General HealthPCOS/PCOD

Why does PCOS give rise Metabolic Disorders?

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women and it affects one in five women. The pathophysiology of PCOS is complex and research on this condition overlaps with disciplines of biochemistry, gynaecology, clinical genetics etc. PCOS can also inadvertently cause metabolic disorder which was reported in first-degree relatives. Patients with PCOS manifest various metabolic syndromes such as visceral obesity, insulin resistance, hyperinsulinemia, dyslipidemia, and are at risk of developing cardiovascular diseases (CVD), Type 2 diabetes, and endometrial cancer.

Trends in Cardiovascular Medicine states that ‘Obesity in women with PCOS may be due to insulin resistance, which leads to hyperinsulinemia. This could stimulate ovarian steroidogenesis.’ This condition inhibits the secretion of sex hormone-binding globulin in the liver, and adds onto the available androgen. Chronic exposure to elevated androgen levels causes visceral fats to accumulate.

Visceral obesity due to PCOS is characterized by excess fat deposition in the visceral region, thereby increasing the risks of developing diabetes mellitus and other metabolic syndromes. The metabolism of visceral adipose tissue augments the adipocytokine production which in turn gives rise to hyperinsulinemia.

Hyperinsulinemia refers to the increased secretion of insulin from the pancreas and is often associated with Type 2 Diabetes Mellitus. A majority of PCOS patients develop insulin resistance which further aggravates hyperinsulinemia. Studies have found that obese PCOS patients have significantly higher blood glucose levels (detected by an oral glucose tolerance test) in comparison to leaner PCOS patients.

Hyperlipidemia or dyslipidemia is where lipid levels in the bloodstream is abnormally high and is common in PCOS patients. Around 70% of PCOS patients have hyperlipidemia. Higher lipid levels is especially prominent in those patients who have insulin resistance. Studies report that the quality of low-density lipoprotein (LDL) is altered in PCOS patients. Lipoproteins is one of the risk factors for coronary heart diseases.  Lifestyle modifications are the first-line of therapy for people affected with both PCOS and hyperlipidemia.

Visceral obesity, hyperinsulinemia and dyslipidemia form a vicious cycle in PCOS and an increase in any one can adversely affect the other two. Doctors recommend overweight PCOS patients to undergo metabolic screening tests. Regular screening helps in monitoring the status of metabolic syndromes and thus prevent the occurrence of cardiovascular diseases in women.

According to the American Heart Association, one has to get their lipid levels checked once in four years. This is applicable for those who are twenty years and above and are not affected by any heart disease. Women with PCOS have a 2.7-fold increased risk of developing endometrial cancer. The increase in estrogen levels relative to progesterone is one of the reasons for disease progression. The endometrium of PCOS women is prone to get exposed to unopposed estrogen that results from anovulation.

PCOS can be controlled with an appropriate and personalised treatment regimen.  If the person suspects their lipid profile is abnormal, lifestyle modifications can help normalise it.  All the key hallmark symptoms of PCOS such as insulin resistance, obesity/visceral obesity, dyslipidemia, hyperandrogenism, and hypertension can heighten the chances of developing CVD. However, it is recommended to address the severity of risks on a case-specific basis. PCOS patients should undergo treatment and medication that are tailored for them. Encouraging a well-balanced diet and exercise routine in PCOS patients have proven to be beneficial by reducing metabolic risk factors.

Author:

 Amirtha Varshini Ramesh is pursuing her Master’s by research with Biotechnology specialization. She loves exploring the nuances in health, nutrition, and wine sciences.

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