PCOS (Polycystic Ovary Syndrome): Causes, Symptoms, Complications, Diagnosis, Treatment & Prevention

Last Updated on May 5, 2023 by Shabnam Sengupta

Research suggests that PCOS (Polycystic Ovary Syndrome) is one of the most common endocrine disorders with a prevalence rate between 6% to 20% among women in their reproductive age. PCOS can lead to many diseases like type 2 diabetes, cardiovascular diseases, cancer, etc., and certain psychological disorders like depression, anxiety disorders, etc. According to a 2016 report on the website of National Health Portal of India, studies conducted in South India and Maharashtra report that there is a prevalence rate of 9.3% and 22.5% of PCOS among women respectively.

Introduction

PCOS (Polycystic Ovary Syndrome) is a very common hormonal disorder nowadays among the females of the reproductive age group, i.e., from 14-44 years. As the name, Polycystic Ovarian Syndrome suggests, ‘poly’ means many, and ‘cysts’ are fluid-filled sacs within the ovaries. A female with PCOS has many fluid-filled cysts in her ovaries. However, some women suffering from PCOS do not have cysts in the ovary.

In a healthy reproductive female, around 10-20 immature eggs start maturing under proper hormonal control, and by the 14^th day of the menstrual cycle, 1 or 2 mature eggs are released from the ovary into the Fallopian tube for fertilisation. On the contrary, the patients with PCOS have disrupted hormonal levels, and so, the immature eggs are unable to mature and release. Instead, they are entrapped in the fluid-filled sacs forming multiple cysts within the ovaries.

As there are no mature eggs, the female doesn’t undergo ovulation that results in infertility issues.

The hormones involved in PCOS are:

1. Estrogen: It is a normal female hormone which is needed for ovulation. It is released by the mature egg in the ovary. Its levels are low in a woman suffering from PCOS. 
2. Progesterone: Similar to the previous one, it is also a hormone needed for the normal functioning of female reproductive organs and ovulation and is decreased due to PCOS. This is also released from the ovary by the linings of mature eggs.
3. Insulin: It is a metabolic hormone that is released from the pancreas. Its main function is to break down glucose present in the blood for its absorption by various organs for their normal metabolism and functioning. But in PCOS, there is decreased sensitivity for insulin by the cells, which leads to increased levels of glucose within the blood. As a compensatory measure, there is a reflux rise in the insulin level in the blood. Increased level of insulin triggers androgen released by the ovaries, leading to the development of PCOS.
4. Androgen: They are a group of hormones that give male characteristics and are primarily found in the male body. It is also released in very trace amounts by the ovaries. When there is an excessive rise in insulin, the production of androgen is stimulated, making the PCOS worse.

(There is also a rise in the level of Prolactin among a small percentage of women suffering PCOS. Prolactin is the milk generating hormone that leads to lactation.)

Causes

Although there is no definitive cause that has been linked to the development of the disease, the probable contributing causes are listed below:

1. Higher levels of insulin: This is due to increased insulin insensitivity in the body probably caused by diabetes mellitus or some other disorder, which leads to increased production of androgen.
2. High levels of androgens: This can be due to insulin involvement or some other factor where greater amounts of testosterone are released.
3. Positive family history: Multiple genes have been associated with the development of the disease, which is passed on from one generation to another.
4. Low-grade inflammation: Usually associated with obesity, it leads to insulin insensitivity, which further leads to PCOS.

Symptoms

1. Irregular periods: Due to decreased female hormone levels and increased androgen levels, the endometrial lining* is not shed regularly, leading to infrequent menstrual flow or its complete absence.
2. Abnormal hair growth: High levels of androgen cause hair growth on cheeks, chin, stomach, breast, pubic area, etc.
3. Oily skin and acne: This is also caused due to high levels of androgens which leads to increased sebum production and acne and pimple development on the skin.
4. Male pattern baldness: This is also caused due to increased levels of androgens. 
5. Pelvic pain: This happens when there are multiple large cysts in the ovary leading to compression of ovarian and surrounding tissues and nerves.
6. Heavy bleeding: As there is infrequent shedding of the endometrial lining, the lining gets very thick and leads to heavy and prolonged bleeding when it sheds after a longer period of time.
7. Headache and mood swings: This occurs due to altered levels of hormones in the blood. 
8. Dark skin: Seen around the armpit and pubic region due to increased androgen levels.
9. Fatigue: This happens as a result of sleep apnea caused due to PCOS, where the person repeatedly wakes up in sleep and doesn’t get adequate rest.

Complications

1. Infertility: Due to the absence of mature ova, there is no ovulation, and hence no fertility in the female. 
2. Metabolic syndrome: This is a group of disorders with high blood pressure, high blood sugar, high cholesterol, high triglycerides, etc.
3. Type 2 diabetes: This is caused due to increased insulin resistance. 
4. Sleep apnea: Usually associated with obese females with PCOS as fat deposition near the airway causes narrowing of a pathway that leads to apnea episodes.
5. Gestational diabetes: Caused due to less insulin sensitivity
6. Depression: Caused due to hormonal imbalances
7. Anxiety: This is also due to imbalanced hormone levels. 
8. Endometrial cancer: Due to prolonged thickening and non-shedding of the endometrial lining, there is a greater risk of malignant transformation. 
9. Cardiovascular disease and stroke: PCOS leads to an increased risk of obesity and fat deposition within the blood vessels making the women with the condition susceptible to various cardiovascular disorders.

Diagnosis

For the diagnosis of PCOS, the female should have two out of the three symptoms mentioned below:

1. Irregular menstrual cycle
2. Cysts in the ovary 
3. Increased androgen levels in the blood

The following things are done in order to make the diagnosis of PCOS:

1. Positive history of irregular periods and abrupt weight gain.
2. Blood tests showing decreased levels of estrogen and progesterone and increased levels of testosterone.
3. Ultrasound of pelvis confirming the presence of multiple cysts within the ovaries.
4. Manual pelvic examination to see if there is any gross abnormality or growth of tumor in the reproductive tract.
5. Supporting examinations of parameters like blood sugar, cholesterol, and triglycerides are done.
6. Psychological evaluation for conditions like depression and anxiety is done.

Treatment

There is no definitive treatment for PCOS. However, with proper lifestyle modification and medications, the hormonal balance can be attained, which can result in a good quality of life along with fertility for the patient.

• Lifestyle modification: This primarily includes –

1. Diet changes: Food less rich in carbs and fats are to be preferred, along with a protein-rich diet.
2. Regular exercise: This helps to keep the weight in check, even a 5-10% reduction in the weight can drastically improve the signs and symptoms of PCOS. It also helps in better insulin sensitivity.

• Medications (if pregnancy is needed):

1. Clomiphene: This promotes ovulation.
2. Metformin: It helps in insulin sensitivity and ovulation.
3. Gonadotropins: Injections are given to restroom the hormonal balance.
4. Spironolactone: It helps to decrease the levels of androgens. 

• Medications (if pregnancy isn’t needed):

1. Combined birth control pills: This has both estrogen and progesterone and helps in restoring the hormonal balance in the body.
2. Progesterone only pills: This has only progesterone.

Besides these, supporting medications to decrease hair growth, acne, and pimples, etc. can be given.

Prevention

The best way to prevent PCOS is by maintaining a healthy weight with BMI in the range of 18.5 to 24.9 alongside a healthy protein-rich diet.

*Endometrium is an inner lining of the uterus, which thickens and renews itself every month in order to prepare for pregnancy. If pregnancy does not happen, it sheds.

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