PCOS is a very common hormonal imbalance condition which affects many women in the reproductive age group. It does not just affect the reproductive organs i.e the ovaries, but it affects the entire body. Hence, it was renamed from Polycystic ovarian disease to Polycystic ovarian syndrome (PCOS)
Polycystic ovarian syndrome or PCOS is a very common gynaecological diagnosis. 2-5 out of every 10 women suffer from PCOS. This data is not very clear because some women experience no symptoms of PCOS but on incidental sonography, find out they have Polycystic ovarian syndrome. So it is safe to say, that PCOS is a lot more prevalent in the world than we know.
WHY IS POLYCYSTIC OVARIAN SYNDROME (PCOS) SO RAMPANT?
PCOS is a lifestyle disease. A sedentary lifestyle and a diet with more processed foods and inflammatory foods have thus prone the current generation of women to suffer from this disease.
Obesity is another cause for PCOS. Women who are obese, have low glucose tolerance and high levels of insulin. Hence, insulin resistance is one of the major factors contributing to anovulation.
Genetics might play a role in PCOS. But our mothers or grandmothers never suffered from this disease. So the genetic aspect of it is not quite reliable. But yes, a woman having PCOS has a higher chance that her daughter will have PCOS as well.
WHAT HAPPENS IN PCOS?
To understand what happens to the ovaries in PCOS, we first need to understand the normal menstrual cycle. The hormones involved in the menstrual cycle are: Estrogen, Progesterone, FSH (follicle stimulating hormone) and LH (leutenizing hormone).
NORMAL MENSTRUAL CYCLE:
On average, a normal menstrual cycle is 28-32 days long. Ovulation occurs around mid cycle i.e around day 14-16. Before ovulation, Estrogen is the predominant hormone, and after ovulation, Progesterone predominates.
From day 1 to day 12 or 13, Estrogen keeps rising and reaches a peak. During this time, FSH also rises, and stimulates a few follicles in the ovaries to start maturing, so that one of them can ovulate. When Estrogen reaches a peak, LH hormone is released in a surge or spike. This arrests further maturation of the follicles and causes the most mature and largest follicle to release an egg (ovulation).
Once ovulation has occurred, progesterone comes into picture and predominates, in order to prepare the uterus for a pregnancy. If this egg has been fertilized by a sperm, pregnancy occurs. Progesterone will keep rising and the woman will miss her next cycle. But, if it is not fertilized, progesterone levels drop and this causes menstrual bleeding to occur.
The hormones are in a very delicate balance with each other. This hormonal balance is lost with PCOS.
MENSTRUAL CYCLE IN PCOS:
In PCOS, because of insulin resistance and excess abdominal fat, Estrogen levels remain high right from the beginning of the cycle. The body feels that the peak of Estrogen has already reached, and so it starts to release LH in high quantities consistently. Ovulation can happen only if there is a sudden spike of LH. Consistently high levels of LH arrests the further maturation of follicles and prevent ovulation from occurring.
The ovaries get filled with immature follicles which do not degenerate. Due to an inflammatory process, these immature follicles, get filled with fluid, and appear as cysts on Usg.
Due to high level of Estrogen and excess abdominal fat, Estrogen gets converted into androgens i.e testosterone. This further disrupts the hormonal levels and prevents ovulation from occurring.
WHAT ARE THE SIGNS AND SYMPTOMS OF PCOS?
The commonest symtoms of PCOS that a woman experiences are:
- Menstrual irregularities : The cycles maybe longer than 35 days and sometimes complete amenorrhea (absent menses) for many months. This is because ovulation doesn’t happen every month and hence menses do not occur. Some women may also experience much shorter cycles and bleeding between periods.
- Weight gain : Women with PCOS are often overweight and have a high BFP (body fat percentage) especially around the abdomen and waist. They also have difficulty losing weight.
- Infertility : Because ovulation doesn’t happen every month, women with PCOS have difficulty in conceiving as they are not able to track their ovulation date. Also PCOS poses a higher risk of miscarriage.
- HAIR-AN syndrome : This stands for 1) Hyperandrogenism 2) Insulin resistance 3) Acanthosis nigrans. Hyperandrogenism means excess testosterone levels which are seen in PCOS women. Furthermore, excess testosterone leads to facial hair growth (hirsutism), acne and baldness.
- Insulin resistance : This is commonly seen in PCOS women which predisposes the patient to type 2 diabetes. The peripheral cells lose their sensitivity to insulin and hence they cannot utilize glucose for energy. This causes blood sugar levels to rise, causing the pancreas to secrete more and more insulin to control the blood sugar. Fasting insulin more than 25 mIU/L is seen in insulin resistance. Excess insulin further causes darkening of skin folds esp around the axilla, neck and abdomen which is called acanthosis nigrans.
COMPLICATIONS OF PCOS :
- Type 2 diabetes
- Heart diseases
- Cholesterol abnormalities
- Risk of miscarriages
- Ovarian and endometrial cancer
- Risk of Thrombo-embolism
DIAGNOSIS OF PCOS :
- Sonography: Presence of 12 or more fluid-filled sacks around the periphery of the ovaries. Also, large bulky ovaries with volume >10 cc. There may be increased endometrial thickness
- Insulin levels: Fasting insulin levels of >25 mIU/L is characteristic of insulin-resistant PCOS. Fasting blood sugar may also be increased >120 mg/dl
- Hormonal levels: Raised LH levels or high LH: FSH ratio
- Androgen levels: Raised levels of free testosterone
- Prolactin levels: Maybe raised in PCOS
- AMH levels: These are indicative of ovarian reserve. PCOS patients have a higher level of AMH >2.5 because of the presence of multiple immature follicles in the ovaries.
HOW BODY FAT AND WEIGHT AFFECTS HORMONE LEVELS :
We require a healthy amount of fat tissue for the production of hormones esp Estrogen. The Estrogen released is inactive and undergoes conversion in the fat cells into the active form.
When this fat tissue is in excess esp around abdomen and waist, excess conversion of estrogen into the active form takes place causing high estrogen levels and hormonal imbalance. Also, fats help in the conversion of estrogen to androgens i.e testosterone, causing further hormonal imbalance.
Fat tissue interferes with the action of insulin and hence contributes to insulin resistance.
Studies have shown that just a 5-10% reduction in weight esp body fat greatly affects the hormonal levels and balances hormones. It also reduces insulin resistance and hence increases the chances of ovulation.
Weight loss with PCOS also reduces the risks of complications that may arise with this condition.
PCOS is a lifestyle disease and hence a change in lifestyle along with homeopathic treatment can definitely cure PCOS of its roots. You don’t need to take hormonal medications and fertility treatments. Currently, there is no cure for PCOS in conventional medicine. But homeopathy gives wonderful results and not just decreases the symptoms but completely remove the cysts from the ovaries.
To know more about dietary recommendations with PCOS, click here.
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Author- Dr. Tasneem .H. Soni