In a world where silent battles are fought within the body and where women’s health concerns often take a back seat, there’s a silent and complex condition affecting millions: Polycystic Ovarian Syndrome (PCOS). Often misunderstood and overlooked, PCOS is more than just a reproductive health issue; it’s a multifaceted condition that demands attention, understanding, and support. Polycystic Ovarian Syndrome (PCOS) emerges as a formidable adversary for countless women.

Join us on a journey to unravel Polycystic Ovary Syndrome and explore the challenges and triumphs that come with it. Let’s dive into the complexities of PCOS and unveil the known and unknown about PCOS that many silently endure. 

Did you know that PCOS is the most common hormone disorder affecting 7 out of 100 women of reproductive age group worldwide? PCOS affects many women, you are not alone if you have PCOS.

Understanding PCOS

Just like the name suggests, PCOS is a syndrome comprising of a group of signs and symptoms and therefore no single sign or symptoms which defines it or is diagnostic of PCOS. It is a complex disorder with systemic metabolic manifestations. It is characterized by increased ovarian androgen levels (hyperandrogenemia), ovulatory dysfunction, and the presence of cysts on the ovaries (polycystic ovaries).

PCOS is more than just a reproductive health issue.  

Cause of PCOS

The exact cause of PCOS remains unclear. It is thought to arise from insulin resistance with a lack of sensitivity to insulin in the target areas. This in turn leads to the secondary increase of insulin from the pancreas to overcome the initial challenge. The hyperinsulinemia stimulates excess production of androgen hormones from the ovaries. 

Insulin resistance also causes the metabolic complications associated with PCOS

There is a genetic cause as well as mother and sisters of the PCOS patient may be at increased risk of PCOS

Obesity is thought to be involved in the aetiology.

The Many Faces of PCOS

 PCOS is no “one size fits all condition”. Two out of three of the following criteria are used to make a diagnosis of PCOS; Hyperandrogenemia whether clinical or biochemical, ovulatory and/or menstrual dysfunction, and PCO. From irregular periods and acne to weight gain and fertility challenges, PCOS manifests in a myriad of ways. Understanding the range of symptoms is crucial in recognizing and addressing the condition effectively.

PCOS Symptoms

Hyperandrogenemia

High ovarian androgen levels manifest clinically and biochemically upon laboratory testing in about 7 or more women with PCOS out of 10. Your doctor may request to check for blood levels of some of the androgens such as testosterone

The clinical features are:

1. Hirsuitism which is increased facial and body hair assuming the male-type pattern of terminal hair growth with hair at the upper lip, chin, chest, lower back, upper back, lower abdomen (diamond shaped), upper abdomen, thighs and upper arm of varying density.

2. Acne 

3. Hair loss on the scalp and thinning of hair on the scalp which is known as androgenic alopecia.

Ovulatory and Menstrual Dysfunction

Ovulatory dysfunction can be seen clinically as

4. Oligomenorrhea (menses with intervals of >/= 35 days) or absent menses (amenorrhea) with fewer than ten bleeding cycles per year. Overt menstrual dysfunction is seen in 80% of women with PCOS.

5. Subclinical presentation is not seen clinically since there is no disruption of menstrual regularity. Although menses are present every month, most of the cycles are anovulatory. Checking the mid-luteal phase progesterone in those who want to conceive in such cases can reveal whether ovulation occurred or not. About 20% of women with PCOS continue to have regular menstrual cycles.

Polycystic Ovaries

While PCOS implies the presence of polycystic ovaries (PCO), this is not mandatory to make a diagnosis of PCOS. The absence of PCO does not also exclude PCOS. Up to 25% of adolescent girls and young women have PCO as a normal physiology and this is not equivalent to PCO. Women approaching menopause may not have PCO yet can have PCO if they have the above two criteria.

Increased ovarian volume (>10ml) in the absence of a dominant follicle measuring >1cm or the presence of increased tiny multiple cysts/follicles (12 follicles measuring 2-9mm in diameter) in either ovary on ultrasound is defined as PCO.

PCO is found in 2 out of 10 women with PCOS.

Other cutaneous/Metabolic/Systemic features of PCOS

 6. Skin Tags

7. Darkening of the skin (Acanthosis nigricans)

8. Obesity-central adiposity with increased abdominal waist circumference

9. Low self-esteem/ Depression/ Anxiety.

10. Hyperinsulinemia and glucose intolerance

11. Dyslipidemia with increased levels of bad cholesterols and decreased levels of bad cholesterol

12. Type 2 Diabetes Mellitus

13. Infertility

14. Sleep apnea.

From irregular periods and acne to weight gain and fertility challenges, PCOS manifests in a myriad of ways. Understanding the range of symptoms is crucial in recognizing and addressing the condition effectively

Impact on Mental Health

PCOS has an impact on mental health

Behind the clinical diagnosis lies a tapestry of emotions. Women with PCOS navigate a complex maze of frustration, anxiety, and self-esteem issues

Patients may feel alone and with a lack of understanding of the condition may feel dejected and even think they are responsible for what is happening to them. About 5 out of 10 women with PCOS may suffer from obesity and this adds to the mental pain. The cutaneous manifestations as well as infertility challenges hurt mental wellness.

PCOS often exists in the shadows of stigma and misinformation. Breaking down these barriers is essential for fostering understanding, empathy, and support. Shining a light on the realities of PCOS through open conversations, awareness campaigns, and community support can contribute to dismantling the stigma surrounding this prevalent  but often overlooked condition. If you know someone with PCOS you may want to direct them to a health professional.

PCOS and Pregnancy

Pregnancy Complications in women with PCOS

Some of the complications that can arise include miscarriages, gestational diabetes mellitus, preeclampsia and preterm birth.

PCOS Treatment Options

 PCOS treatment is directed towards treatment goals as no one blanket treatment can be given for every dysfunction.  Your doctor will ask you about your main concern and goal and thus direct treatment as such. However, lifestyle therapy has been shown to improve the metabolic and reproductive functions

Lifestyle Therapy

Healthy Diet

No single diet is superior to another.

Overall you may want to restrict the amount of calories you take in case of obesity

Physical Exercise

Exercise is good and important as it will assist in avoiding some of the metabolic complications that may be present currently or in the future such as cardiovascular diseases like hypertension, type 2 Diabetes Mellitus

Stress Management

Psychological well-being is pivotal in maximizing overall health. You can speak to a professional psychologist.

Many women with PCOS silently battle its effects, often facing challenges that extend beyond the physical realm. Emotional and psychological struggles, such as anxiety, depression, and body image issues, cast a long shadow on those grappling with PCOS. The societal pressure to conform to conventional beauty standards amplifies this struggle, emphasizing the need for a holistic approach to support

Many patients fail to appreciate the heavy load they carry as they seek solutions for PCOS and may underrate the need for counselling while facing PCOS.

Treatment of Menstrual Irregularities/Hirsuitism and Acne

Hormonal Contraceptives

Your doctor may prescribe hormonal contraceptives to regulate the menses as well as for treatment of excess hair growth and acne

 

Infertility Treatment

Ovulation Induction Medication

PCOS patients suffer from Chronic anovulation with the multiple follicles/cysts in the ovaries being in an “arrested state”.

For many individuals with PCOS, the dream of starting a family can be a rollercoaster ride. The condition is a leading cause of infertility, throwing another curveball into the mix. Fertility treatments, emotional resilience, and a strong support system become crucial components of the journey toward conception, as individuals navigate the challenges posed by PCOS on the road to parenthood

Discuss with your doctor about your treatment options. Diagnosis of PCOS does not rule out other possible causes of subfertility and anovulation such as thyroid disease, hyperprolactinemia, stress, male factor infertility, and tubal factor infertility and this will be ruled out.

PCOS is a diagnosis of exclusion-Thyroid disease, hyperprolactinemia and non-classical congenital adrenal hyperplasia (causes adrenal androgen excess) are ruled out at the time of diagnosis as they result in similar clinical features as PCOS.

Insulin Sensitizer Medicines

In women with PCOS and Type 2 DM, Insulin sensitizer medication may be prescribed by your doctor if lifestyle therapy has not achieved the goal of controlling the blood sugars..

While there’s no one-size-fits-all solution, a combination of lifestyle modifications, medication, and emotional support can significantly improve the quality of life for those with PCOS. From dietary changes to hormonal therapies, understanding the available options is empowering.”

FAQ

1. Yes, you can be able to get pregnant naturally or with the help of ovulation induction and more.

 

Conclusion

Though PCOS is a complex disorder, it is quite common and the signs and symptoms can be managed effectively depending on the desired goal. As we conclude our exploration of PCOS, one thing becomes clear – it’s time to empower voices and ignite change. By raising awareness, fostering understanding, and advocating for inclusive healthcare, we can transform the landscape for individuals navigating the complexities of PCOS. It’s a call to action for a world where everyone, regardless of their health journey, feels seen, heard, and supported

Let’s unravel the mystery, dispel the myths, and stand united in the face of PCOS – a condition that deserves not just our attention, but our collective understanding and compassion.

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