
What should be done for PCOS?
Women with PCOS have irregular and/or infrequent ovulation, and often have irregular menstrual periods. If periods are absent, it is important to induce them from time to time with the hormone progesterone because menstruation prompts the shedding of the uterine lining, preventing a build-up of the lining. This induced bleeding lowers risk of developing uterine cancer. PCOS often is a cause of infertility due to failure to ovulate. The usual course of treatment is a drug called clomiphene citrate. If that doesn't work, the next step is injectable gonadotropins. Many
gynaecologists are increasingly prescribing insulin-sensitising drugs designed to treat diabetes (such as metformin) to induce ovulation with or without clomiphene citrate. Studies indicate such drugs alone or in combination with ovulatory medication may be effective for both infertility and other symptoms of PCOS.
It has been clearly shown that a weight loss of even as little as 5 per cent can induce ovulation in a majority of women. Therefore, diet and exercise, leading to weight loss, is the first line of treatment. Walking for 30 minutes every day would go a long way in relieving the symptoms of PCOS by increasing the utilisation of the excess insulin.
PCOS is strongly linked to excess weight and insulin resistance and women with PCOS are at risk for developing Type II diabetes. For women with PCOS who are overweight, a treatment plan will usually incorporate diet and exercise programmes. PCOS is also now recognised as being associated with a possible increased long-term risk of cardiovascular disease, unless lifestyle changes are initiated.
Is there a cure for PCOS?
Since PCOS is a metabolic disorder, there is no `cure' for the condition. With proper treatment, PCOS can be managed and the symptoms, relieved. The treatment is directed towards correcting the symptoms that are the most bothersome. In the case of young girls, the treatment is aimed at regularising the periods. In a married woman, who is keen on having a baby, the treatment is aimed towards ovulation. Diet and exercise, leading to weight loss, are important steps in the treatment of PCOS.
GITA ARJUN
(The author is a Chennai-based obstetrician and gynaecologist interested in women's health issues)
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