Polycystic Ovarian Syndrome (PCOS) is a combination of symptoms that arise from a hormonal imbalance in women.
Signs and symptoms include:
- Menstrual irregularities i.e. missed periods or no periods at all. This is associated with anovulation which causes subfertility or infertility.
- Hyperandrogenism, the over production of mainly testosterone by enlarged ovaries. This is induced by hyper-insulinemia, i.e. the overproduction of insulin in response to insulin resistance (insulin receptors insensitivity). The high levels of testosterone stimulates hirsutism, acne, male pattern pubic hair and clitorromegaly (enlarged clitoris) in some.
- Obesity: The hyper-insulinemia along with a high sugar diet causes obesity in some.
Worldwide, PCOS affects 6% to 10% of women, making it the most common endocrinopathy in women of childbearing age. In some populations the incidence can be as high as 30-50%, but it is very heterogeneous (variation in signs and symptoms).
PCOS gets its name from the characteristic of enlarged ovaries with many small cysts in the periphery. However, having ‘polycystic’ ovaries does not necessarily mean that the woman also has the syndrome.
There are many misconceptions about PCOS. This guide dispels some of these common myths.
MYTH: “I have PCOS so I can’t get pregnant without medical intervention.”
TRUTH: Some women with PCOS are able to become pregnant with no medical assistance. Many more are able to become pregnant with minor assistance, and others still with IVF. It depends on the severity of your PCOS. More research into the infertility and other issues related to PCOS may unlock the key to helping more patients conceive. Just remember, a diagnosis does not mean that you cannot conceive.
And, if you do conceive, PCOS can make it hard to carry a pregnancy to term. Women with PCOS have a higher incidence of gestational diabetes, miscarriages, pre-term deliveries, and stillbirths.
MYTH: “I would know if I had PCOS.”
TRUTH: Not necessarily. While for some women the symptoms are clear, PCOS is associated with a wide range of symptoms, some of which are shared with other conditions. One of the most common symptoms is the irregularity of menstrual periods; however women with PCOS can have regular monthly menstrual cycles.
It can take some time to reach a conclusive diagnosis. Checking over time — repeatedly — can be integral to catching it. So if you have not yet been formally diagnosed, visit your doctor again to get checked.
MYTH: “My ultrasound did not show cysts on my ovaries, so I don’t have PCOS.”
TRUTH: Despite its name, not all women with PCOS actually have cysts on their ovaries. Some women do not show cysts on their ovaries but have other symptoms that lead to them being diagnosed and treated for PCOS. Other women have cysts on their ovaries but do not have PCOS. The presence of cysts can be an important symptom in identifying PCOS, but it is only part of the picture.
MYTH: “All women with PCOS are overweight.”
TRUTH: While PCOS and the resulting insulin resistance can lead to excess weight and obesity, not all women who have PCOS are overweight, nor do women who live with this condition have to remain overweight if they are having trouble losing excess pounds. A proper diet and certain insulin-regulating medications can help the weight problems that are commonly caused by this disorder.
MYTH: “If no one else in my family has it, I can’t have it either.”
TRUTH: There appears to be a genetic component to PCOS. Women whose mother or sister has PCOS are more likely to have PCOS. However, this is not always the case, and women can also have the condition even if no one else in their family is known to have it.
MYTH: “If I lose weight, my PCOS will go away.”
There’s no cure for PCOS. However there are treatments that can improve your health and fertility.
Losing weight is one of the most important things you can do. Modest weight loss of 5-10% of initial body weight improves metabolic, physiological and psychological aspects of PCOS. Losing weight can help balance your hormone levels which can help improve your fertility and significantly reduce the potential risk of diabetes, heart disease and other conditions.
Hormone therapy in the form of oral contraceptive pills, metformin and/or aldactone are medications commonly used with great success in managing the symptoms and outcomes of PCOS. You may be given clomiphene citrate, which helps you to produce more FSH. If you are also insulin resistant, you may be given a drug called Metformin (or glucophage) that makes you sensitive to insulin and can help return ovulation to normal.
Depending on what other symptoms you have, you might be given medication for acne or excess hair growth. Fish oil improves many aspect of PCOS from hair quality to mood. Eating protein and/or fat-containing foods every 3 to 5 hours throughout the day may help to stabilize blood sugar levels and prevent cravings. Regular exercise is an effective way to improve insulin levels.
The optimal treatment for PCOS is a multi-pronged approach involving diet and lifestyle modification, medications and supplements.
The management should be:
- Regular/chronic exercise. If overweight or obese, it is best to do non-weight bearing exercises to minimize the risk of damage to ankles, knees and hips e.g. swimming and cycling.
- Eat a low glycaemic diet, i.e. avoid sweet drinks and simple carbohydrates i.e. too much flour, rice, Irish potatoes. Increase complex carbohydrates i.e. provisions, oats, green bananas, breadfruit.
- Metformin in the appropriate dosage for size.
- Combine oral contraceptive (COC) in those not trying to get pregnant. The best one is Diane 35.