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PCOS is caused due to Hormonal imbalance in femaleβs body. It is the most common endocrine disorder and generally affects female between ages 18-35 years. Itβs a disease of unknown etiology and affects approximately 5-10% of women. It is a myth that women with PCOS cannot get pregnant, itβs treatable and women can get Pregnant.
TYPES OF PCOS
Phenotype A: Hyperandrogenism, ovulatory dysfunction, polycystic ovarian morphology
Phenotype B: Hyperandrogenism, ovulatory dysfunction
Both A&B are considered as classic PCOS. There is increase in menstrual irregularity,abdominal obesity, insulin resistance, risk of type 2 DM, Metabolic Syndrome.
Phenotype C: Hyperandrogenism, Polycystic Morphology
There is lesser hyperandrogenism, milder form of Dyslipidemia, Reduced incidence of metabolicsyndrome.
Phenotype D: Ovulatory Dysfunction, Polycystic ovarian Morphology
No androgen excess and thereβs little chance of Metabolic syndrome.
Some times itβs genetically inherited. (If mother and aunts are affected the chances of getting pcos is higher).
Excess insulin production or insulin resistance as there are faults in insulin receptors and post receptor signalling. As a result insulin levels rise and circulating insulin contribute to excess androgen production and an ovulation.
There is increase production in male hormones and hyperandrogenism which can lead to an ovulatory cycles and also cause Hirsutism and Acne.
There is inappropriate production of FSH &LH hormone because of which follicular development is limited.
Others like sedentary lifestyle, pollution which can act as contributory factor.
Menstrual Disorder associated with less menstruation or oligomenorrhea (occurring every 2-3 months or heavy menstrual heavy bleeding)
Excessive growth in facial or body hair
Loss of hair on scalp
Increase in weight especially around the waist area.
Acne Pigmentation or Darkening of skin around neck region (Acanthosis nigricans)
Difficulty in pregnancy/conceiving.
Rapid mood changes associated with depression and psychological problems.
Symptoms vary from women to women. Some will have mild symptoms and others can be severely affected.
PCOS can be diagnosed if any of the 2 following symptoms are seen:
-Irregular,infrequent periods or no periods
-Increase in facial or body hair or blood tests which show increased testosterone levels.
-Ultrasound showing polycystic ovaries.
BMI measurement at every visit
Glucose tolerance test
Lipid Profile
USG showing poly cystic ovarian morphology and Doppler showing increased stromal morphology.
Testosterone level >60 ng/dl
SHBG is on lower side
LH:FSH ratiois increased
AMH>5ng/ml
Insulin levels : fasting insulin>20-30 and 2hr PP >100
1. Lifestyle Management
-Diet: low glycaemia index diet,lot of fruits and fiber rich food.
-Regular exercise-150 minutes of exercise every week is essential.
-Weight loss- 5-10% is also found to be effective as it helps in regularizing your hormones and menstrual cycle.
-Bariatric Surgery in patients with BMI>40kg/m2
-Quit Smoking as it causes increase androgen level and insulin resistancein body.
2. Management of Hirsutism
Drugs like Antiandrogens, Flutamide, Fenestramide, Cryproterone Acetateand O.C.Pills can be given.Dermatological interventions like laser, waxing, plucking can be done.
3. Treatment of Acne
Use of O.C.Pills or Desogesteral and topical ointments like salisylicacid, benzoic peroxide can be given.
4. Management of Menstrual Dysfunction
O.C.Pills can be given and mostly those with estrogens at low doses.Progesterone therapy can be given to those who cannot tolerate estrogen.
5. Management of Infertility in PCOS
Clomiphene citrate and Aromatase inhibitors can be used for 6 ovulatory cycles
Laparoscopic ovarian drilling can be done.
Lastly if nothing works we can plan for In Vitro Fertilisation with various different Protocols.
*Metformin
It can be given in dose 500-1500mg/day. It helps in increasing the frequency of ovulation and it causes decrease in OHSS and insulin resistance.
*Ionositol
Itβs an insulin sensitizer. It acts on ovary and decreases hyperndrogenemia and regulates cycle for ovulation.
*Vitamin D
Has beneficial effect on insulin resistance , hyperandrogenemia, and follicular maturation.
*L-Methyfolate
Helps DNA synthesis and reduces homocystine levels and improvesendothelial functions.
*Antioxidants
N-Acetyl Cystine
Antiapoptoic activity, decreases cholesterol level and has effect on insulin receptor activity.
Melatonin & Carnitine
Prevents Intrafollicular oxidative damage . Prevents DNA Damage and reduces Insulin resistance
*Omega 3 fatty acids & Selenium
Reduces insulin Resistance and total cholesterol
*Multivitamins
Reduces ROS levels and improves reproductive outcome
PCOS in pregnancy can lead to Miscarriages.
They will achieve menopause 2 years later than healthy women due to prolonged reproductive function as well as increased ovarian reserve.
One in every ten women can develop diabetes.
Women with PCOS can have high blood pressure due to related insulin resistance and overweight.
It can also lead to Heart problems.
If fewer than 3 periods a year, endometrial is thickened and may lead to endometrial cancer.
It is also related to Depression and Mood swings.
PCOS has increased risk of metabolic dysfunction, impaired glucose Tolerance,Type 2 diabetes Mellitus and Dyslipidemia.
Oxidative stress caused by ROS production in immune cell plays a fundamental role in the genesis and progression of endothelial dysfunction which leads to development of arterial hypertension and cardiovascular disease.