PCOS is a hormonal and Metabolic condition that affects women of child bearing age 15-44 years.

What predominantly occurs is that there’s an increase in the male hormone which is androgen commonly known as testosterone which leads to all the problems in PCOS. There is disruption in normal hormonal cyclic changes that occur in a normal woman that menstruate regularly.

Essentially there is anovulation .i.e. the ovary is not able to release one egg per cycle leading to chronic anovulation. PCOS is in consequence of chronic anovulation and this leads to irregular cycles.

PCOS affects 5 to 10% of woman in childbearing age, it can be diagnosed for Woman in their 20s or any time after puberty.

It is a genetic condition that means if your mother or sister has it you will have an increased risk of having it. Your risk also increases if you are overweight.

Let’s understand how a girl normally menstruates, one who is not PCOS and one who is ovulating. The pituitary hormone called FSH is released this FSH stimulates the ovary to form one follicle which has an egg. Every month one follicle is selected, this follicle grows to about 20 mm. When this follicle is mature .i.e. 20 mm LH is released from pituitary and this causes ovulation. If after ovulation the egg meets the sperm, pregnancy occurs. The dominant follicle then converts into a corpus luteum, which secrets progesterone which makes the lining of the uterus, i.e. the endometrium more thicker and secretetory in nature and preparing it for pregnancy.

If the sperm Does not meet an egg, i.e. if pregnancy does not occur then there is fall in estrogen and progesterone, which causes a withdrawal and this leads to menstruation, which is shredding of the endometrium. This happens every month every cycle from the time of menarche to menopause releasing one egg per month. In PCOS due to hormonal imbalance ovulation does not happen every month. The FSH is unable to select one dominant follicle, so many small follicles grow and this leads to the typical appearance of multiple fluid filled cysts in the periphery of the ovary leading to increase in the size and volume of the ovary and it’s typical polycystic appearance.

The LH also is high  in these women which leads to an increase in the androgen i.e. the male hormone which leads to problems of acne, excessive hair fall, excess of facial and body hair. Also because there is no regular cyclic changes of estrogen and progesterone, menstruation does not occur regularly. Other symptoms may also be inability to conceive, male pattern balding, thinning of hair on the scalp, excessive weight, gain difficulty to lose weight. Because there is associated insulin resistance they can have gestation diabetes, type II diabetes in the future they can also have an increase of ischaemic heart disease, cardiovascular disease hypertension and dyslipidemia leading to high cholesterol.

There is also abnormal uterine bleeding because these women do not menstruate regularly. There is an increased unchecked growth of the endometrium which causes it to grow thicker unchecked causing endometrial hyperplasia and this also has an increased risk of endometrial carcinoma. These women also have an increased risk of depression, anxiety and eating disorders. And because of obesity, they also may have associated sleep apnea. If you have any of the earlier mentioned symptoms you must visit your gynecologist, they will perform certain blood tests to check androgens in your blood and also certain hormonal test are done like prolactin and thyroid which may also cause irregular periods. FSH and LH ratios are performed and an ultrasound is performed to check the appearance of ovaries, polycystic ovaries typically have cysts at the periphery, their volume is large and stromal hyperplasia.

To check for any insulin resistance, there are tests that are performed which are the blood sugars the glucose tolerance the fasting insulin levels and glycosylated hemoglobin, the AMH .i.e. the anti mullerian hormone is another test which detects the ovarian reserve of a women and it has been a biomarker in detecting PCOS. AMH is increased in these women.

PCOS is seen in obese women and in lean women, PCOS in obese women is managed by mainly lifestyle modification – a healthy diet and a regular exercise schedule, minor changes in the diet like decreasing your calories intake reducing your overall carbohydrate intake a high protein diet may be effective. Certain diets like to Keto or intermittent fasting to reduce the weight over a short period of time and then regularly having a normal healthy diet is extremely important, a good exercise routine which is regular is very important which includes HIIT high-intensity interval training and a lot of cardio and fat burning exercises.

Also metformin is a drug which is an insulin sensitizer, which can be added if there is associated insulin resistance in these women however metformin does not replace the lifestyle modification healthy diet and exercise. Other insulin sensitizer like myo inositol andanti-gyroinositol which are antioxidants can also be used.

The acne, excessive facial hair citizen and scalp hair thinning we need additional advice from a dermatologist however oral contraceptives and anti-androgens are the mainstay of treatment. If irregular periods are predominantly the complain, oral contraceptives are preferred if you do not wish to conceive if you wish to conceive you can take cyclic progesterone every 4 to 6 weeks to get your periods regularly.

For women that have inability to conceive treatments that can be offered, weight loss of even 5% to 10% can induce ovulation in these women. So always begin with weight loss and lifestyle modification, additionally oral ovulogens drugs like Letrozole additionally adding gonadotropinand can help in induced ovulation in these women and these can be performed with either timed intercourse or an intra uterine semination to increase the chances of pregnancy. If IUI does not work these woman can be offered In vitro fertilization, at our centre we perform IVF cycles using the Freeze all technique for PCOS women that is we give the trigger using anagonist and freeze all the embryos which prevents almost by hundred percent chances of OHSH in women who have PCOS.

Don’t fall for any gimmicky sites and products trying to say if you do this, your PCOS will get cured. There’s no permanent cure for PCOS, visit a gynaecologist and with lifestyle changes and/or some medication, PCOS symptoms can be kept in check !

Dr. Aditi Tandon

MS Obgy