POLYCYSTIC OVARIAN SYNDROME (PCOS)

PCOS is one of the most common metabolic or endocrine disorders mostly affecting women who have a sedentary lifestyle, which is manifested by chronic an-ovulation and hyperandrogenism. There are two types of PCOS : Obese PCOS and Lean PCOS, of which the former is most common and comparatively easier to cure than the latter.

Why is it caused?

PCOS is a multi-factorial and polygenic condition which is characterized mainly by excessive androgen production of the ovaries and also insulin resistance. This condition is seen in about 20% of normal women, more prevalent in the age group of 20-30 and those who have an inactive lifestyle. Regular intake of junk foods, sweets, carbonated drinks and lack of physical exercises contribute to the increasing incidence of the disease condition. Let’s have a study about PCOS in general… The ovarian volume increases to more than 10ml, the stroma increases, the capsule gets thickened and becomes pearly white in colour. There will be presence of multiple follicular cysts measuring about 2-9mm in diameter (due to low Follicle Stimulating Hormone, follicular growth gets arrested at different phases of maturation). On ultrasound scan, the ovary seems like wearing a pearl necklace (due to the presence poly cysts)

Signs and Symptoms

• Obesity (abdominal-50%), BMI >30
• Amenorrhoea (absence of menstruation)
• Oligomenorrhea (reduced menstrual bleeding)
• Dysfunctional uterine bleeding
• Hirsutism (abnormal hair growth especially on face, breast region etc)
• Acne
• Acanthosis nigricans (skin thickened and pigmented grey brown in nape of neck, inner thighs, groin and Axilla – a definite sign of insulin resistance)
• Alopecia (loss of hair in patches)
• Infertility

On internal examination, bilateral enlarged cystic ovaries can be seen.

How can PCOS be diagnosed?

• Ultrasonography
• Body Mass Index
• Blood pressure
• Serum Levels of Testosterone, Follicular stimulating Hormone(FSH), Luteinizing hormone(LH), Prolactin
• Thyroid stimulating hormone
• 2 hours Glucose tolerance test
• Lipid profile

On USG, we can see that ovaries are enlarged, ovarian(stromal) volume is greater than 10ml, and there is an increase in number (>12) of peripherally arranged cysts (2-9 mm dia). 10-20% of USG, may show polycysts, but if menstrual cycles are regular, and no clinical features are found, it is considered normal, but it may be indicative of metabolic disturbances like diabetes mellitus in future and need to be taken care of without delay. Increase in LH level, increase in estradiol and estrone, S. Testosterone >150 ng/dl, fasting insulin rate is also seen to increase.

What are the sequelae of PCOS?

Short Term Effects

• Obesity
• Menstrual abnormality
• Anovulation and Infertility
• Miscarriage
• Abnormal lipid profile
• Androgen excess (acne, hirsutism, alopecia)
• Insulin resistance (glucose intolerance, acanthosis nigricans)

Long Term Effects

• Diabetes Mellitus -15%(due to insulin resistance)
• Endometrial cancer (due to persistently elevated estrogen effect)
• Dyslipidemia (decreased HDL, increased LDL and Triglycerides)
• Hypertension
• Cardiovascular Diseases
• Atherosclerosis
• Obstructive Sleep Apnea (due to obesity)

How can you manage PCOS?

PCOS is a condition which can be cured with ease if diagnosed at an early stage. Treatment of PCOS needs individualisation of patients, depending on their presenting symptoms. Treatment is primarily targeted to correct the biochemical abnormalities. Weight Reduction (specifically loss of abdominal fat) is most importantly the First Line of Treatment. BMI<25 improves menstrual disorders, impaired glucose intolerance, hirsutism, acne and obesity. Lifestyle modification, with a strict diet and exercise is the most beneficial method of management. Diet Low Glycemic Index diet like whole grains, legume, seeds, fruits, low carbohydrate foods; Anti-Inflammatory foods like berries, fatty fish and leafy greens, natural unprocessed foods, high fiber foods, spinach, broccoli, cauliflower, dried beans, lentils, olive oil, avocados, spices like cinnamon and turmeric should be made a part of your regular diet. Diet plans may also be changed depending upon the condition of each patient, so it is always better to consult a doctor or dietician before choosing. Foods to be avoided include refined carbohydrates (pastries, white bread), sugary beverages (sodas and energy drinks), processed meat, solid fats, excess red meat (steaks, burgers, pork), curd, fried foods.

Exercise

Exercises in the form of either circuit training high intensity cardio workouts, zumba, or in the form of yoga need to be followed strictly for a minimum of 30-40 minutes daily. In case of Yoga, doing Surya Namaskar is found to be highly effective in treatment of PCOS, along with other postures like Naukasana, Badhakonasana, Bhujangasana, Dhanurasana, Ushtrasana, Pavanamuktasana , Shalabasana, and Paschimottasana. Along with yoga, practising pranayama (breathing exercises) is also seen to have a positive impact on bringing back the body to a healthy state. Self care practices, getting enough sleep and relaxation can make life even more pleasant and stress free.