Polycystic ovarian syndrome (PCOS) is a very common disorder of the endocrine system among women of reproductive age group. It is a condition of imbalance of the hormones, which can cause either cyst around the ovaries, problems with menstrual cycles, infertility, unwanted hair growth, acne, etc. The cause of PCOS is unknown. There is no cure for PCOS as well, but the symptoms can be treated.
Signs and Symptoms of PCOS
There are many signs and symptoms, which one may experience with the PCOS. PCOS cannot be diagnosed with any one test alone, and the symptoms can differ from person to person. Some of the symptoms are:
- Weight gain.
- Infertility due to anovulation or absence of ovulation.
- Irregular menstrual cycles.
- Excessive unwanted hair growth on the face, chest, abdomen, back, thumb, or toes.
- Cysts on the ovaries.
- Anxiety, depression, mood swings.
- Thinning of hair.
Long-Term Complications of PCOS
Women diagnosed with PCOS, also stand at a high risk of developing some of the following long-term health complications:
- High blood pressure: Higher levels of insulin in the body have a direct impact on the blood pressure levels. Women with PCOS have a risk of developing high blood pressure three to four times more than normal women between the ages 40-59 years.
- High Cholesterol: Women with PCOS have a high level of bad cholesterol (LDL) and low level of good cholesterol (HDL), this is mainly due to hyperandrogenism (increased level of testosterone hormone secretion) that leads to high level of fat deposits in the bloodstream.
- Sleep apnea: Women with PCOS can also develop sleep apnea, i.e., breathing stops for a short time during sleep. Although obesity is considered the main risk factor for sleep apnea, PCOS women are also considered at high risk due to various factors in addition to the obesity. Hyperandrogenism is considered one of them.
- Endometrial cancer: Women with PCOS produce the hormone oestrogen but not progesterone due to the absence of ovulation. Progesterone is required for the shedding of the endometrium (uterine lining), and lack of progesterone production causes thickened endometrium, which can cause irregular or heavy bleeding and over time can lead to cancer.
- Heart attack: Higher levels of insulin production also put the women with PCOS at risk for cardiovascular diseases. The risk of heart attack in women with PCOS is 4 to 7 times greater than in the women of the same age group who do not have PCOS.
- Diabetes: More than 50% of the women are estimated to have either pre-diabetes or diabetes before the age of 40. It occurs as PCOS women are resistant to insulin and as a result, higher levels of insulin hormone are produced to combat the same. This leads to insulin resistance and hence diabetes.
- Breast cancer: The major risk factors for breast cancer are known to be obesity, infertility, and hyperandrogenism. As women with PCOS are known to have either or all of these symptoms, they are considered to be at risk for breast cancer, although this is not substantiated yet. Nonetheless, PCOS women are considered to be at high risk for the same when they also carry a positive family history of breast cancer.
- Ovarian cancer: There is also a risk of ovarian cancer with women having PCOS, mainly because of the extended use of fertility drugs to trigger ovulation. This risk appears to be even greater with nulliparous women or with women who have early menarche or early menopause.
Treatment and Risk Reduction Strategies
PCOS symptoms can be controlled with medications and also with lifestyle modifications.
- Lifestyle Modifications: There are many long-term benefits associated with maintaining a healthy lifestyle. Women with PCOS are known to be either obese or overweight; therefore it is important for women with PCOS to keep obesity at bay and also to maintain BMI in the normal range. Weight reduction helps in increasing the metabolic rate, regulate insulin and other hormone levels, and also help in regularisation of the monthly cycle. Hence, having a well-balanced, low-caloric, low-glycemic index diet with avoidance of processed food and inclusion of whole-grain foods, fruits, vegetables, and lean meat in the diet along with a minimum of 30 minutes of aerobic exercise goes a long way in helping to control weight issues and keep other long-term complications at bay.
- Birth Control Pills: Birth control pills are prescribed for women who are not interested in getting pregnant. They help in regulating the menstrual cycle and also to reduce the male hormone levels in the body and helps with acne.
- Fertility Drugs: Women with PCOS face fertility issues due to lack of ovulation. Hence fertility medications help women with PCOS conceive. Some women are also known to undergo a procedure called ovarian drilling to increase ovulation, usually in cases where they do not respond to fertility medications.
- Anti-Diabetic Medications: Doctors are known to prescribe anti-diabetic medicines to treat women with PCOS, although this may not be approved by US Food and Drug Administration. It helps in insulin regularisation as well as in lowering the production of testosterone. It checks the excess hair growth and acne, and in some cases, after prolonged use for a few months, it can even help with ovulation. The other uses include reducing BMI and improved cholesterol levels. All these medications should be taken under the guidance of your physician.
- Surgery: In case of morbidly obese women, in whom diet and exercise regimes have had little or no effect, bariatric (weight loss) surgery can help in resolving PCOS related complications. It should be kept in mind that this surgery should be the last option when all other options have failed.
Being diagnosed with PCOS is a very frustrating and worrisome experience. Having the diagnosis of PCOS without an easy cure can be difficult. However, it is very important for you to know that you are not alone. Look for support groups, talk to your counsellor to deal with the emotional affects of PCOS. Ensure you are compliant with the medications prescribed, be it for diabetes, periods regulation, excess hair growth, or any other health problem. Ensure you have regular follow-ups with your doctor and get all the tests prescribed (be it for diabetes, hypertension, or any other possible problems) done on a regular basis. If you are a tobacco user, consider quitting the same. Remember, the earlier the PCOS is diagnosed, the better chance you have at reducing the risk of long-term complications.
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- PCOS Health Risks – Accessed on August 20, 2016 – http://www.uchospitals.edu/specialties/pcos/risks.html
- Long-Term Consequences of Polycystic Ovary Syndrome – Accessed on August 20, 2016 – https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_33.pdf
- Long-Term Health Consequences of PCOS – Accessed on August 20, 2016 – http://humupd.oxfordjournals.org/content/8/3/231.full.pdf
- Polycystic Ovary Syndrome (PCOS) Fact Sheet – Accessed on August 20, 2016 – http://womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html
- Long-Term Health Consequences of PCOS – Accessed on August 20, 2016 – http://www.ranzcog.edu.au/component/docman/doc_details/934-long-term-health-consequences-of-pcos-c-gyn-26.html