Polycystic ovary syndrome (PCOS) is primarily caused by hormonal imbalance. The term ‘Polycystic’ refers to the numerous cysts present in the ovaries which are typically fluid-filled sacs. This syndrome occurs in women of childbearing age. PCOS causes symptoms like irregular or no periods, acne, excessive body hair growth (hirsutism), and male pattern baldness. Women with PCOS possess higher levels of androgen and lower levels of progesterone. This leads to undesirable complications such as infertility, ovarian dysfunction, hyperandrogenism, gestational diabetes, neonatal complications, etc.
Infertility- The American Society of Reproductive Medicine defines infertility in women as unsuccessful pregnancy even after 6 months of regular sexual intercourse. Research indicates that about 10 to 12% of women are affected by PCOS and the condition accounts for about 80% of anovulatory infertility cases. Normally, the androgen produced in women is converted to oestrogen. In PCOS, the overwhelming levels of androgen interfere with ovulation which in turn causes difficulties with conception. Tubal patency and spermogram (semen analysis) tests can help to formulate appropriate infertility treatments for women suffering from PCOS
Ovarian dysfunction- Ovarian dysfunction results from oligomenorrhoea. However, longer anovulation leads to uterine bleeding which resembles a regular menstrual cycles and interestingly, about 60% of women with PCOS are fertile. The human ovaries are susceptible to an autoimmune attack which can lead to ovarian dysfunction. This dysfunction can manifest as premature ovarian failure (POF), polycystic ovary syndrome (PCOS) and endometriosis. Studies show that around 90% of those who suffer from both PCOS and infertility are obese. Obesity exacerbates reproductive complications via hyperandrogenism.
Hyperandrogenism- Increased androgen levels are seen in PCOS. This occurs due to the synthesis of ovarian androgens by the elevated luteinizing hormone and insulin levels. Clinical hyperandrogenism includes symptoms such as male type terminal hair growth called ‘hirsutism’ which is evaluated by the Ferriman-Gallwey score. Acne is also a common manifestation of PCOS. PCOS patients predominantly have biochemical hyperandrogenism and measuring androgen levels in these patients may not give conclusive results as the assays are specific for higher male androgen levels. Treatment usually involves hormone therapy. Medical practitioners prescribe oral isotretinoin and oral antibiotics with topical creams to treat acne accompanied with hyperandrogenism.
Gestational Diabetes- While it is hard to get pregnant with PCOS, the women who do become pregnant struggle with gestational diabetes and can develop type-2 diabetes. Gestational diabetes refers to diabetes during pregnancy due to insulin resistance. Most women do not observe any symptoms while developing the condition. Some signs include excessive thirst, frequent urination, and weight gain. The evaluation or diagnosis requires a glucose tolerance test during the first and second trimester of pregnancy. Practitioners recommend pregnant women to test for high glucose levels earlier than usual for gestational diabetes. Adding to that, these individuals should consult their medical practitioners about lifestyle and possible risks associated with gestational diabetes and PCOS.
Pregnancy/Neonatal complications- In a 2012 report, the World Health Organization states that women with PCOS are at risk of prenatal barriers, preeclampsia, fetal growth restrictions, preterm delivery, and pregnancy-induced hypertension. Most risks aside from increased perinatal morbidity, occur due to the fertility treatments that PCOS patients undergo to treat anovulatory infertility. The PCOS and miscarriage association still require more evidence. Differences in fetal growth of PCOS patients have been observed. Pregnancy complications is normally due to infertility drugs consumed during PCOS, placental alteration in gene expression, altered trophoblast invasion and placentation.
Women with PCOS show increased risks in reproductive health but the precise mechanisms of how it happens still remains a mystery. The long-term risks associated with PCOS-affected mothers and babies are still unclear. Further research is needed to explore the association between PCOS and pregnancy which will aid in reducing neonatal complications.
Amirtha Varshini Ramesh is pursuing her Master’s by research with Biotechnology specialization. She loves exploring the nuances in health, nutrition, and wine sciences.