Polycystic ovary syndrome (PCOS)

What is PCOS?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects one in 10 women of childbearing age. In India the prevalence varies from 6-36%. It is now called a syndrome as it is a collection of symptoms (problems) that are present together. Not all women have all the symptoms. To be labeled as PCOS, a woman must have two out of three possible problems: chronic lack of ovulation (anovulation), persistently raised male hormones (hyperandrogenemia) and ovaries showing small multiple follicles (mistakenly referred to as cysts) containing eggs. These issues lead to permanent health and appearance problems along with infertility.

What are the symptoms of PCOS?

• Irregular menstrual cycles Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or, their periods may come before 21 days or more often. Some women with PCOS stop having menstrual periods for months or get them only when they take medicines.
• 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 percent of women with PCOS.
• Acne on the face, chest, and upper back.
• Thinning hair or hair loss on the scalp; male-pattern baldness.
• Weight gain or difficulty losing weight.
• Darkening of skin, particularly along neck creases, in the groin, and underneath breasts.
• Skin tagswhich are small flaps of excess skin in the armpits or neck area.

How is PCOS diagnosed?

PCOS women could be obese, lean or normal. If we go through internet you find so many other types but as per the international criteria to diagnose PCOS, there are four subgroups and these groups are called phenotypes. Group A and B together make classic PCOS, while group C is called ovulatory PCOS, and group D is called borderline PCOS. Classic ones have all the three features like menstrual irregularities, hirsutism and their ovaries are full of small follicles, and are obese. Group C could be obese or normal weight with menstrual dysfunctions and lots of hair and acne. On the contrary group D look normal and only have menstrual problems and follicles in their ovaries.

How is PCOS treated?

There is no cure for PCOS, but you can manage the symptoms of PCOS. You and your doctor will work on a treatment plan based on your symptoms, your plans for children, and your risk for long-term health problems such as diabetes and heart disease. Many women will need a combination of treatments, including:

• Lifestyle modifications like diet and exercise for Weight loss. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a 10 percent loss in body weight can help make your menstrual cycle more regular and improve your chances of getting pregnant.
• Hair removal or slowing hair growth. You can try facial hair removal creams, laser hair removal, or electrolysis to remove excess hair. A prescription skin treatment (eflornithine HCl cream) can slow down the growth rate of new hair in unwanted places.
• Prescription medicines to regularize your periods. Your doctor may prescribe hormonal birth control, such as the pill, patch, shot, vaginal ring, or hormonal intrauterine device to improve acne and reduce unwanted hair. Other medicines can block the effect of androgens or lower insulin and androgen levels. If you are trying to get pregnant, your doctor may prescribe medicines to help you ovulate, such as letrozole or clomiphene.
• In vitro fertilization (IVF). In IVF, your eggs are fertilized with your partner’s sperm in a laboratory and then placed in your uterus to implant and develop. Compared with medicine alone, IVF results in higher pregnancy rates and lowers your risk for twins and triplets (by allowing your doctor to transfer a single fertilized egg into your uterus).
• Surgery. The outer shell (called the cortex) of the ovaries is thickened in women with PCOS and thought to play a role in preventing spontaneous ovulation. Ovarian drilling is a surgery in which the doctor makes a few holes in the surface of your ovary using lasers or a fine needle heated with electricity. Surgery usually restores ovulation, but only for six to eight months.