Introducing PCOS

Have you experienced irregular or no menstrual period, acne, hirsutism (excess body and facial hair), difficulty in getting pregnant and/or the presence of cysts in the ovaries? Chances are you’re most likely suffering from Polycystic Ovarian Syndrome (PCOS). Essentially an endorcrine disorder leading to hormone imbalance, almost 5-10 per cent of women in their repoductive age are affected by PCOS in India as compared to their Caucasian counter parts (1, 2). 

While the cause of PCOS has yet not been scientifically determined, studies have shown that PCOS affects more women living in urban areas than those residing in rural regions (3)., clearly indicating that while genetics plays a big role in increasing the risk, enviromental factors like a sedentary lifestyle, nutritional deficiencies, unhealthy eating habits, chronic inflammation and poor immunity also significantly contribute to the development of PCOS (5).

Understanding and changing these environmental influences can help control and prevent PCOS along with associated long-term health issues like Type 2 diabetes, heart disease, depression and infertility. 

What is PCOS?

As women, most of us are now well aware that Polycystic Ovarian Syndrome (PCOS) is the primary cause for irregular periods and/or infertility. But what exactly is this disease? PCOS is a complex hormonal disorder governed by specific hormone changes. Many of you suffering from PCOS have probably googled the causes and stumbled upon a lot of medical jargon. Let’s take a step back and understand the basics.

Sex hormones, like the luteinising hormone (LH) and the follicle stimulating hormone (FSH), are required for the growth and functioning of the reproductive system. They ensure regular ovulation and therefore, regular menstruation. The imbalance of these hormones is what leads to increased levels of androgens (all women have low levels of male hormones called androgens in their body) in females. When these levels get elevated, ovulation and therefore menstruation becomes irregular along with development of acne and hirsutism (hair in places where there shouldn’t be). The suggested causes of these imbalanced hormones are due to the polycystic ovary itself or due to resistance to insulin (1) (A topic which we’ll touch upon in a later post).

It is also important to clarify the term ‘polycystic’ which would normally mean multiple cysts on the ovaries. This is a bit misleading, because not all women with PCOS have multiple cysts on the ovaries and not all women with multiple cysts have PCOS. These so-called ‘cysts’ in PCOS are a large number of partially formed follicles present in the ovaries. 

Symptoms and Diagnosis of PCOS 

PCOS can be a complex condition to identify because there are a number of red flags that present themselves differently. So, while women may show mild or no signs others may experience more severe symptoms.

The high androgen levels circulating in the body cause most of the symptoms seen in PCOS. Additionally, a lesser known phenomenon called ‘insulin resistance’ plays a key role in the development of PCOS and is found in 60 – 80 % of women with PCOS (1, 2). Insulin, a hormone produced by the pancreas of the body, is needed to control blood sugar levels in our blood. It helps to shift the glucose in the blood (broken down from the food we eat) into the body’s tissues, where it is further broken down to produce energy needed for our daily functions. Insulin resistance implies that these tissues are not responding to the insulin secreted. As a result, to compensate, the pancreas secrete a higher amount of insulin to overcome this block. High levels of insulin can not only cause a variety of symptoms in PCOS but also increase the levels of androgens in the body, further amplifying the condition.

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More on Symptoms and Diagnosis

1. Menstrual cycle: Disruption of the normal average 28-day cycle (21 to 35 days) can be a result of either high androgen and insulin levels or both. An irregular period is defined as either less than 8 cycles per year or more than 35 days a cycle.
While these irregular cycles may make it more difficult for women with PCOS to conceive naturally, it is important to note that all PCOS sufferers are not infertile. Studies have shown that women with PCOS can have the same number of children as women without PCOS (3).

2. Excess hair (hirsutism) or hair loss (alopecia): Both of these are again caused by high level of androgens in the body. The excess hair grows in areas that are normal in men (especially facial hair) and the hair is thicker and darker. Secondly, male-pattern balding—receding frontal hair line or thinning of hair on top of your head—can also occur.

3. Acne: High level of androgens increase the oil production in the skin, therefore leading to increased acne.

4. Weight gain: A lot of women (though not all) can progressively gain weight or have difficulty losing it. These issues are both a cause and effect of high insulin levels in the body. Stay tuned for more on this topic!

5. Psychological effects: Women with PCOS have a higher risk of depression and low self-esteem (4). The development of excessive hair growth and acne often invokes distress in young women and may lead them to avoid normal social activities. Also, high insulin levels can lead to fatigue and sleep disruption.

Please note, this post is not to self-diagnose but to spread awareness. If you do think you have any of the above symptoms, do not panic. Instead, visit your gynaecologist or endocrinologist for detailed testing.

Weight and PCOS

Unfortunately, it is true that women with PCOS have a greater risk of obesity due to the complex hormonal changes in their bodies. The changes in hormones control hunger and appetite, making it difficult to lose weight or increase the likelihood of gaining weight for some women. Others may experience a vicious cycle of insulin resistance and weight gain. Insulin resistance in PCOS high levels of male hormones deposition of fat around the abdomen triggers insulin resistance. (1).

Weight loss of roughly 5-10 percent in those who are overweight has proven to reduce insulin resistance (2), normalise periods, reduce inflammation and improve fertility (3). A target of about 1/2 – 1kg per week is safe and realistic, although this depends on the person.

Interestingly, PCOS also occurs in women who are within the healthy weight range or even lean, ruling out weightloss as the only factor involved in the management of PCOS. Furthermore, focusing on weight can work adversely especially for those suffering from eating disorders and/or poor body image issues. A wholesome balanced diet is therefore recommended regardless of weight.

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