MD, MMED Fam Med, CCFP, Endocrinology/ Diabetes Polycystic ovary syndrome (PCOS) is a health problem that affects 1 in 10 women of childbearing age. Women with PCOS have a hormonal imbalance and metabolism problems that may affect their overall health and appearance. PCOS is also a common and treatable cause of infertility. PCOS Awareness Month is a designated event created to increase awareness of, and education about, PCOS among the public, women, girls and healthcare professionals. The aim of PCOS Awareness Month is to help improve the lives of those affected by PCOS and to help them to overcome their symptoms as well as prevent and reduce their risks for life threatening related diseases such as diabetes, cardiovascular disease, non-alcoholic fatty liver disease and cancer.
WHY SHOULD WE KNOW ABOUT PCOS? • 10-15% -Women worldwide have PCOS ( 1 in 10) • 50% of these Women are Undiagnosed • 90% presents with infertility issues and obesity • 50% develops Diabetes or Prediabetes before the age of 40 • PCOS increases the risk of miscarriages in early part of pregnancy by three folds. • Increase risk of developing endometrial cancer three folds. • Increase risk of having heart Attacks
WHAT CAUSES PCOS? The exact cause of PCOS is unknown. Most experts suggest that several factors, including genetics, play a role, along with: • High levels of androgens. Androgens are “male hormones,” all women make small amounts of androgens. Androgens control the development of male traits, such as `male-pattern baldness. Women with PCOS have more androgens than normal. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne. • High levels of insulin. Insulin is a hormone that controls the conversion of carbs into energy. Insulin resistance occurs when the body’s cells do not respond normally to insulin resulting in high insulin levels. Many women with PCOS have insulin resistance, especially those who have overweight or obesity, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.
WHAT ARE THE SYMPTOMS OF PCOS? Some of the symptoms of PCOS include: • Irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Alternatively, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods. • Too much hair on the face, chin, or parts of the body where men usually have hair. This is called “hirsutism.” Hirsutism affects up to 70% of women with PCOS. • Acne on the face, chest, and upper back. • Thinning hair or hair loss on the scalp with male-pattern baldness • Weight gain or difficulty losing weight • Darkening of skin, particularly along neck creases, in the groin, and underneath breasts • Skin tags, which are small excess flaps of skin in the armpits or neck area • Infertility
HOW TO TELL IF SOMEONE HAS PSOC? There is no single test to diagnose PCOS. To help diagnose PCOS and rule out other causes of symptoms seen, doctors explores a patient’s medical history and do a thorough physical exam along with different tests, which includes: • Physical exam of body mass index (BMI), waist size ,skin for extra hair on face, chest or back, acne, or skin discoloration or any hair loss or signs of other health conditions such as an enlarged thyroid gland. Pelvic exam for signs of extra male hormones (for example, an enlarged clitoris) • Pelvic ultrasound (sonogram). This test uses sound waves to examine the ovaries for cysts and check the endometrium (lining of the uterus or womb). • Blood tests. Blood tests check the androgen hormone levels, Thyroids levels and Sugar levels
HOW IS PCOS TREATED? There is no cure for PCOS, but the symptoms of PCOS can be managed. A treatment plan is developed based on a person’s symptoms, desire to have children, and risk of long-term health problems.
STEPS TO IMPROVE MY PCOS SYMPTOMS • Losing weight. Healthy eating habits and regular physical activity can help relieve PCOS-related symptoms. Losing weight may help to lower blood glucose levels, improve the way the body uses insulin, and help hormones reach normal levels. Even a 10% loss in body weight can help to make menstrual cycle more regular and improve the chances of getting pregnant. • Removing hair. Facial hair removal creams, laser hair removal, or electrolysis to remove excess hair. • Slowing hair growth. A prescription skin treatment can help slow down the growth rate of new hair in unwanted places. • The use of Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormone intrauterine device (IUD which helps to: o Regulate cycle and acts as a contraceptive o Lower the risk of endometrial cancer o Helps to improve acne and reduce extra hair on the face and body • Anti-androgen medicines. These medicines block the effect of androgens and can help reduce scalp hair loss, facial and body hair growth, and acne. • Metformin. Metformin is often used to treat type 2 diabetes and may help some women with PCOS symptoms. Metformin improves insulin ability to lower your blood sugar and can lower both insulin and androgen levels. After a few months of use, metformin may help restart ovulation, but it usually has little effect on acne and extra hair on the face or body. Recent research shows that metformin may have other positive effects, including lowering body mass and improving cholesterol levels.
COMPLICATIONS AND CONSEQUENCES OF HAVING PCOS Studies have found links between PCOS and other health problems, including: • Diabetes. More than half of women with PCOS will have diabetes or prediabetes (glucose intolerance) before the age of 40. • High blood pressure. Women with PCOS are at greater risk of having high blood pressure compared with women of the same age without PCOS. High blood pressure is a leading cause of heart disease and stroke. • Unhealthy cholesterol. Women with PCOS often have higher levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol. High cholesterol raises the risk of heart disease and stroke. • Sleep apnea. This is when momentary and repeated stops in breathing interrupt sleep. Many women with PCOS are overweight or obese, which can cause sleep apnea, which can also increase the risk of heart disease and diabetes. • Depression and anxiety. Depression and anxiety are common among women with PCOS. • Endometrial cancer. Problems with ovulation, obesity, insulin resistance, and diabetes increase the risk of developing cancer of the endometrium (lining of the uterus or womb). • Infertility • Gestational diabetes or pregnancy-induced high blood pressure • Miscarriage or premature birth • Non-alcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver • Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase the risk of cardiovascular disease • Abnormal uterine bleeding While there is no cure for PCOS, choosing the right nutrition can lead to happy and healthy living. In overweight persons, as little as a 5% weight loss has been proven to greatly improve PCOS symptoms. Along with choosing low-GI foods, moderately reducing carb intake, avoiding sugary foods and having a good intake of healthy fats and lean protein is a good place to start. Regular exercise can provide excellent benefits as well. By making good choices, is the first step in taking control of PCOS symptoms.
