PCOS is a group of hormonal and metabolic syndromes that affect women of the reproductive age group, worldwide. The incidence of PCOS has increased in the recent decade. WHO estimated that around 116 million women were affected by it according to some studies conducted in 2012. Although it has not been declared a serious medical ailment by the WHO, it is a cause of concern because of the declining rate of fertility observed in women suffering from it.
Pathophysiology of the disease
The cardinal features of PCOS include amenorrhea, irregular menstrual cycles, hirsutism, and obesity. Hirsutism is due to the production of excess androgens or male hormones from the ovaries. Obesity in addition, further adds to the trouble, as the androgens concentrated in the adipocytes convert into Estrogen via the aromatase enzyme. This increased Estrogen is responsible for all the effects and disastrous consequences of long-term PCOS.
Increased Estrogen provides positive feedback on the LH hormone and continuously maintains a high level of LH; on the contrary to a normal cycle where an LH surge is vital for ovulation. Since there is a continuously elevated LH throughout the cycle, anovulation and infertility occur.
Burden of the disease
Apart from infertility in the reproductive age group, women with long-term PCOS are at an increased risk of developing endometrial carcinoma, breast cancer, and heart diseases along with diabetes due to insulin resistance. Most of these ailments can be attributed to increased Estrogen levels.
High levels of Estrogen stimulate the receptors on the breast and endometrial tissue, increasing the risk of cancer of these parts. Furthermore, the triad of obesity with a waist circumference of >88cm, triglycerides >150mg/dL, and fasting blood sugar of >140mg/dL is called Metabolic X Syndrome. Heart disease is seen due to the increment in androgens that in turn cause the levels of LDL to go up which is atherosclerotic in nature.
The month of September, specifically September 1st is celebrated as the PCOS awareness month to educate more women of this condition and help them cope with the stress of it. The PCOS awareness month aims at reducing the burden of the disease by encouraging suitable exercises and a proper diet for primary disease prevention.
Diagnosis of PCOS
The Rotterdam Criteria is most commonly used to make a diagnosis of this. According to it, any two of the following should be present in a female who presents to the clinic with a suspected case of PCOS
- Hyperandrogenism which can either be measured as elevated levels of androgens in serum or the presence of male pattern body hair distribution (hirsutism).
- Ovulatory dysfunction in the form of Amenorrhea/prolonged menstruation/irregular cycles.
- USG evidence in either one or both the ovaries with >12 follicles per ovary, volume of ovary>10cc, and size of each follicle <1cm.
Prevention and treatment of PCOS
Treatment of infertility and irregular cycles is relatively easier as the primary healthcare provider. Drug of choice for infertility is Letrozole, which has an anti-androgenic effect and prevents the conversion of androgens to estrogen in the adipocytes, therefore, reducing the levels of Estrogen altogether. For women suffering from diabetes and obesity, Metformin is recommended due to its additional anorexigenic effect.
Apart from medication, some lifestyle changes are recommended to women suffering from PCOS. Losing weight is primarily suggested to eliminate the additional source of Estrogen generating adipocytes. Maintaining a BMI of 20-22 is ideal in such cases. Therefore, the focus should be placed on regular weight control exercises like cycling, brisk walking, and treadmill for maximum prevention.
Diets to be encouraged
Following a specific diet becomes important for keeping PCOS at bay and for not aggravating it.
- Since insulin resistance is seen in 40% of women with PCOS, foods with a low glycemic index should be consumed. These include whole raw fruits, plain unsweetened yoghurt, legumes and unsalted nuts.
- Green vegetables like kale, spinach and broccoli.
- Dark red fruits like cherries, blueberries and raspberries.
- Include anti-inflammatory spices like turmeric and cinnamon in food preparation.
Individuals reported having lost more weight when they shifted from saturated fat to mono-unsaturated fat consumption. This was achieved by replacing the regular cooking oil with virgin olive oil and including more plant-based fats like avocados in the diet.
Difference between PCOD and PCOS
PCOD is the presence of higher levels of Androgens released by the ovaries, sans the other metabolic and hormonal imbalances. This is more commonly seen and can be corrected more easily. PCOD is usually not an obstruction to conception and women conceive with little aid.
PCOS on the other hand is a hormonal and metabolic disorder wherein, the ovaries release excessive amounts of the male androgenic hormones that in turn cause a myriad of serious long-term diseases. Here, conceiving becomes challenging due to prolonged anovulation.