What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a gynecological hormonal disorder, which affects 8-10% of women in their reproductive age from puberty to menopause.

As of today, the cause for PCOS is not known, but we do know that PCOS is a hormonal disorder which is genetically determined, and environmentally controlled. It is associated with irregular periods, leading to infertility, raised androgen levels ie. excessive male hormone leading to acne, facial hair, loss of scalp hair and enlarged ovaries with multiple follicles seen on ultrasound. 80% of PCOS women are obese, and are known to have Insulin Resistance (IR) which is a relative lack of insulin hormone, leading to Diabetes, Hypertension, High Cholesterol, Obesity in future. IR is also known to be present in 25% lean PCOS women. . It is a life-long condition which cannot be completely cured but can definitely be kept under check.

How do we diagnose PCOS? This is done by a detailed history including that of periods, weight gain, hair growth, acne, hair loss on the scalp and pigmentation. A detailed examination, blood investigations and ultrasound. If a woman above 18 yrs. of age has at least 2 of the following criteriae present, then she is diagnosed as having PCOS.

  • Less than 8 periods per year.
  • Clinical Lab evidence of increased male hormone.
  • Polycystic or enlarged ovaries above 10ml each on ultrasound.

How do we treat PCOS?

The treatment is tailored based on the lady’s symptoms, test results and the desire to get pregnant.

Lifestlye modification is the first line treatment for PCOS. A low calorie diet and regular exercise is the key to weight loss. Weight loss can improve fertility, regularize periods, reduce the insulin levels and androgen levels. A weight control program with regular aerobic exercises, preferably under a nutritionist’s guidance, is highly recommended.

  • Birth Control Pills: These can be used in women not keen to get pregnant. The pills  regulate the periods and correct excessive hair growth and acne by reducing the male hormone, and offer contraception when needed. They also  help to reduce excessive blood loss in those women who bleed heavily after 2-3 months of no period.
  • Insulin Sensitizing Drugs: Drugs that lower insulin levels include metformin and Inositols. Metformin promotes fertility and regularizes periods, promotes weight loss with exercise, and improves insulin sensitivity. It can be safely used in women desirous of childbearing as it prevents miscarriages, gestational diabetes and high blood pressure during pregnancy in PCOS women.
  • Ovulation inducing drugs: These are the medications that help infertile women release an egg every month especially in those who have irregular periods. Those who do not respond to medical treatment may require assisted reproduction. 
  • Anti-male hormones drugs/ Antiandrogens: These are used when the androgen levels are high or women have symptoms of excessive facial hair or loss of scalp hair or excessive acne. These drugs are used under medical supervision and women should be advised not to get pregnant whilst on these therapies as it effects the pregnancy.
  • Points to remember:
  1. PCOS is a Syndrome ie. it is a collection of problems, which are known to cause problems. Since It is not a disease for which there is a known cause or cure, hence the terminology Polycystic Ovarian Disease (PCOD) has been dropped and PCOS is the current terminology used.
  2. The appearance of enlarged ovaries or polycystic ovaries does not necessarily mean that you have PCOS especially in young adolescents, because many young girls may have polycystic ovaries but not PCOS.
  3. PCOS is a problem which commences at puberty but does not end at menopause, it leaves its mark even beyond menopause, if it is not monitored through reproductive life.

The author is the Director of Gynaecworld, the Center for Women’s health and  Fertility, and the President of the PCOS Society of India, Mumbai.  Email: durushah@gmail.com