PCOS affects one in ten women worldwide. The sheer magnitude of the problems suggests that a proper understanding of the term is required for addressing the problems that a woman suffering from pcos suffers.
As the term suggests it is a syndrome comprising of two out of three of the below (Rotterdam criteria)
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- Menstrual irregularity (Infrequent menses at interval of more than 35 days, very less bleeding during menses)
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- Hyperandrogenism ( Blood parameters or symptoms like hirsutism i.e hairs in male distribution, alopecia
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- Polycystic pattern in Usg
Etiology of PCOS is often multifactorial or unknown though in some case mother or other members of the maternal side having PCOS might predispose to having PCOS.
Pathology of PCOS is mainly Insulin resistance and Abnormal increased male hormones. First we come to insulin resistance because it is the single most modifyable factor decreasing which can be easy and most effective for symptoms of PCOS.
Imagine this you have just eaten and your blood has enough blood sugars for all your cells to utilize but the sugars cant enter the cells and you feel fatigued and hungry again even after having just eaten. This is due to insulin resistance. Your cells take up sugars with the help of a hormone Insulin secreated from the pancreas. In a person with high insulin resistance inspite of high insulin secretion from the pancreas insulin can’t enter the cells and help sugar uptake. So blood sugars remain high , insulin remains high but the cells starve. High insulin increases insulin like growth factors which in turn increase the androgen production in the ovary and adversely affect the ovum health causing infertility.
High androgen production in the ovary adversely affect the development of healthy eggs every month and is also responsible for symptoms like increased hair in male patterns and Alopecia.
Both Insulin resistance and increased androgen production can be attributed to Obesity. BMI or body mass index more than 5 is a marker of obesity. Decreasing weight by even 10% can improve the symptoms of PCOS. Weight reduction can be done by easy lifestyle changes like daily exercise , dietary restriction and reducing alcohol intake and other addictions.
Now coming to symptoms of PCOS. People suffering from pcos either mainly have irregular menses or suffer from inability to concieve. Menses may come at long intervals or in some bleeding may be very scanty. In some cases after a long gap of a few months there may be very heavy bleeding. Couples may be trying for years to concieve but unable to concieve. There may be excessive hair growth in areas like upper lip, chin, upper arm ,chest, abdomen, back and thighs. Another common symptom is highly resistant Acne. Sometimes there may be excessive pigmentation in areas like neck ,armpit, below breasts. These all point to insulin resistance.
Treatment of PCOS includes first and foremost weight reduction. Pharmacological treatment includes combined oral contraceptives for cycle control and ovulation inducing drugs for infertile couple. Some drugs like metformin commonly used for diabetes may be used sometimes for combatting insulin resistance. Sometimes laparoscopic surgery like laparoscopic ovarian drilling may be required. For treatment of infertility artificial reproduction methods like IUI and IVF might be required when drug treatment fails to help in conceiving.
For anymore queries regarding PCOS you might contact me Dr Arundhati Chakrabarty, Obstetrician and Gynaecologist or subscribe to my youtube channel @DrArundhatiGynaecologist.