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    fertility basics

    Polycystic Ovary Syndrome (PCOS): Problems, Causes, Symptoms and Treatment

    • 12988 views
    • 4.6   (7 Votes)
    Medically Reviewed by Dr. Deepika Tiwari - MS, MBBS on 29 Mar 2019 - Written by Dr. Sunil Eshwar - MD, MBBS, DNB - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MS, MBBS

    Polycystic Ovary Syndrome is a hormonal abnormality in women of reproductive age. It is characterized by overproduction of androgen and enlarged ovaries. Besides surgical and medical treatments, there are natural remedies for treating PCOS. Find here the symptoms, causes and risks associated with PCOS.

    Polycystic Ovarian Syndrome (PCOS) also called PCOD (Polycystic Ovarian Disease) is a common hormonal imbalance among women of reproductive age due to excess production of a male hormone called androgen. Polycystic Ovarian Syndrome is primarily characterized by ovulatory dysfunction and hyperandrogenism. Adolescent girls with PCOS have increased risk of infertility, type-2 diabetes, cardiovascular disease and metabolic syndrome. PCOS is one of the leading causes of infertility in women and the most common cause of hyperandrogenism/anovulatory symptoms in teenagers. It is a syndrome with multiple clinical presentations, therefore any of the above clinical signs should cause concern for PCOS. It is a spectrum disorder comprising the given features:

    • Cutaneous hyperandrogenism (acne, hirsutism, pattern balding)
    • Menstrual irregularity
    • Polycystic Ovary
    • Obesity and insulin resistance

    Early treatment and identification of PCOS is key to preventing more severe long-term sequelae including infertility, type 2 diabetes, and potential endometrial carcinoma. Women with PCOS produce higher amounts of male hormones called androgen. These hormones are responsible for the regulation of the menstrual cycle. Excess production of androgen leads to a hormonal imbalance in women; it causes them to skip menstrual periods and makes it harder for them to get pregnant. The ovaries also develop numerous small collections of fluid filled follicles and fail to regularly release eggs. PCOS occurs when lack of ovulation alters levels of estrogen, progesterone, Follicle-stimulating hormone (FSH), and luteinizing hormone (LH). In the case of PCOD, Polycystic ovaries are a bit larger than the ovaries of a normal female. The level of estrogen and progesterone remains low during PCOS. (1)

    In this article we will look at:

    1. Symptoms of PCOS

    Signs and symptoms of PCOS are noticeable during the first menstrual period during puberty. Sometimes PCOS develops later in response to substantial weight gain or when a woman has pregnancy problems.

    PCOD

    Some of the common symptoms of PCOS include:

    • High level of male hormones (androgen)
    • Infertility Problems and irregular periods
    • Severe acne breakouts on areas like face, chest and upper back
    • High cholesterol and triglycerides acanthosis nigricans, or dark patches of skin
    • Excess hair growth (hirsutism) or hair Loss
    • Overweight or obese
    • Darkening of the skin especially on the neck, groin, underarms and under the breasts
    • Small Cysts in ovaries
    • Heavy bleeding or Painful Menstruation Cycle
    • Decreased libido
    • Anxiety, depression and headaches

    If any of the symptoms occur, consult a gynecologist and diagnose for PCOD. (2)

    2. Causes of PCOS 

    The exact cause of PCOS is still unknown. In most cases, it is associated with abnormal hormone levels in the body, including high levels of insulin.

    Some factors that might play a role include the following:

    • Genes: Heredity may also be linked to PCOS. Certain genes may be transferred from the parents to the child. 
       
    • Insulin resistance: About 70 percent of women with PCOS have insulin resistance. Insulin is a hormone produced in the pancreas that allows the cells to use sugar from foods for energy. When the cells become resistant to insulin, it can raise the level of blood sugar and the body might produce more insulin. Excess insulin increase androgen production thereby causing difficulty with ovulation, which leads to PCOS.
       
    • Inflammation:Research has shown that women with PCOS suffer from a type of low-grade inflammation, which can stimulate polycystic ovaries to produce androgens. Inflammation can lead to heart and blood vessel problems.
       
    • Excess androgen:The ovaries produce abnormally high levels of androgen, resulting in and acne and hirsutism. (3)

    3. PCOD Risk Factors

    There are several health risks associated with PCOS, which include:

    • Infertility
    • Gestational diabetes 
    • Pregnancy induced by high blood pressure
    • Miscarriage or premature birth
    • Nonalcoholic steatohepatitis (severe liver inflammation caused by fat accumulation)
    • Metabolic syndrome (high blood pressure, high blood sugar, abnormal cholesterol or triglyceride levels)
    • Type 2 diabetes or Pre-diabetes
    • Sleep apnea
    • Depression, anxiety and eating disorders
    • Abnormal uterine bleeding
    • Cancer of the uterine lining (endometrial cancer)
    • Obesity and high cholesterol
    • Elevated lipids and liver disease. (4)

    4. Tests for PCOS

    While diagnosing PCOS, the doctor may take a number of tests to determine the presence of PCOS. Tests include:

    • A pelvic exam: The doctor conducts a pelvic exam for visual and manual inspection of reproductive organs for masses, growths or other abnormalities.
       
    • Blood tests: Blood tests are required to measure the levels of male hormones, such as DHEA and testosterone, as well as gonadotropins. This testing can exclude possible causes of menstrual abnormalities or androgen excess that mimics PCOS. 
       
    • Additional blood test: Additional blood test are conducted to measure glucose tolerance, cholesterol levels and triglyceride levels.
       
    • Ultrasound: An ultrasound test is conducted to check abnormal follicles and other problems associated with ovaries and uterus. (5)

    5. Surgery Option For PCOS

    After weight loss and fertility drugs are recommended, the doctor may suggest a Laparoscopic Ovarian Drilling PCOS treatment if a person suffers from polycystic ovary syndrome (PCOS). PCOS treatments such as Ovarian Drilling are known to regulate hormone levels and improve ovulation, menstrual cycles thereby increasing the chances of getting pregnant. Nowadays, Clomid is preferred over laparoscopic procedure because Clomid can also be a reliable medication to induce ovulation.

    Some of the PCOS surgeries include:

    • Laparoscopic Ovarian Drilling: Ovarian drilling is a surgery in which tiny holes are made in the surface of the ovary using lasers or a fine needle heated with electricity. Surgery can reduce the level of androgen and restores ovulation. Laparoscopic ovarian drilling is usually done through a small incision (laparoscopy), with general anesthesia. (6)
       
    • Oophorectomy: An oophorectomy is a surgical procedure where one or both of a woman's ovaries are removed. Oophorectomy is usually performed to prevent or treat certain conditions, such as ovarian cancer or endometriosis. The surgery may be a part of a hysterectomy or may just remove ovaries. (7)
       
    • Laparoscopic Cyst Aspiration: Ovarian cysts are conventionally managed by laparoscopy. Patients usually undergo fine needle aspiration of ovarian cysts under ultrasound control. Cysts aspiration is performed transvaginally and is simple, safe and useful in the management of ultrasonically benign unilocular ovarian cysts in pre-menopausal women. Surgery can be reserved for cysts, which recur after aspiration, cysts in post-menopausal women, cysts with a hemorrhagic aspirate and those with ultrasonic criteria of malignancy. (8)

    6. Medical Treatments for PCOS

    Some of the medical treatments available for treating PCOS are:

    • Oral contraceptive pills:Along with lifestyle changes, combined hormonal contraceptives (CHCs) are the first-line management options for clinical manifestations of PCOS, specifically menstrual irregularity, hirsutism, and acne. (9) Contraceptives contain an estrogen component and a Progestogen component that vary in terms of composition and affinity to receptors of other steroid hormones (mineralocorticoids, glucocorticoids, androgens, and estrogen). Both estrogen and progestogen contribute to the management of the clinical manifestations of hyperandrogenism. Oral contraceptive pills (OCPs, birth control pills) contain estrogen and progestin, which is helpful for reducing androgen production, and regulate estrogen. Pills that regulate hormones can lower the risk of endometrial cancer and correct abnormal bleeding. (10)
       
    • Progestin:OCs contains low doses of estrogens and progestins. Progestins inhibit ovulation via suppression of LH surge. Progestins also make the cervix hostile to sperm penetration by increasing the viscosity of cervical mucus and prevent implantation through an alteration of the endometrial lining. To reduce androgenic side effects, several new progestins derived from progesterone or spironolactone has been developed in the last few decades. These progestins, such as drospirenone, trimegestone, nestorone, cyproterone acetate, and nomegestrol acetate are designed to bind specifically to the progesterone receptor and to have no androgenic, estrogenic or glucocorticoid actions. (11)
       
    • Spironolactone (Aldactone):Spironolactone (Aldactone) is a diuretic (water pill) that can reverse the effects of excess androgen produced during PCOS. Spironolactone is usually prescribed for young women with PCOS who are taking oral contraceptive pills and who are “hirsute” (have extra hair in unwanted places). (12)
       
    • Clomifene (clomiphene):Clomifene (clomiphene) is a medication used to treat infertility in women who do not ovulate. This includes those who have polycystic ovary syndrome. Use results in a greater chance of twins. It is taken by mouth once a day. Some doctors may recommend Clomiphene (Clomid) to induce ovulation in women who desire to become pregnant. (13)
       
    • Metformin (Glucophage):Metformin (Glucophage) is a drug to treat type-2 diabetes and can be used to treat women with PCOS. Metformin helps regulate menstrual cycles, start ovulation, and lower the risk of miscarriage in women with PCOS. Long-term use also lowers diabetes and heart disease risk related to high insulin levels. It helps start ovulation in women with PCOS who have not responded to treatment with clomiphene. Some doctors may recommend taking metformin (Glucophage) in addition to clomiphene to start ovulation. (14)

    Women with PCOS and infertility may require other treatments for infertility like IVF and IUI in case these medications are unsuccessful. 

    7. Natural Remedies for PCOD Symptoms

    • First, it is imperative to undertake a low-carbohydrate diet. According to a study, a low-carb ketogenic diet led to significant improvement in weight, percent free testosterone, LH (luteinizing hormone) /FSH ratio, and fasting insulin in women with obesity and PCOS over a 24 week period.
       
    • Then there are the supplements. In a twelve-week trial of PCOS patients using 500 mg of quercetin twice daily, improvements were seen in insulin sensitivity, testosterone, and LH (luteinizing hormone).

      PCOD
       
    • Resveratrol is another promising nutrient for PCOS. 1500 mg of trans-resveratrol was shown to lower the level of testosterone by 23 percent. By contrast, taking metformin for six months was shown to lower testosterone only by 8 percent. Resveratrol lowered DHEAS (Dehydroepiandrosterone sulfate) by 22 percent and decreased fasting insulin levels by 32 percent.
       
    • According to some studies, Berberine is shown to be comparable to metformin in blood sugar lowering effects, has also been explored as a treatment for PCOS. 
       
    • Inositol is probably the best-studied nutrient for the treatment of PCOS. It’s a B vitamin, harmless even at high doses, which is fortunate since 4 grams of inositol have been used in studies evaluating its effect on fertility, androgen levels, insulin response and weight gain. 4 grams inositol daily would entail swallowing a lot of pills, so it is generally suggested dissolving a level teaspoon of powdered inositol in an 8 oz. glass of cold water daily as it is slightly sweet so it is well tolerated. In a double-blind placebo trial, Costantino et al showed that myo-inositol (4 g/day) decreased insulin, testosterone, and blood pressure in women with PCOS.
       
    • Since vitamin D plays a role both in glucose homeostasis as well as ovarian function, its inclusion in a PCOS supplement program is imperative. Indeed, it is estimated that 85 percent of women with PCOS are deficient in D.
       
    • Other nutrients that have been proposed for PCOS include chromium, zinc, magnesium, n-acetylcysteine, and cinnamon. Keep in mind that if patients are taking metformin, they need to take extra B12. 
       
    • Much has been made of the role of regular exercise in PCOS. Exercise helps with insulin resistance and if combined with a low-carb diet, can counter weight gain. But care must also be taken with strength training because of the tendency of PCOS women to bulk up with resistance exercise due to their high levels of androgens. A program emphasizing mostly aerobic exercise, with occasional high-reps or low-weight strength routines is preferable. 
       
    • Lifestyle interventions are the first treatments doctors may recommend for women with PCOS, and they often work well. PCOS symptoms and the odds of getting pregnant can be improved by weight loss. It is important to follow-up with the doctor’s advice and make sure all the medications prescribed to regulate periods and lessen your chance of getting diabetes are followed. (15)

    If you are looking for ways to improve diagnosis and treatment of PCOS you can call us at Elawoman +918929020600.
     

    Dr. Sunil Eshwar

    Written by

    MD, MBBS, DNB
    Infertility Specialist, IVF Specialist
    Bangalore

    Dr. Sunil Eshwar is an Infertility specialist who is presently specializing in laparoscopic surgery, high-risk pregnancies and infertility treatments such as IVF and IUI. Dr. Sunil Eshwar completed his MBBS from Bangalore Medical College and Research Institute in 2000 and MD from Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) in 2004. Later, he completed DNB from National Board of Examination in 2006. Dr. Sunil Eshwar is currently practicing at Apollo Fertility, Brookfield, Bangalore. For more information about Dr. Sunil Eshwar, visit elawoman.com

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    7 Comments

    user_img

    Brienne Tarth

    My weight is increasing drastically and I lost so much hair this month. Is that mean I have PCOS as I could see some symptoms?

    Oct. 13, 2018, 2:40 p.m. 4.5

    user_img

    Nancy Clove

    I opted natural remedy to fight PCOS symptoms like maintaining a healthy diet with low carbohydrate, exercise and meditation.

    Aug. 3, 2018, 9:45 p.m. 4.5

    user_img

    Shalini Mathur

    Please suggest me with some hair growth medicine. My PCOS was treated a year ago, but my hair didn't come back.

    March 11, 2018, 11:32 a.m. 4.5

    user_img

    Malika Rawal

    I was diagnosed with PCOS after my ultrasound. My doctor suggested me with anti-estrogen tablets which are Clomid and it works good with very mild side-effects.

    Dec. 10, 2017, 4:30 p.m. 5.0

    user_img

    Alka Yadav

    I too have PCOS but I did not go for laparoscopy and you won't believe I have attained pregnancy. I have taken certain diet plan and I worked a lot on my weight loss. I believe my hard work has brought me the success. You should also work out as it does wonders.

    Nov. 2, 2017, 3:31 p.m. 4.5

    user_img

    Vasanthi

    I have PCOS. I'm not getting fat. Egg is also releasing on time but not getting pregnancy. Doctor suggested me to go for laparoscopy. Can anyone suggest me.

    April 6, 2017, 11:25 a.m. 5.0

    user_img

    Barkha Saxena

    Women with PCOS can also have cancer of the uterine lining i.e endometrial cancer. It requires surgery for further treatment.

    Feb. 24, 2017, 5:24 p.m. 4.5

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