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When should the woman see the doctor?
Most patients of PCOS visit the doctor on appearance of symptoms like irregular or absent menses, heavy menses, excessive acne, excessive facial and body hair or difficulty to achieve pregnancy. Inability to achieve pregnancy even after 1 year of trying defines infertility. If the couple is over 35 years of age, in ability to achieve pregnancy after trying for a maximum of six months is enough reason to visit a specialist for infertility treatment.
How will the doctor diagnose PCOS?
The diagnosis of PCOS is a complex process and no single test can give the right answer. It is highly recommended that you visit a specialist. Your doctor or infertility specialist will talk to you and ask you a few questions about your medical history and family history. The specialist will ask you about your weight control, lifestyle factors like exercise, working pattern, pattern of menstrual cycle, etc. The specialist may ask you about any difficulty in getting pregnant.
The specialist will do a complete examination depending on symptoms of the case. Then the specialist performs some blood and urine tests. The specialist may suggest doing an ultrasound.
Hormonal imbalance in PCOS.
In every human being (male and female), the hormone master switch lies in the lower part of the brain called the hypothalamo-pituitary axis. This master switch controls the entire body’s hormone levels. In the female, the ovary normally produces female sex hormones and a small amount of male sex hormone (androgen). In the case of PCOS, due to imbalance in the hypothalamo-pituitary axis, the female ovary starts to produce more male hormone than necessary. This hampers the normal growth of ovarian eggs (follicles) and causes them to be arrested in an immature state. The excess male hormone production also leads to irregular or absent ovulation, which women experience as irregular or absent menstrual periods.
This process is the main cause of irregular cycles and infertility. Excess male hormone in the female may produce excessive male-pattern facial and body hair and oily skin with / without acne. There is also another metabolic problem called insulin resistance that can happen in some. This gives rise to weight gain and the weight gain gives rise to PCOS. This forms a vicious cycle.
What are the symptoms of PCOS?
Women may complain of mild symptoms like occasional irregular cycles, acne and oily skin. Some may experience increased symptoms like absence of menses for 2 to 3 months, heavy menses or severe acne. A few patients may present with severe problems like excessive hair growth and infertility.
What increases a woman’s risk for PCOS?
Genetic- Family members diagnosed with PCOS increases risk. Also, family members with obesity and diabetes may indicate a difficulty in achieving success against PCOS. PCOS can be inherited from the mother’s and also father’s side. There are several other factors that are not yet well understood.
Polycystic ovarian syndrome (PCOS)
What is PCOS?
PCOS or Polycystic ovarian syndrome is a structural and functional disease of the ovary. Structurally, the ovaries enlarge typically between 2-3 times the normal size. Functionally, there is hormonal imbalance which leads to the various signs and symptoms of PCOS which eventually leads to its diagnosis.
PCOS or polycystic ovarian syndrome affects nearly 10% of women in the reproductive age group and is one of the leading causes of infertility. The actual statistics of PCOS in Goa are not known.
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In women in the reproductive age group, infertility is the major concern. This infertility is due to decreased or absent egg production (anovulation). The specialist may prescribe medicines for egg production. There are some surgical options also available for PCOS. The actual treatment process is much more complex and is best left to the specialist. This treatment works best when combined with a weight management plan.
Excessive hair growth
This is a symptom that causes embarrassment to many ladies. The main reason for excessive hair growth is more than normal levels of male hormones (androgens) in circulation. The androgens cause the male pattern of hair on face, neck, chest, abdomen, back, arms and legs. This condition is called hirsutism. The treatment is mainly correction of the hormone imbalance using hormone therapy. Unfortunately, the hormone therapy can stop the production of new hair, but the hair already produced will not stop growing. Patients have to shave, wax or bleach the abnormal hair or go for cosmetic procedures like laser for permanent cure. Best results are obtained only after the hormone therapy has taken full effect and new hair production has stopped.
PCOS and pregnancy
Women with PCOS have difficulty in conceiving. Also during pregnancy they are faced with a few difficulties.
There is an increased chance of miscarriages.
There is increased risk of pregnancy associated with diabetes (gestational diabetes). This may cause the baby to be larger than normal.
There is an increased risk of pregnancy complicated with high blood pressure. This may cause a decrease in growth of the baby and produce a smaller than normal baby.
All the above factors may be associated with a premature delivery.
Treatment of PCOS(polycystic ovarian syndrome)
Unfortunately, there is no cure for PCOS. One can only control it and lessen its effects. The treatment plan for every patient is tailor made to suit her individual needs, her symptoms and patient profile.
In adolescent girls and unmarried girls, the main complaint may be acne, oily skin, excess hair growth, irregular or heavy menses etc. the most important aspect of PCOS treatment is regular exercise, low calorie diet and weight management.
Exercise may include light or heavy exercise as per the comfort levels of the individual woman. Walking for at least one hour per day for at least five days per week is a good start. Sports are also an excellent way to lose weight. A low calorie diet is planned as per the patient’s food habits. The help of a dietician is valuable so that the patient does not have relapses. A diet containing fruits, vegetables and whole grain is recommended. Saturated fats like cheese, ghee, butter are to be avoided. It is to be noted that even a 5% reduction in weight is of great help to correct the hormone imbalance in the woman and may restore normal ovarian function.
What are the health concerns during the later part of life?
Women with PCOS often have associated conditions in the later part of life.
PCOS can affect the metabolism of blood sugar. Insulin is a hormone that helps the body’s cells get the sugar they need for energy. Sometimes these cells do not fully respond to insulin. This causes a condition called insulin resistance which predisposes the woman to diabetes in later years of life.
PCOS may cause a woman to have raised levels of lipids in blood. This is further complicated by the raised insulin levels. All these factors combined may lead to heart diseases like coronary artery disease and heart attack.
If blood vessels in the brain get narrow, there is an increased risk of stroke.
Uterine diseases and cancer
PCOS is a condition in which there are high levels of a circulating hormone called estrogen. The estrogens cause the uterine lining to thicken up. It is a known fact that women with PCOS often do not have a regular menstrual cycle and hence do not regularly shed the uterine lining. This causes the uterine lining to get thicker and thicker. This process over the years may lead to a precancerous condition of the uterine lining called hyperplasia and may later on lead to uterine cancer.
The raised levels of estrogen predispose the breast to several diseases. The most dangerous among them is breast cancer. Breast cancer is preventable with regular breast cancer screening.
Living with PCOS
Most women learn to live with PCOS. The modern medicines with their high safety profile have made the woman’s life healthy and safe.
All women with PCOS should remember the following:
Regular exercise, low calorie diet and weight management is the main treatment of PCOS.
Ladies with PCOS require the constant supervision of the specialist throughout their life. This maintains her hormonal balance and ensures a healthy future.
Infertility- It is recommended that the couple starts trying for pregnancy early after marriage. If there is a difficulty in conception, expert help should be taken without waiting for long.
During the later part of life, regular follow up with a gynaecologist is necessary. This ensures early diagnosis and treatment of PCOS related diseases.
Regular breast cancer screening is a must for all cases of PCOS after the age of 35 years.