Aditi (name changed) was troubled. She was anxious about her appearance and body weight since she felt that she was hairy and obese. Her periods were also irregular. She blamed herself, that is, until her symptoms were diagnosed as PCOS.
PCOS or Poly Cystic Ovarian Syndrome is one of the most common endocrine disorders that affect women of the reproductive age (12 to 45 years). It is increasingly becoming very common among young women. Dr. P. Rajasree, the Chief Medical Officer, of the University of Hyderabad Health Centre says, “Almost 20 to 30 percentages of women today are affected with PCOS. I would attribute it to a change in lifestyle with today’s youngsters indulging more in junk food and an unhealthy lifestyle.”
PCOS or Stein-Leventhal Syndrome as it is otherwise called is a leading cause of infertility among women today. “But not all women with PCOS are infertile,” says Dr. Rajasree. The syndrome has many symptoms, not all of which may be apparent in a woman. The intensity of each symptom may differ from person to person.
The most obvious symptom is infrequent or no menstrual periods, and/or irregular bleeding. This may be due to anovulation or the lack of ovulation when the egg is released from the ovary (See box). The other symptoms include acne, obesity and hirsutism, that is, excess hair growth in various parts of the body like lower abdomen and chest. This is due to excess male hormones like testosterone in the body.
But PCOS may still be present in a woman who is lean and does not have excessive hair growth. Divya, a student did not have any external appearances of PCOS though her periods were very irregular. But an ultrasound scan revealed bulky ovaries with the presence of many cysts.
PCOS increases the risk of many other diseases like high blood pressure and cholesterol and problems related to liver and heart. There is also the risk of developing Type II diabetes in women with PCOS. This is because tests have revealed women with PCOS show insulin resistance. Insulin is needed to control the blood sugar level. Researchers believe that abnormal insulin levels may be leading to the development of PCOS. Another risk is the development of uterine cancer or endometrial cancer (cancer of the uterine lining). This is often due to over accumulation of uterine lining due to the lack of periods.
The causes of PCOS are still being researched but some researchers believe that it could be hereditary. A woman with PCOS is likely to have a mother or sister with the same syndrome. Though PCOS cannot be prevented, the syndrome is treatable. Says Dr. Rajasree, “In the earlier stages, fertility medicines can be used. If they do not have the desired effect, the patient may always opt for ‘Ovarian drilling’ through laparoscopy.”
Ovarian drilling is a surgical procedure through which the cysts are punctured to release the fluids and it can lead to a normal cycle at least long enough to be able to conceive. In many cases where the woman is overweight, it has been noticed that a healthy lifestyle and weight loss itself can make a difference and increase ovulation naturally. Medication and surgery is only resorted to if the patient has difficulty in getting pregnant. There have been cases where women have undergone a normal life without being diagnosed with PCOS. “I have had irregular periods all my life but I had two children, one soon after my marriage. I was never diagnosed with PCOS but now I think I might have had since my daughter suffers from it,” says Komalam, a homemaker.
PCOS is treatable and can be controlled by following a healthy lifestyle and dietary regulations for many women. Even in cases, where women undergo difficulty in conceiving, medical treatment and alternate methods like IVF (In vitro fertilisation) are available. There are creams, medicines and laser treatment available to get rid of unwanted hair and the related embarrassment too. More than this, women who are emotionally troubled due to this syndrome may find support in talking to other women who are in the same situation.
What Happens in PCOS
The ovaries are two small organs, one on each side of a woman's uterus. A woman's ovaries have follicles, which are tiny sacs filled with liquid that hold the eggs. These sacs also are called cysts. Each month about 20 eggs start to mature, but usually only one matures fully. As this one egg grows, the follicle accumulates fluid in it. When that egg matures, the follicle breaks open to release it. When the single egg leaves the follicle, ovulation takes place.
In women with PCOS, the ovary doesn't make all of the hormones it needs for any of the eggs to fully mature. Follicles may start to grow and build up fluid. But no one follicle becomes large enough. Instead, some follicles may remain as cysts. Since no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman's menstrual cycle is irregular or absent. Plus, the cysts make male hormones, which also prevent ovulation.
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