Polycystic_Ovarian_Syndrome (PCOS/PCOD)

Symptoms: Infrequent menstruation, heavy bleeding during periods, abnormal hair growth, acne, weight gain, darkened skin, persistent headaches, hair thinning and baldness, fatigue, trouble sleeping, abnormal lipid levels in the blood, problem with conception (pregnancy)

Causes: High percentage of male hormones or androgen, genetics or family history, insulin resistance, higher inflammation in the body

Risk Factors: Diabetes (type 1 and 2), gestational diabetes, unhealthy lifestyle, genetics

Severity: Mild to severe

Which doctor to consult: OB-Gynaecologist

Overview

Polycystic ovarian syndrome is a health condition that affects women during  their reproductive years. It usually occurs due to excess androgen formation, insulin secretion resistance, and genetic factors.

The polycystic ovary contains many harmless follicles in which eggs develop. When the sacs fail to release eggs, the hormonal imbalance leads to PCOS.

This condition can lead to enlarged ovaries and the formation of multiple fluid-filled sacs called cysts on the outer edges of the organ. These cysts contain follicles carrying immature eggs up to 8 mm in size.

Depending on the extent of PCOS development or the cyst numbers, the severity of the condition varies. Usually, the patients exhibit mild to severe symptoms, including irregular periods, weight gain, excessive hair growth or thinning, oily skin, failed pregnancy, etc.

PCOS doesn't have a cure, but its symptoms can be treated with medication and lifestyle changes. In addition, laparoscopic ovarian drilling is also recommended for patients with fertility complications.

If not diagnosed and treated timely, PCOS can lead to an increased risk of type 2 diabetes and heart conditions. The prolonged presence of PCOS and hormonal imbalance can also cause ovarian cancer in the patients and extreme fertility complications.

When to Consult a Doctor?

On Symptoms: Upon observations of signs such as infrequent menstruation, heavier bleeding, oily skin, acne, extreme hair loss, and hair growth in unwanted areas, consultation with a gynaecologist is essential. The frequency and length of the periods must be taken into consideration for seeking consultation. That's to say, the appropriate time to consult an expert is as soon as the patient exhibits the related symptoms.

Failure to Get Pregnant:  PCOS can increase the risk of pregnancy failure in the first trimester of gestation. Moreover, if you're trying to conceive but have been failing for a year, your chances of carrying cysts in your ovaries are high. That's why immediate consultation is crucial if you're pregnant or aiming to in the near future.

On Annual Screening: Most ovarian disorders slowly build up inside the body without causing severe discomfort. For any person of childbearing age, it's essential to check the overall health and functioning of the reproductive system. That's why an annual gynae visit is a must to prevent complications.

Diagnosis

Preliminary Discussion: The primary diagnosis for PCOS involves understanding the signs and symptoms through the patient's description. In this step, the gynaecologist will enquire about the first occurrence and observation of the signs. In addition, the doctor will require details about the family history associated with PCOS. Upon  comprehensive evaluation, your gynaecologist will suggest a combination of diagnostic tests.

Physical Exam: Your doctor may also check the changes in blood pressure, the alteration in skin and hair and BMI. In addition, the analysis for PCOS will also include pelvic examination by evaluating the look and feel of body parts, including swelling around ovaries, and routine pelvic tests.

Diagnostic Tests

• Imaging Tests: To deduce the exact position and extent of the PCOS, gynaecologists recommend ultrasound imaging of the ovaries. It involves checking the lining of the uterus, follicular growth and swelling of ovaries. Depending on the sexual activity of the patients, the gynaecologists recommend screening tests comprising transvaginal ultrasound and abdominal ultrasound.
• Blood Tests: Your gynaecologist might also recommend a series of blood tests to analyse the androgen levels in the body. In addition, these blood tests also help confirm the possibility of complications such as high blood pressure. Through these tests, your doctor checks the disturbance in reproductive hormones to exclude other similar-looking diseases.
• Advanced Tests: The gynaecologists can also prescribe advanced hormonal panel tests, including prolactin, luteinising hormone and follicle-stimulating hormone assessment. Any drastic elevation in the levels of these hormones is a sign of severe complications like cancer. In addition, the recommended analysis for PCOS also includes the CA125 marker test to confirm the likelihood of cancerous growth.

Treatment

Lifestyle Changes: The specific PCOS treatment involves tackling the symptom of the condition with healthy habits. Lifestyle changes aimed at weight loss  can help the medications work effectively and ensure good metabolism. Depending upon your goals, your gynaecologist might recommend handling bodily changes to determine the best management course.

Medication: Based on the severity of symptoms, your gynaecologists can suggest a combination of medications. It includes birth control pills, progestin therapy, Clomiphene, Letrozole, Metformin, Gonadotropins and Aldactone. 
Surgery and Alternative Treatment:  In addition to the medications, your gynaecologists can also recommend a series of hormonal therapies, removal treatment and surgery. These methods are more helpful when medications fail to prove useful.

Hormonal therapies involve a combination of estrogen-progestin contraceptives with metformin and spironolactone. This helps address reproductive, metabolic and dermatologic disruptions in the patient's body.

To deal with excessive hair growth, your expert doctor also recommends electrolysis and laser hair removal. It involves multiple rounds of the procedure on the affected area to control the follicular hair growth.

For patients dealing with complicated fertility problems, the laparoscopic ovary drilling procedure is used. This method enables the restoration of normal ovarian functioning through surgical treatment of cyst formations.

Risk and Complications if Left Untreated

• Infertility: If left untreated, PCOS can continue to disrupt the hormonal balance inside the patient's body. With such an imbalance, the ovulation which enables reproduction is severely affected. This can lead to infertility and miscarriages after multiple attempts to conceive. In addition, untreated PCOS can cause premature birth and complications in the newborn.
• Diabetes: Due to the disturbance in the insulin tolerance level, you can struggle with obesity and weight gain. The impaired glucose tolerance combined with weight gain can become a major factor in the occurrence of type 2 diabetes. Even for pregnant patients, it can cause extreme discomfort due to the onset of gestational diabetes. 
• Cardiovascular Complication: PCOS cause pancreatic b-cell dysfunction in the body, leading to changes in lipoprotein profile. Such disruptions in the hormonal secretions pave the way for clotting and obstruction in blood vessels. This causes an elevation in the overall blood flow, which forms the primary factor for cardiovascular disorders. 
• Cancer of the uterus: If you have undetected PCOS, you're more at risk of developing cancer in the uterus. It can occur in the form of endometrial growth and ovarian tumours. In addition to the changes in ovulation patterns, hypertension, diabetes, and related factors can increase  the chances of this life-threatening complication. 
• Metabolic Syndrome: Syndrome X is a combination of multiple risk factors associated with PCOS. It involves changes in abdominal weight, hypertension, high blood sugar and unhealthy cholesterol levels. Due to the combined effect of the symptoms, PCOS patients are more likely to develop metabolic syndrome if left undiagnosed.
• Depression and Anxiety: Female sex hormones create an impact on psychological health as well. Sleep apnea is also a major contributor to the psychological problems observed in PCOS patients. Consistent disruption of the hormonal secretions with a lack of proper rest leads to the development of mood swings. In addition, bodily changes also impact confidence and self-image. If you are a PCOS patient, you're more prone to postpartum depression after childbirth.

Additional Information

Types of PCOS

• Insulin Resistance: In this type, your body starts secreting higher than normal levels of insulin causing a condition called hyperinsulinemia. It occurs due to the dysfunction of the pancreas. Due to the reduced sensitivity of the body cells towards insulin, the condition develops. 

In this PCOS condition, your body will gain more weight around the abdomen and waist. It also causes sugar  cravings along with brain fog. Such a heightened level of insulin leads to enhanced androgen levels causing hair growth, male pattern loss and acne. 

To improve the condition, your gynaecologist will recommend a range of lifestyle activities to enhance insulin sensitivity. The treatment will involve physical exercises, low-sugar food intake and supplementation with magnesium, inositol,  chromium, NAC and berberine.

• Post-Contraception PCOS 

It is one of the rare forms of PCOS which occurs after stopping contraception intake. In this condition, the usual PCOS symptoms start appearing only after you restrict pill usage. 

This condition occurs due to the impact of synthetic progestins in oral contraceptives. After stopping the medication, your body undergoes a regular balancing drive leading to an increase in androgen. 

In this type, the patient will not face any insulin resistance, and it improves within 3-6 months. However, adequate medication and nutritional support can quickly alleviate the symptoms and resolve  the complication.

• Adrenal PCOS 

Adrenal PCOS is one of the rarest forms of PCOS, which impacts 10% of the affected population. It occurs due to the rise in DHEA-S, which is a form of androgen in adrenal glands. 

Such elevation in the specific androgen isn't usually detected with normal diagnosis as other hormones remain in the normal range. 

Since this happens due to an increase in stress levels, upon confirmation, your gynaecologist will suggest relevant treatment. It will also involve avoidance of food which can spike up bodily stress responses like caffeine. 

• Inflammatory PCOS 

Due to the prolonged exposure of ovaries to hormonal imbalance, chronic inflammation persists. This leads to the overproduction of testosterone in the ovaries. Such hyperactivity of testosterone causes headaches, fatigue, skin issues, joint pain etc. 

In order to provide effective treatment, your gynaecologists recommend a range of blood tests. These assessments consist of observing inflammatory markers like high CRP, fasting glucose levels, and insulin.

What does the diagnosis of PCOS require?

PCOS diagnosis requires clinical analysis of the symptoms. That's to say, there's no single test that affirms the presence of PCOS. 
That being said, your gynaecologists can recommend a number of analyses to assess the dysfunction in your hormones. These tests include: 

• Testosterone levels
• Luteinizing Hormone (LH) 
• FSH (follicle stimulating hormone) proportions
• Fasting glucose in the blood 
• Lipid/cholesterol levels
• Prolactin level
• Pregnancy test
• Thyroid levels
• Ultrasound or scanning of ovaries to observe cysts and other formations 

To confirm the presence of PCOS, your gynaecologists need to consider only two factors out of three, i.e.:

• Increase in androgen through physical examination or lab tests with hormonal assessments 
• Irregular periods 
• Fluid-filled cysts on the ovaries
• Since not all women having cysts on ovaries suffer from PCOS and vice versa, combined analysis ensures more effective treatment.