I bet every woman must've heard the term PCOS by now. It is very common nowadays. Either the woman herself is suffering from it or she must be having one of her friends/ sisters/ cousins/ colleagues suffering from the disorder. But, how many of us know what it is or how to deal with it?
Polycystic Ovary Syndrome is a very common endocrine disorder seen in reproductive females. The statistics say that 1 in 10 women are affected by it. We do not have a cure for it yet and most certainly, we still do not know A-Z about the disorder. There is still a lot of research going on about it around the world. And here I write this article to share some of the known details of this disorder.
HOW DOES HAVING PCOS FEEL?
The image above summarizes most of the common symptoms seen in the disorder. These include-
Oligomenorrhea/Amenorrhea- Irregular menstrual cycles or no cycles at all.
Hyperandrogenism- Acne, Hirsutism, Alopecia. Androgens stimulate the production of sebum (oil) in the skin causing Acne. There is excess body hair growth (Hirsutism) but you lose hair at places where you need the hair to be ( Hair thinning on the head- due to dihydrotestosterone-DHT induced Androgenetic alopecia)
Ultrasound showing partially developed cystic ovaries. Despite its name, not all women with PCOS actually have cysts on their ovaries.
Weight changes- Obesity- abrupt gain in weight. But not just this, even sudden loss in weight triggers PCOS.
Mood changes- Did you know that adult women with PCOS have higher rates of moderate to severe anxiety and depression?! And that adolescents have an increased rate of mood changes?! There is also an increased prevalence of psychosexual dysfunction, eating disorders, and overall has an impact on body image.
Elevated insulin or insulin resistance is not part of the diagnostic criteria but is seen in the majority of women with PCOS.
If PCOS is not addressed, these women have an increased risk of developing Metabolic syndrome, Obstructive sleep apnea, Cardiovascular disease, Gestational diabetes, Miscarriages, Endometrial cancer, Infertility.
Less than 50% of the women are properly diagnosed, leaving millions of girls and women living with symptoms, going unsupported.
PATHOPHYSIOLOGY OF PCOS
The causes of PCOS can be multifactorial. Genetic factors, hormonal imbalances, and lifestyle factors interacting with numerous environmental variations add up to the pathophysiology of the disorder. One of the most common misconceptions is that PCOS is a specific disorder and a cause of ovulation dysfunction. But, PCOS is actually not a specific disorder that causes anovulation, it is instead the consequence of a chronic anovulatory state. And now because there are many causes for ovulation dysfunction, there are many causes for PCOS.
There is a series of coordinated hormonal events happening between the brain, ovary, and uterus, But here in PCOS, there is a disconnect in the communication between the brain and ovary. Instead of the cyclic pattern of hormonal changes that occur in a normal monthly menstrual cycle, there is abnormal secretion of hormones in the disorder. Normally, pulsatile gonadotropin (GnRH) secretion from the brain is required for the release of hormones. However, in PCOS, we have abnormal gonadotropin secretion resulting in a steady state of hormones that vary very little throughout the cycle. Probably the diagram below could make you understand it better. The left side of the picture shows you the hormonal pattern in a normal cycle vs the right side showing you a 'steady state' of hormones in PCOS.
All this distorted endocrine milieu along with insulin resistance disrupts the follicle development, ultimately causing ovulatory dysfunction. It starts with a very high Gonadotropin-releasing hormone pulse frequency, which favors high levels of Luteinizing hormone and low levels of Follicle-stimulating hormone. The normal ratio of LH: FSH is 1:1, but here it becomes greater than 2:1. This increased LH level along with insulin will increase the androgen production from the ovary and adrenal glands. The increased androgen along with insulin will again act on the liver to decrease SHBG (Sex hormone-binding globulin) levels, resulting in more free androgen circulating in the body which aggravates insulin resistance. Hence there exists an overall high androgen and insulin resistance state that continues in a self-perpetuating cycle.
CAUSES & TYPES OF PCOS
INSULIN RESISTANT PCOS - Metabolic Syndrome/ Pre-diabetes. Caused by smoking, sugar, pollution, transfat. High insulin levels in the body prevent ovulation and trigger the production of excessive testosterone. How to rule out if you have this or not? Get fasting insulin levels and postprandial insulin levels checked. Lab values near the higher end of the normal levels or higher levels in both tests indicate that you are pre-diabetic or insulin resistant. Recent studies show inositol supplements having a positive effect on these patients.
INFLAMMATORY PCOS - Inflammation due to stress, environmental toxins, dietary allergens like gluten/dairy prevents ovulation causing hormonal imbalance. Unexplained fatigue, headaches, joint pains, having pre-existing inflammatory conditions like psoriasis, eczema, IBD, etc can give clues to inflammation in the body. Inflammatory markers like CRP, ESR are raised in this type of PCOS. Stress relief management and avoiding inflammatory triggers show improvement in these cases.
PILL-INDUCED PCOS - It is common to experience a surge in androgens when coming off of a birth pill. Birth control pills suppress ovulation. Most women resume ovulating after the effect of the pill is over while some do not, even after months to years. If you had regular and normal menstrual cycles before starting the pill, but irregular once off the pill, consult your Ob/Gyn.
ADRENAL PCOS - Abnormal stress response leading to an increase in only adrenal androgens is seen in this type. DHEA-S is highly raised. Testosterone is normal or slightly raised. (DHEA-S is the androgen produced in adrenal glands and Testosterone is produced in ovaries).
HIDDEN PCOS - Some underlying hidden drivers like- thyroid disease (hypothyroidism worsens insulin resistance); Vitamin D/zinc deficiencies (ovaries need these nutrients for proper functioning); elevated AMH- Anti-Mullerian Hormone (decreases FSH); elevated prolactin (increases DHEA), can cause PCOS.
ATYPICAL LEAN PCOS - One misbelief is that only overweight or obese women have PCOS. This is not true with every PCOS case out there. Especially in recent times, we are seeing many thin built females being diagnosed with the disorder. Typically PCOS is seen in obese individuals. That being said, PCOS isn't ruled out in individuals having a thin built lean body presenting with PCOS symptoms!
HOW TO DEAL WITH PCOS?!
Visiting your OB/GYN is the first thing to do. The doctor would dig deeper into your root cause and your laboratory values to come up with a treatment plan for you.
Your doctor might order a few of the blood tests from the above list. Ultrasound is ordered too when required. Usually, fasting levels of the hormones on Day 2/3 of your periods are tested. You will be put on a specific medication regimen based on your labs, symptoms, and severity.
Now, are you done? Will you be free of PCOS? Is your PCOS managed?
Not totally! Unless you follow some self-management strategies and lifestyle modifications, you cannot totally get rid of it. And what are they?
-> Eating well and eating healthy - Reducing sugary foods, staying away from trans-fat loaded junk food, avoiding inflammatory foods like dairy in case of acne, help with PCOS. Taking a diet high in protein and low in carbohydrates (especially foods with high glycemic index are to be avoided).
-> Consuming anti-inflammatory foods - the ones rich in Vitamin C are the best choice. Vitamin A, E rich foods too! Have more nuts, green leaves, fresh vegetables, fruits, fatty fish, flaxseeds, chia seeds, legumes, and pulses. Healing your gut of inflammation by taking probiotics and high fiber.
-> Ditch the sedentary lifestyle - Exercise daily. Be it walking, jogging, skipping, or going to the gym. Keep your body fat percentage in the normal range.
-> Stress reduction - mindfulness-based stress reduction strategies, meditation, yoga. These do wonder for your mind and body!
-> Follow up with your doctor regularly -There is something called patient compliance and it needs to exist for any treatment to work. Hence, go for regular checkups with your doctor. Ask questions, let your doctor know if you are facing any side effects with the medications, discuss other treatment options available, and do keep a note of your progress.
-> Maintaining proper sleep hygiene - minimum of 7-8 hours of sleep. A good amount of sleep is required for the normal secretion of hormones. This should come under your 'Self-care routine', because why not?! You should always be your priority!
-> Talk to fellow cysters to know their stories on how they are coping up with the PCOS struggle! And support them when required. (Cyster is a slang term for a woman with polycystic ovary syndrome (PCOS). It is a play on the words "cyst" and "sister" and is meant to promote sisterhood among PCOS women for support)
-> Lastly, you need to be patient. You cannot become PCOS-free the next day or the next month. It takes months and also a few years for some. Just enjoy the healing process!
PCOS may not have a cure yet, but by making these few lifestyle changes and by maintaining a balance between your physical, mental and, emotional health, this disorder can be battled against with ease!
REFERENCES-
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171421/
https://en.wikipedia.org/wiki/Polycystic_ovary_syndrome
National Institutes of Health (NIH) (2014-07-14). "Treatments to Relieve Symptoms of PCOS".
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136064/
https://web.archive.org/web/20150402132607/http://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/relieve.aspx
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083905/ , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774551/
"Diagnostic Criteria and Epidemiology of PCOS". Polycystic Ovary Syndrome Current and Emerging Concepts. Dordrecht: Springer. p. 7. ISBN9781461483946.
https://www.indiraivf.com/types-of-pcos/ , https://www.composednutrition.com/blog/types-of-pcos,https://assets.jeanhailes.org.au/Fact_sheets/pcos, https://www.larabriden.com/4-types-of-pcos-a-flowchart/
Images - Instagram, Google, https://www.instagram.com/p/CEo17DxHn0h/ , https://www.instagram.com/p/CE4RNfOhJVs/, https://www.instagram.com/p/B7bn_OKp6PR/, https://www.google.com/search?q=speroff+8th+edition+pcos+pathophysiology&sxsrf
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