PCOS or Polycystic Ovarian Syndrome is a very real women’s health issue. Given the kind of lifestyles we have, it is rearing its head more often than ever! Consider this article as a thumb rule guide to everything you really need to know about PCOS.
What is PCOS??
Polycystic ovarian syndrome (PCOS) is a condition in which the level of female sex hormones that is- estrogen and progesterone are out of balance due to various metabolic disturbances.
This can further lead to a wide spectrum of clinical features such as obesity, menstrual abnormalities, and hyperandrogenism or increased level of male sex hormones.
Prevalence of PCOS
One out of every ten female of reproductive age group suffers from PCOS. Yes, you read it right: PCOS is a common female endocrine disorder with prevalence ranging from 2.2% to 26%. [i]
Actually, the incidence of PCOS is fast increasing lately due to a change in lifestyle and stress.
Age groups which are affected by PCOS
Age group which is most sensitive to PCOS
PCOS is becoming a common problem amongst adolescents, developing soon after puberty.
Symptoms of PCOS
PCOS is called a Syndrome because it occurs due to multiple causes and it has variable clinical expressions. This means you can have one or more of the following symptoms.
The most common symptoms of PCOS are:
- Menstrual abnormalities – This includes irregular periods, missed periods, disturbed menstrual flow etc.
- Hirsutism or excessive facial hair growth – PCOS mainly includes excessive facial hair growth but may also include chest and other body parts.
- Alopecia – There may be increased loss of hair from scalp which can lead to male pattern baldness.
- Adult acne – Due to excessive production of male hormones that is testosterone, the patient may have to suffer from acne even in their early 20s and 30s.
- Central obesity – Central obesity basically means centripetal deposition of fat that is towards the center of your body that too mainly in your abdominal area. The barrel-like fat deposit over and around your stomach.
- Darkening of skin – In PCOS due to increased production of melanin a velvety black pigmentation occurs in the neck and its adjacent areas. That’s correct, sometimes we feel it’s due to jewelry allergy, but such repeated pigmentation in the neck and groin area is a fair indicator, of insulin resistance.
- Inability to conceive – Imbalance in the level of sex hormones leads to anovulation which leads to infertility- basically the eggs don’t mature and immature eggs are not ovulated.
What are the investigations which one should go for, to confirm PCOS?
- Ultrasonography (USG) – Ultrasound is diagnostic of PCOS.
It confirms the enlargement of ovaries, the presence of cysts in ovaries.
USG is also used to watch the response of medication and to decide when to stop the drug therapy.
- Hormonal blood tests– the Hormonal study is done to elicit the level of hormones in the body. Blood tests are used to assess the levels of androgens in your body, to diagnose whether you have hyperandrogenism.
Now, what exactly happens inside the body in PCOS?
In this section, we will explain in layman terms, what is happening inside your Body. Scientific principles have been simplified for easy understanding.
We all have a busy schedule which we have to follow every day and at the end of the day, we are left with no time for any kind of physical activity. After coming tired from our workplace, we all lie sedentary in our house on the couch, bed or wherever we find a place. We love to eat junk food and eat at odd hours. But this junk food contains a high level of carbohydrates which you can also call the ‘bad carbohydrate’.
- Carbohydrate gets digested in our body and produces glucose.
- As soon as glucose is absorbed into the blood, insulin comes into action and stores the extra glucose in the liver and muscles. This maintains the normal blood glucose level in a healthy person.
- Glucose enters the liver through certain receptors.
- Imagine these receptors to be like gates which are normally locked.
- Insulin is the key to the “locks” of these gates.
- Insulin comes and opens these locks and glucose enters the liver. This normalizes the level of glucose in the blood.
- But due to our lifestyle or genetic disposition, if a person gains fat around the stomach area- the visceral fat. It has major repercussions to imbalance the blood glucose.
- This particular central obesity fat is metabolically active. It releases chemicals like adipokines and cytokines.
- These chemicals behave like gum and block the gates(receptors) of the liver.
- So even though there is insulin present it is UNABLE to help glucose enter the liver, because the “lock” is blocked.
- This thing is called Insulin Resistance and can further lead to diabetes.
- So what happens- Glucose level increases in the blood, Insulin is also increasing in the blood and metabolism is not happening properly.
- This EXCESS Insulin acts in two ways:
- It being a fat depositing hormone FURTHER increases the fat deposits- creating a vicious cycle of fat deposition
- It produces androgens or the male sex hormone
The visceral fat cells convert this excess androgen into estrogen.
This is a notable point
Simultaneously there is a delicate balance of hormones in a normal female body.
- FSH (Follicle Stimulating Hormone) which matures the eggs for ovulation
- LH (Leutenizing Hormone)
You remember we said that an increase in insulin creates more androgens which are converted into estrogen in those fat cells?
THAT is the TRIGGER POINT.
This imbalance reduces the FSH and the ovum does not get mature. So NO Ovulation. That’s why there are irregular periods and problems in Conception.
The increased androgens are the cause of male pattern baldness, acne, and Hirsutism.
The “Cysts” that we see in the Ovaries during PCOS Ultrasound are actually immature ova.
So, what happens if PCOS is left untreated?
- Infertility and Miscarriages – Due to obesity or fat deposition the chemicals secreted from fat cells interfere with insulin signaling pathways which result in insulin resistance and an increase in insulin level. This increased insulin level, in turn, increases the level of luteinizing hormone which increases the level of testosterone or androgen due to which there is the improper maturation of oocyte which leads to infertility or miscarriages.
- Stress – The symptoms of PCOS can also lead to anxiety or depression because of many symptoms of PCOS like excessive hair growth on face and body, alopecia, acne, increased weight and fertility problems are very devastating and the feeling of not being perfect can be very stressful. The depression and anxiety related to PCOS can have a great impact on your physical, psychological and social life. It can disturb eating and sleeping habits decrease self-confidence self-esteem, increase the feeling of worthlessness. Something no young girl should go through.
- Diabetes – Insulin resistance-related PCOS can directly lead to increased serum glucose level due to inhibition of insulin which further precipitates out a health condition known as diabetes.
- Cardiovascular Diseases – Cardiovascular diseases are one of the long-term consequences of PCOS. It includes symptoms such as increased abdominal fat, increased the level of bad cholesterol that is (LDL), decreased the level of good cholesterol (HDL), increased level of triglycerides and hypertension. Neglected PCOS can also lead to some other very serious health problems like heart disorders, liver diseases, kidney problems, Alzheimer’s disease and premature aging.
How can we break the vicious circle of PCOS?
There are many ways by which one can break this vicious circle of PCOS.
- Cutting down the intake of bad carbs – This is the major step which one should take towards breaking the vicious circle of PCOS. You should decrease the intake of food which contains a high level of fat, bad carbohydrates. Instead increase the intake of diet rich in fiber, cereals, vegetables, grains etc. As soon as you lose your weight you will notice that all the symptoms related to PCOS will start to disappear on its own.
- Proper workout routine – One should follow a proper workout routine including cardio exercises, walk of at least one hour. The more you sweat the more you lose weight. This also loosens the “gum “attached to liver gates we explained earlier.
- Drug therapy suggested by your physician – The therapy suggested by a physician may include hormonal pills which will help in correction of irregular periods problem and may also improve acne problem, hirsutism, and male pattern baldness.
The therapy may also include androgen-lowering drugs, blood sugar lowering drugs like metformin to control insulin, blood sugar and androgen levels.
Finally, please seek expert medical help. While you should not have a panic attack on thinking you have PCOS, it is a smart choice to work with a team of experts and get holistic help.