“Never choose indifference”
Dr Tariq Jagnarine
Fam Medicine, Endocrinology / Diabetes
Never choose indifference – choose to fight. This September, Polycystic Ovarian Syndrome (PCOS) Awareness Month promotes further research and knowledge of this terrible disease. Affecting as much as 20% of women between the ages of 18 and 44, PCOS is one of the leading causes of poor fertility, and while there currently is no known cure, treatment can significantly reduce the risk of long-term complications, such as type 2 diabetes, heart disease, and endometrial disease.
Arm yourself with education about PCOS, and as we continue to learn more, the closer we get to understanding this disease and eliminating it.
Polycystic Ovarian Syndrome (PCOS) is a condition that affects a woman’s hormone levels. Women with PCOS produce higher-than-normal amounts of male hormones. This hormonal imbalance causes their bodies to skip menstrual periods and makes it harder for them to get pregnant.
PCOS also causes hair growth on the face and body, and baldness. And it can contribute to long-term health problems, like diabetes and heart disease. Birth control pills and diabetes drugs (which combat insulin-resistance, a PCOS symptom) can help fix the hormonal imbalance and improve symptoms.
Many women have PCOS, but don’t know they have PCOS. In one study, up to 70 percent of women with PCOS hadn’t been diagnosed.
PCOS affects a woman’s ovaries, the reproductive organs that produce estrogen and progesterone — hormones that regulate the menstrual cycle. The ovaries also produce a small amount of male hormones called androgens. The ovaries release eggs to be fertilised by sperm. The release of an egg each month is called ovulation.
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are produced in the pituitary gland, control ovulation. FSH stimulates the ovary to produce a follicle — a sac that contains an egg — and then LH triggers the ovary to release a mature egg.
PCOS is a “syndrome,” or group of symptoms, that affects the ovaries and ovulation. Its three main features are:
* Cysts in the ovaries
* High levels of male hormones
* Irregular or skipped periods
In PCOS, many small, fluid-filled sacs grow inside the ovaries, as the word “polycystic” indicates. These sacs are actually follicles, each one containing an immature egg. The eggs never mature enough to trigger ovulation. The lack of ovulation alters levels of estrogen, progesterone, FSH, and LH. Progesterone levels are lower than usual, while androgen levels are higher than usual. Extra male hormones disrupt the menstrual cycle, so women with PCOS get fewer periods than usual.
CAUSES
The exact cause of PCOS is still unknown. It is believed that high levels of male hormones prevent the ovaries from producing hormones and making eggs normally.
* Genes, insulin resistance, and inflammation have all been linked to excessive androgen production.
* Genes: Studies show that PCOS runs in families. It’s likely that many genes — not just one — contribute to the condition.
* Insulin resistance: Up to 70 percent of women with PCOS have insulin resistance, meaning that their cells can’t use insulin properly. Insulin is a hormone the pancreas produces to help the body use sugar from foods for energy. When cells can’t use insulin properly, the body’s demand for insulin increases. The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones.
* Obesity is a major cause of insulin-resistance. Both obesity and insulin-resistance can increase your risk of contracting type 2 diabetes.
* Inflammation: Women with PCOS often have increased levels of inflammation in their bodies. Being overweight can also contribute to inflammation. Studies have linked excessive inflammation to higher androgen levels.
COMMON SYMPTOMS OF PCOS
Some women start seeing symptoms around the time of their first period. Others discover they have PCOS only after they’ve gained a lot of weight, or they’ve had trouble getting pregnant.
The most common PCOS symptoms are:
* Irregular periods. A lack of ovulation prevents the uterine lining from shedding every month. Some women with PCOS get fewer than eight periods a year, or none at all.
* Heavy bleeding. The uterine lining builds up for a longer period of time, so the periods can be heavier than normal.
* Hair growth. More than 70 percent of women with this condition grow hair on their face and body — including on their back, belly, and chest. Excessive hair growth is called hirsutism.
* Acne. Male hormones can make the skin oilier than usual, and cause breakouts on areas like the face, chest, and upper back.
* Weight gain. Up to 80 percent of women with PCOS are overweight, or have obesity.
* Male pattern baldness. Hair on the scalp gets thinner, and may fall out.
* Darkening of the skin. Dark patches of skin can form in body creases like those on the neck, in the groin, and under the breasts.
* Headaches. Hormone changes can trigger headaches in some women.
Having higher-than-normal androgen levels can affect a patient’s fertility and other aspects of their health.
* Infertility: To get pregnant, a woman has to ovulate. Women who don’t ovulate regularly don’t release as many eggs to be fertilised. PCOS is one of the leading causes of infertility in women.
* Metabolic syndrome: Up to 80 percent of women with PCOS are overweight, or have obesity) Both obesity and PCOS increase your risk for:
* High blood sugar
* High blood pressure
* Low HDL “good” cholesterol
* High LDL “bad” cholesterol
Together, these factors are called metabolic syndrome, and they increase the risk for:
* Heart disease
* Diabetes
* Stroke
* Sleep apnea: This condition causes repeated pauses in breathing during the night, which interrupt sleep. Sleep apnea is more common in women who are overweight — especially if they also have PCOS. The risk for sleep apnea is 5 to 10 times higher in women who have both obesity and PCOS than in those without PCOS.
* Endometrial cancer
During ovulation, the uterine lining sheds. If women don’t ovulate every month, the lining can build up. A thickened uterine lining can increase their risk for endometrial cancer.
* Depression
Both hormonal changes and symptoms like unwanted hair growth can negatively affect a person’s emotions. Many with PCOS eventually experience depression and anxiety.
DIAGNOSIS
Doctors typically diagnose PCOS in women who have at least two of these three symptoms:
* High androgen levels
* Irregular menstrual cycles
* Cysts in the ovaries
Also, symptoms like acne, face and body hair growth, and weight gain are explored as part of the diagnosis.
A pelvic exam can look for any problems with the ovaries or other parts of the reproductive tract.
Blood tests check for higher-than-normal levels of male hormones, cholesterol, insulin, and triglyceride levels to evaluate the risk for related conditions like heart disease and diabetes.
An ultrasound uses sound waves to look for abnormal follicles and other problems with the ovaries and uterus.
If someone is coping with PCOS or any of its symptoms, they may feel frustrated at times. Taking proactive steps regarding their health can improve their mood as well as reduce their symptoms. “Never choose indifference”.
