PCOS (Polycystic Ovary Syndrome) is one of the most common disorders during the reproductive years because of the hormonal imbalance that takes place mostly during this phase. It is also one of the most common reasons for infertility caused due to lack of ovulation in women. Dr Aruna Kalra, Senior Gynecologist and Obstetrician at CK Birla Hospital, Gurgaon, in conversation with THIP Media explains the health condition, diagnosis and precautions that one needs to be taken to prevent or control PCOS.
Q: Why have the cases of PCOS become more common than they were in the past?
PCOS is a lifestyle disorder. It is not a disease or ailment rather, it is a syndrome. Nowadays, lifestyle has changed a lot, and PCOS has actually become endemic.
When girls reach their puberty around eleven-twelve years of age, they have baby fat. In the initial four to five years when menstrual periods start, the ovary and pituitary axis are at the developing stage. This may cause irregularities in the cycle, but we do not consider this as PCOS. But because of obesity, unhealthy and sedentary lifestyle, and all the more because of COVID nowadays, these girls continue to be obese even during adolescent years and suddenly they fall under the PCOS bracket. They never have regular periods. So, the foremost reason for the increase in PCOS cases is bad lifestyle habits like lack of exercise, bad eating habits, etc. This has adverse effects on ovarian functions and can cause hormonal imbalance.
Q: Does genetics play a role in PCOS? If yes, then does it mean that if a woman’s kin is suffering from PCOS, then she too will?
PCOS can be of two varieties – one is obese PCOS, and the other one is thin PCOS. Currently, we are seeing a lot of girls who are very thin and have good BMI or low BMI in some cases, and yet they do not get proper periods and develop acne and/or facial hair and other symptoms of PCOS. This condition is called thin PCOS. These girls have genetic mutants in them, and they are the carriers of the PCOS gene. In most cases, when the mothers have not breastfed the kids, they tend to develop this condition. Proper breastfeeding prevents the kids from hypertension, diabetes and heart diseases. So, when kids are not provided with good immunity through breastfeeding in their initial years, it can lead to PCOS.
Since PCOS is a lifestyle disorder, you will find multiple members of a family suffering from hypertension or type 2 diabetes and other such lifestyle disorders. This can lead to genetic mutation in a family, which leads to PCOS among girls due to genetic reasons. Nevertheless, diet and more importantly exercise are crucial factors that help in controlling the symptoms in any type of PCOS.
Q: How to diagnose the signs and symptoms of PCOS?
PCOS is a syndrome, which has to be diagnosed clinically on the basis of the symptoms, signs, blood test and then ultrasound. Irregular periods, excessive facial and body hair due to androgen, acne, pigmentation and sometimes infertility are some of the symptoms of PCOS.
The first step in the diagnosis process of PCOS is to determine if a woman has some or all of these symptoms. The second step is to get tests done to find abnormality of hormonal levels and/or insulin resistance. In some cases, the test results may be absolutely normal, but they may continue to show symptoms. In such cases, a lot of times, we find that the hormonal levels or insulin resistance levels get abnormal eventually. After we have determined the symptoms and abnormalities in hormonal levels, we do ultrasound. It is mostly done to check endometrial thickness to rule out the chances of the patient being in the cancer or precancer spectrum. Usually, we recommend our patients to take progesterone for five days if they are not getting their periods for 45 days or more. Otherwise their endometrial thickness would increase gradually. This can cause abnormal bleeding and thickness, which may further lead to grave situations. In ultrasound, we just do not see the number of follicles, but also the volume of both the ovaries. If the volume, test results and symptoms all align with the diagnosis of PCOS, only then we confirm the diagnosis.
After the diagnosis, the treatment starts. The level one therapy is dietary modification and exercise, which will be the same for any symptom of PCOS. However, rest of treatment is targeted according to the symptoms of the patient.
Q: Can a woman with PCOS conceive?
If a patient manages to lose weight and maintain it within their required BMI and starts menstruating every month, they can definitely conceive. Losing weight in itself is a treatment of PCOS symptoms, and women with PCOS can conceive if they follow a healthy lifestyle.
Q: Are birth control pills safe for treating PCOS?
In the case of PCOS, birth control pills are not prescribed as contraceptives. They are prescribed in order to regularise their menstrual periods. This is because irregular periods can lead to unhealthy uterine cavity that can cause endometrial thickness or painful and heavy bleeding. So, these pills on one hand are effective in regulating their periods, reducing their acne, facial hair, hyper pigmentation, etc., and on the other hand, they act as oral contraceptives as well.
Oral contraceptive pills are absolutely safe provided your doctor has prescribed them, and they know your medical history. It is very important to confirm any history of any kind of hormone dependent cancer, or any predisposition to such cancers or deep vein thrombosis, as we do not want progestational side effects or water retention in such cases.
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