Polycystic Ovarian Syndrome (PCOS) or Disease (PCOD)

Polycystic ovarian syndrome is a multisystem endocrinopathy with ovarian expression of metabolic  disturbance and a wide spectrum of clinical features, such as hyperandrogenism and obesity along with metabolic disorders. This disease was earlier known as Stein-Leventhal syndrome. The  incidence appears to be on the increase due to change in lifestyle and stress. The patients are mostly 15-25 years of age, when the disease begins soon after puberty, but may  manifest during reproductive period. PCOS includes chronic non-ovulation, hyperandrogenism associated with normal or raised oestradiol level (E2), raised LH and low FSH/LH ratio. The disease has genetic and familial tendency and may be autosomal dominant inherited.

Causes

The exact cause of polycystic ovary syndrome (PCOS) is unknown, but it’s thought to be related to abnormal hormone levels.

  1. Resistance to insulin
  2. Insulin is a hormone produced by the pancreas to control the amount of sugar in the blood. It helps  move glucose from blood into cells, where it is broken down to produce energy.
  3. Insulin resistance means the body’s tissues are resistant to the effects of insulin. The body therefore has to produce extra insulin to compensate.
  4. High levels of insulin cause the ovaries to produce too much testosterone hormone, which interferes with the development of the follicles (the sacs in the ovaries where eggs develop) and prevents normal ovulation.
  5. Insulin resistance can also lead to weight gain, which can make PCOS symptoms worse because having excess fat causes the body to produce even more insulin.
  • Hormone imbalance

Many women with PCOS are found to have an imbalance in certain hormones, including:

  • raised levels of testosterone – a hormone often thought of as a male hormone, although all women normally produce small amounts of it
  • raised levels of luteinising hormone (LH) – a hormone that stimulates ovulation, but may have an abnormal effect on the ovaries if levels are too high
  • low levels of sex hormone binding globulin (SHBG) – a hormone that helps reduce the effect of testosterone
  • raised levels of prolactin (only in some women with PCOS) – a hormone that stimulates the breast glands to produce milk in pregnancy

The exact reason why these hormonal changes occur is not known. It’s been suggested that the problem may start in the ovary itself, in other glands that produce these hormones, or part of the brain that controls their production. The changes may also be caused by the resistance to insulin.

  • Genetics

Polycystic ovary syndrome (PCOS) sometimes runs in families. If any relatives, such as your mother, sister or aunt, have PCOS then the risk of you developing it is often increased.

This suggests there may be a genetic link to PCOS, although specific genes associated with the condition have not yet been identified.

Symptoms

The symptoms of polycystic ovary syndrome (PCOS) usually become apparent in your late teens or early twenties.

Not all women with PCOS have all of the symptoms. Each symptom can vary from mild to severe. In many women, the only symptoms are menstrual problems or a failure to conceive.

Common symptoms of PCOS include:

  • irregular periods or no periods at all
  • difficulty getting pregnant (because of irregular ovulation or failure to ovulate)
  • excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks
  • weight gain
  • thinning hair and hair loss from the head 
  • oily skin or acne

Fertility problems

Polycystic ovary syndrome is one of the most common causes of female infertility. Many women discover they have PCOS when they’re trying to get pregnant and are unsuccessful.

During each menstrual cycle the ovaries release an egg (ovum) into the uterus. This process is called ovulation and usually occurs once a month. Women with PCOS often fail to ovulate or ovulate infrequently, which means they have irregular or absent periods and find it difficult to get pregnant.

Risks in later life

Having PCOS can increase your chances of developing other health problems later in life. For example, women with PCOS are at an increased risk of developing:

  • Type 2 diabetes – a condition that causes a person’s blood sugar level to become too high
  • Depression and mood swings, as the symptoms of PCOS can affect your confidence and self-esteem
  • High blood pressure and high cholesterol, which can lead to heart disease and stroke
  • Women who are overweight may also develop sleep apnoea – a condition that causes interrupted breathing during sleep

Investigations

  • Ultrasound findings are confirmative of PCOS.
  • In most cases, ultrasound alone is reliable in the diagnosis. In some cases low FSH/LH ratio and raised testosterone, androstenedione and dehydroepiandrosterone (DHEA) will be observed.  Fasting insulin level is more than 10mlU/ml in insulin resistant case.

Prevention

  • If you are overweight, weight loss may be all the treatment you need. A small amount of weight loss is likely to help balance your hormones and start up your menstrual cycle and ovulation.
  • Eat a balanced diet that includes lots of fruits, vegetables, whole grains, and low-fat dairy products.
  • Get regular exercise to help you control or lose weight and feel better.
  • If you smoke, consider quitting. Women who smoke have higher levels of androgens than women who don’t smoke.

References