What is Polycystic Ovarian Disease (PCOD) or Polycystic Ovary Syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a health problem that can affect a woman's:

  • Menstrual cycle
  • Ability to have children
  • Appearance
  • Hormones
  • Blood vessels
  • Heart

With PCOS/PCOD women typically have:

  • High levels of 'androgens.' These are sometimes called male hormones, though females also make them.
  • Many small cysts (fluid-filled sacs) in their ovaries
  • Missed or irregular periods (monthly bleeding)

What causes PCOS? 

The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.

A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.

High androgen levels can lead to:

  • Acne
  • Excessive hair growth
  • Weight gain
  • Problems with ovulation 

How many women have PCOS? 

Between 1 in 10 and 1 in 20 women of childbearing age has PCOS. It can occur in girls as young as 11 years old. 

What are the symptoms of PCOD or PCOS? 

The symptoms of PCOS can vary from woman to woman. Some of the polycystic ovary syndrome symptoms include:

  • Infrequent, absent, and/or irregular menstrual periods
  • Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
  • Increased hair growth on the face, chest, stomach, back, thumbs, or toes
  • Male-pattern baldness or thinning hair
  • Cysts on the ovaries
  • Acne, oily skin, or dandruff
  • Weight gain or obesity, usually with extra weight around the waist
  • Skin tags — excess flaps of skin in the armpits or neck area
  • Pelvic pain
  • Anxiety or depression
  • Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
  • Sleep apnea — when breathing stops for short periods of time while asleep

How do I know if I have PCOS? 

There is no single test to diagnose PCOS. Your doctor will take the following steps to find out if you have PCOS or if something else is causing your symptoms.

Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.

Physical exam. Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.

Pelvic exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.

Blood tests. Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.

Ultrasound (sonogram). Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (lining of the womb). This lining may become thicker if your periods are not regular.

How is PCOS treated?

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:

Lifestyle modification. Many women with PCOS are overweight or obese, which can cause health problems. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level. Healthy eating tips include:

  • Limiting processed foods and foods with added sugars
  • Adding more whole-grain products, fruits, vegetables, and lean meats to your diet
  • This helps to lower blood glucose (sugar) levels, improve the body's use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.
  • Birth control pills. For women who don't want to get pregnant, birth control pills can:
  • Control menstrual cycles
  • Reduce male hormone levels
  • Help to clear acne

Fertility medications. Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used.

Another option is in vitro fertilization (IVF). IVF offers the best chance of becoming pregnant in any given cycle. It also gives doctors better control over the chance of multiple births. But, IVF is very costly.

Surgery. "Ovarian drilling" is a surgery that may increase the chance of ovulation. It’s sometimes used when a woman does not respond to fertility medicines. This surgery can lower male hormone levels and help with ovulation. But, these effects may only last a few months.

Medicine for increased hair growth or extra male hormones. Medicines called anti-androgens may reduce hair growth and clear acne. Anti-androgens are often combined with birth control pills. These medications should not be taken if you are trying to become pregnant.

Before taking any Medicines tell your doctor if you are pregnant or plan to become pregnant. Do not breastfeed while taking this medicine.

Other options include:

  • Cream to reduce facial hair
  • Laser hair removal or electrolysis to remove hair
  • Hormonal treatment to keep new hair from growing

Does PCOS change at menopause?

Yes and no. PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.

Polycystic ovary syndrome and pregnancy- How does PCOS affect a woman while pregnant?

Women with PCOS appear to have higher rates of:

  • Miscarriage
  • Premature delivery
  • Pregnancy-induced high blood pressure
  • Gestational diabetes

Does PCOS put women at risk for other health problems?

Women with PCOS have greater chances of developing several serious health conditions. Recent studies found that:

Women with PCOS can have diabetes or pre-diabetes at early age.

Women with PCOS are at greater risk of having high blood pressure.

Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.

Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.

Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.

I have PCOS. What can I do to prevent complications?

If you have PCOS, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOS, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include:

Eating right

Exercising

Not smoking

How can I cope with the emotional effects of PCOS?

Having PCOS can be difficult. You may feel:

Embarrassed by your appearance

Worried about being able to get pregnant

Depressed

Managing PCOS (Diet and Exercise)

Following lifestyle and diet modifications can help manage PCOS symptoms to an extent-

  • Frequently have small meals (5-6 times a day) without fail.
  • Drink a lot of water (8-10 glasses)
  • Try to consume 2-3 servings of fruits and vegetables every day.
  • Stick to a high fibre diet (wholegrains/fruits/vegetables)
  • Give preference to home cooked meals.
  • Add brightly colored and white vegetables to your diet. They have high anti-oxidants.

Food to avoid- 

  • Fried/packaged/processed foods
  • Foods with high glycemic index

​Exercises suggested- 

  • Work out at least 5 times every week for at least 30 minutes
  • Running, swimming, yoga
  • Strengthening exercises​

Even if you don't lose weight, exercise in PCOS helps to improve things like- insulin sensitivity, frequency of ovulation, cholesterol, body composition.

Getting treatment for PCOS can help with these concerns and help boost your self-esteem. It is advised that you should consult gynecologist who can help you based on your symptoms and requirements to manage PCOD/PCOS.