PCOS

All that you wanted to know about PCOS

PCOS is a common condition seen in women due to hormonal disturbances, leading to menstrual irregularities, hyperandrogenism features like acne, excessive hair growth, scalp hair thinning, seteorinea and skin tags. It also presents with obesity and difficulty in child bearing.pcos

 

What are the major causes of PCOS?

The exact cause of PCOS is not well understood. It is a polygenic, mutifactoril and heterogenous disorder with a strong genetic predisposition.

 

Is PCOS a hereditary disorder?

It is a multi genetic disorder. The mode of inheritance remains unclear. No gene has been universally accepted as susceptiality marker; however, there is a definite clustering of PCOS in families. It has been found to be a trait, resulting from interaction of different genes under the influence of environmental factors. Research is going on to identify the exact genes responsible for PCOS.

 

What are the common symptoms?

The person may present with one or more of the following symptoms, the severity may also vary from person to person.

  • Menstrual disturbances: like absent/irregular menstrual bleeding, untimely bleeding episodes and occasionally very heavy bleeding episodes. (b) Excessive weight gain especially in the abdominal region and with a trouble losing weight.
  • Difficulty in conceiving.
  • Features of excessive androgens (male hormones) like acne, excessive hair growth on face and body and thinning of scalp hair due to excessive hair loss. (e) Acanthosis irigricans which is nothing but pigmented linear marks usually in the neck and axillae.
  • It may also cause psychological disturbances like depression.
  • Concurrent health problems like Diabetes, Hypertension and high cholesterol.

 

Weight reduction and PCOS

Weight reduction is easier said than done and it is a constant battle with the scales. This is because of:

  • Insulin Resistance
  • Weight gain
  • Obesity
  • Fat storage

Insulin is an important hormone for regulating the blood sugar levels. Women with PCOS have a dysfunction in B-cells and hence may over react producing more insulin than required (Hyperinsulinemia). This excess insulin causes the excess glucose to be stored as fat.

Slow Metabolism

The women with PCOS have a slower metabolic rate and hence the calorie requirement is lower than the other women.

Appetite control

Hormones involved with hunger and appetite control include ghrelin, leptin and croleeystokinin. Recent research has shown that women with PCOS do not feel as saturated as women who don’t have PCOS.

 

Is there any special test to diagnose PCOS?

There is not one special test to diagnose PCOS. The diagnosis is based on the symptoms/clinical features like:

  • Acne
  • Excessive hair growth
  • Acanthosis nigricans
  • Increased BMI (wt/htZ)
  • Increased male hormone levels
  • Deranged blood sugar levels
  • Enlarged ovaries with multiple small cysts (follicles of 2-9mm size) in the periphery.

 

Major risk factors – PCOS

  • Obesity
  • Strong family history of diabetes especially maternal side.
  • PCOS or irregular cycles in matter or in an immediate maternal or paternal aunt.
  • Low birth treatment of PCOS focuses on management of individual concerns.

 

Weight reduction

Weight reduction of 5-10% has been found to be effective in regulating the menstrual cycles. Weight reduction can be achieved by lifestyle modifications like:

  • Regular moderate exercises as yoga.
  • Dietary modifications by including a balanced diet.
  • Quit Smoking

 

Symptomatic Management – PCOS

To regulate menstrual cycles

  • Birth control Pills/ Oral contraceptive pills.
  • Progestogen for 10+14 days every 1 -2 months.
  • Insulin Sensitizers like Metformin & Thiazolidinediones.

To regulate Ovulation

  • Antiestrogenic drugs, Clomiphenecitrate, Letrazole.
  • (However, the drugs to regulate ovulation need to be taken under supervision of Reproductive Specialist to avoid complications.

To reduce excessive hair growth

  • Combined Oral Contraceptive.
  • Antiandrogens like sptronolactone, flutamide, fi
  • Insulin sensitivity agents. Efl
  • Mechanical hair removal methods.

 

Dietary Recommendations

Dietary recommendations are strictly individualized. However a daily intake of about 1000-1 200 kcal/day is recommended.

Included the following foods

  • With low glycerin index; Fruits
  • Rich in unsaturated fats (Fishes like Salmon, Avacado, Olive oil).
  • Complex Carbohydrates: whole grains, nuts.
  • Foods rich in magnesium rich food – Dark leafy vegetables, nuts, seeds.
  • Maintain dietary diary.
  • Prevent overeating & relapses.

Modification of dietary schedule

A few steps which can help reduce the intake.

  • Take time for chemistry food.
  • Avoid total fasting.
  • Do not eat between meals.
  • Eating always at table.
  • Not doing other activities while eating.

 

Precautions

  • Ideal body weight to be maintained.
  • Exercise regularly.
  • Eat healthy balanced diet.
  • Regular gynec check up pelvic USG, Pap Smear.
  • Monitor Thyroid and Blood sugar levels.
  • Maintain menstrual chart.
  • Avoid stress.

 

Infertility management for patients with PCOS

Infertility management for patients with PCOS is challenging. However, with good patient motivation pregnancy is not unachievable especially with normal male parameters.

It causes infertility due to oligo/ anovulation. Often it could be associated with other factors of infertility.

Ovulation can be regularized with dedicated lifestyle modifications and by drugs used for ovulation induction as mentioned earlier.

Recommended 1st line modality for PCOS women with infertility is drugs used for including ovulation like anti estrogens and Gonadotropins. The 2nd line modality is laparoscopic Ovarian drilling which decreases the androgen secretion from the ovary, improving the ovulation. The 3rd line modality is IVF. ART becomes an important modality in patients with other associated causes of infertility like hibal factor or Endometriosis or the presence of associated male infertility.

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