What is polycystic ovary syndrome?

The term polycystic ovary syndrome (PCOS) describes a group of symptoms and changes in hormone levels. Women with this condition often have many painless cysts in their ovaries which are harmless, but many of the symptoms can be emotionally distressing. Symptoms of PCOS include:

• Irregular or absent menstrual periods
• Excess hair on face and body
• Infertility
• Acne
• Thinning hair on scalp

PCOS affects about 1 in 10 young women. PCOS affects more than reproduction. PCOS has serious medical implications in the form of increased risk for diabetes, heart disease, infertility and even endometrial cancer later in life.

But what has diabetes to do with this?

The pancreas produces a hormone called insulin, which regulates blood glucose levels. If insulin is not acting properly (which is called insulin resistance), then body tries to maintain normal sugars by increasing insulin levels.

The high insulin level acts on ovaries and disturbs its hormones resulting in PCOS. Many of these women have a velvety black pigmentation of neck called acanthosis nigricans, which is a sign of insulin resistance. Over a period of time even high a level of insulin in the body is not able to control blood glucose levels and diabetes develops. Any increase in weight further impairs the action of insulin and worsens the disease symptoms.

Let’s get a detailed inside picture of this disease

In girls and women, the ovaries produce hormones, which have a finely orchestrated monthly cyclical rhythm. The purpose of this cyclical rhythm is to release one egg from ovary (which is called ovulation) every month. Meanwhile the uterus (womb) gets ready for pregnancy. If the woman does not conceive, then the uterus thickened lining sheds off resulting in menstrual bleed.

If the fine synchronisation is disturbed, egg is not released and menses does not occur at regular time. Also the ovaries form excess of male hormones resulting in hirsutism and acne.

So what should one do if she has irregular cycles?

Irregular cycles are most commonly due to PCOS, but disturbance of any hormone in the body will disturb the menstrual cycle. So you need to consult an endocrinologist who will order some tests to rule out any disorders of other hormones like thyroid, adrenal or ovarian. Ultrasound of ovaries shows multiple cysts in half the cases.

Treatment

While PCOS is not curable, there are several approaches to achieving hormonal balance. Symptoms of PCOS are treatable with medications, and changes in diet and exercise. Treatment depends on what is the main problem at that point of time-

Regulate your menstrual cycle. If you're NOT trying to become pregnant,

• your endocrinologist may prescribe low-dose birth control pills that contain a combination of synthetic estrogen and progesterone. They decrease androgen production and give your body a break from the effects of continuous estrogen. This decreases your risk of endometrial cancer and corrects abnormal bleeding.
• An alternative approach is taking progesterone for 10 to 14 days each month. This regulates your periods and offers protection against endometrial cancer, but it doesn't improve androgen levels.

Reduce excessive hair growth. Your doctor may recommend

• birth control pills to decrease androgen production
• spironolactone (Aldactone) that blocks the effects of androgens on the skin. Because spironolactone can cause birth defects, effective contraception is required when using the drug, and it's not recommended if you're pregnant or planning to become pregnant.
• Eflornithine is another medication possibility; the cream slows facial hair growth in women
  The medicines take 3 to 6 months to start showing effect and the effect wanes of after stopping the medication.
• Shaving, waxing and depilatory creams are nonprescription hair removal options. Results may last several weeks, and then you need to repeat treatment.
• For longer lasting hair removal, your doctor might recommend a procedure that uses electric current (electrolysis) or laser energy to destroy hair follicles and control unwanted new hair growth.

Use medication to induce ovulation. If you're trying to become pregnant, you may need a medication to induce ovulation.

• Clomiphene citrate is an oral anti-estrogen medication that you take in the first part of your menstrual cycle.
• If clomiphene citrate alone isn't effective, your doctor may add metformin to help induce ovulation.
• If you don't become pregnant using clomiphene and metformin, your doctor may recommend using gonadotropins — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications that are administered by injection.
• If medications don't help you become pregnant, an outpatient surgery called laparoscopic ovarian drilling is an option for some women with PCOS.

Metformin
Your doctor also may prescribe metformin, an oral medication for type 2 diabetes that lowers insulin levels. This drug improves ovulation and leads to regular menstrual cycles. Metformin also slows the progression to type 2 diabetes if you already have prediabetes and aids in weight loss if you follow a diet and exercise program.