Polycystic Ovarian Syndrome in Young Women
Anindita (29yrs) and her husband came to me complaining that she is not being able to conceive even after two years of marriage. She was over-weight and my first impression that she could have polycystic ovary was confirmed subsequently. Anindita’s is not a stray case. Nowadays, we encounter more and more women in clinic with Polycystic Ovarian Syndrome (PCOS).
Though ‘Polycystic Ovary’ means many cysts in ovary, these cysts are actually immature eggs and the disease is different from other cyts of ovary. PCOS is a manifestation of a hormonal disease which affects other systems of the body as well.
The exact cause of PCOS is unknown.
PCOS is common among young girls and women of reproductive age. Roughly, now a days one in three women is diagnosed with PCOS. It is an emerging health problem during adolescence, therefore promotion of healthy lifestyles and early interventions are required to prevent future morbidities.
Early diagnosis of PCOS assumes significance as it may lead to complications such as infertility, gestational diabetes or pregnancy-induced high blood pressure, miscarriage or premature birth. As insulin resistance (where cells in muscles, fat, and liver do not respond well to insulin and cannot easily take up glucose from blood)is very common in PCOS, in later age, it may lead to diabetes mellitus. Chance of uterine cancer is also high.
Signs and symptoms of PCOS often develop around the time of puberty. But menstrual irregularities are normal in the initial years of puberty and this should not be reckoned as a symptom for diagnosing PCOS. If irregularities persist for more than two years, then diagnosing PCOS can be thought of.
Sometimes PCOS develops later, for example, in response to substantial weight gain. A diagnosis of PCOS is made when one experiences at least two of the following signs:
- Missed or delayed periods.
- Excess facial and body hair (hirsutism) consequent to elevated levels of male hormone, androgen, in women with PCOS
- Ultrasonography shows polycystic ovaries
PCOS signs and symptoms are typically more severe in obese women.
No single test can determine the presence of PCOS, but a doctor can diagnose the condition through medical history, a physical examination, blood tests to measure hormones and an ultrasonography of uterus and ovaries.
Management of PCOS
Lifestyle modification is the mainstay of treatment in PCOS and the focus is to reduce risk factors such as obesity, central obesity (fat around the waist) and insulin resistance. Modifying additional lifestyle factors, such as alcohol consumption, psychosocial stressors and smoking, are also crucial in long-term treatment of PCOS.
Short-term weight loss has been consistently successful in reducing insulin resistance and restoring ovulation and fertility. Even a 7% weight reduction restores regular period.
Significance of exercise in management of PCOS
Regular exercise seems to be the most effective in improving insulin resistance, even without any noticeable change in weight or body fat measurement. Improving insulin resistance is very important as this is the cause of many of the complications in PCOS. Regular physical activity will help to reduce androgens, regulate cycles and improve fertility.
Research has shown that any type of regular exercise- moderate or vigorous aerobic exercise or resistance (using weights) exercise- is effective in improving PCOS symptoms. As long as you are moving and enjoying it, the type of exercise is not so important. The best thing to do is to include some type of physical activity every day for at least 20 minutes and build this up over time. This can also be broken up into smaller 10-15 min sessions spread out over the day.
Hormone treatment with progesterone or estrogen-progesterone pills helps to maintain the cycle as well as to correct hormone imbalance. Insulin sensitiser like Metformin, Inositols helps to reduce symptoms.
To conclude, it must be kept in mind that PCOS cannot be cured, but can be well managed with early diagnosis, life-style modification and medication. The earlier the diagnosis, the better are the results.
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