PCOS is a hormonal disorder that affects the ovaries. Women with PCOS are often characterized with elevated androgen levels, menstrual irregularities and small cysts on one or both ovaries. Studies suggest that this endocrine abnormality mostly affects women of reproductive age.
What are the symptoms of PCOS?
No two women have the same symptoms of PCOS. According to the peer-reviewed International Journal of Gynecology and Obstetrics, the signs and symptoms of PCOS include irregular menstrual cycles, abnormal hair growth, alopecia, acne, acanthosis nigricans (a skin condition), skin tags and enlarged ovaries with numerous small cysts. “Miscarriages and infertility, as well, are symptoms of PCOS due to the high level of testosterone in the body,” says Dr Sarika Gupta, Consultant Gynaecologic Oncology and Robotic Gynaecology, Apollo Indraprastha Hospital, New Delhi.
According to the Journal of Gynaecology and Women’s Health what makes the diagnosis of PCOS difficult is that, there is no reliable test to assess the patients. “But, generally ultrasound and blood tests help the doctors in making the diagnosis of PCOS,” adds Dr Gupta.
A pelvic ultrasound can help to identify and document the presence of polycystic ovaries. “A woman with polycystic ovarian syndrome generally has larger ovaries with 12 or more immature follicles in the ovaries (positioned like a necklace of pearls) measuring 2-9 mm in diameter. However, polycystic ovaries on ultrasound is not present in all patients,” explains Dr Gupta.
“In addition, high levels of LH, testosterone, AHM, prolactin, DHES in the blood test may also be present in PCOS. Another important change seen in PCOS is high insulin levels, abnormal levels of GTT (Glucose Tolerance Test) and change in FSH/LH ratio,” adds the doctor.
Types of PCOS
· Insulin-Resistant PCOS – In this type of PCOS, the levels of glucose in the blood increases, which can potentially lead to type-2 diabetes. “This type of PCOS can be managed by bringing lifestyle modifications such as weight management, reducing sugars and doing exercise,” says Dr Gupta.
· Inflammatory PCOS – In this type of PCOS, some form of inflammation happens in the body. The levels of CRP (C-reactive protein) increases a parameter that detects inflammation. One of the measures to ease the symptoms of this PCOS is to add anti-inflammatory foods such as spinach, kale, collards, walnuts, strawberries to the diet.
· Post-Pill PCOS – In this type of PCOS, you experience the signs of higher levels of androgens in your body once you stop using OCPs (Oral Contraceptive Pill). “An important sign of this type of PCOS is to check if your periods were normal before using OCPs,” says Dr Gupta. Using medicines prescribed by a doctor, stress reduction, right nutrition, regular exercise helps in dealing with this kind of PCOS.
· Adrenal PCOS – In this PCOS, stress begins to impact hormones. Pituitary gland secretes ACTH (adrenocorticotropic hormone) under stress, which in turn, stimulates the production of adrenal androgen hormones. These elevated androgens contribute to PCOS symptoms such as weight gain, acne, mood disorders, unwanted hair growth and menstrual dysfunction. Stress management techniques, diet, exercise, sleep can curb the effects.
· Hidden PCOS – “Hidden hormonal disorders occurring due to hypothyroidism, vitamin deficiencies, high prolactin are some causes of this kind of PCOS,” explains Dr Gupta. Healthy eating, regulation of blood sugar, and weight loss techniques are helpful.
· Lean PCOS – When a woman with a normal body mass index (BMI) suffers from menstrual disturbances, polycystic ovaries and hyperandrogenism, it falls into the lean PCOS category. “Depending on the symptoms of PCOS (whether hirsutism, menstrual dysfunction, acne, infertility), medicines are prescribed besides advising lifestyle modifications,” adds Dr Gupta.
Treatment of PCOS
Treatment for PCOS typically includes insulin-lowering drugs (metformin), anti-androgen therapy, oral contraceptives, and the implementation of lifestyle changes, including weight loss if necessary.
According to a paper published in Fertility and Sterility, in a majority of women, weight loss, accompanied by an increase in insulin sensitivity, helps in the successful treatment of the metabolic and hormonal abnormalities in PCOS.
“While there’s no specific treatment or cure for PCOS, it is important to note that medical and lifestyle management can control PCOS, and can increase the chances of successful pregnancy too,” says Dr Gupta.
Role of diet and lifestyle in PCOS
Research published in American Society for Reproductive Medicine says that a diet relatively low in carbohydrates and cholesterol can improve the metabolic profile of women with PCOS. The diet should be high in fibre and good fats, adds the research.
“Limit the foods that contain trans fats and saturated fats. Embrace whole carbs instead of refined and processed ones. These have a natural fibre profile,” suggests Dr Gupta.
What to include: Whole grains, legumes, nuts, seeds, lean protein, anti-inflammatory foods (turmeric, tomatoes, cinnamon), green and red peppers, berries, plant protein sources, unsaturated fats
What to avoid: Refined carbs, processed meats, sugary beverages, fried foods, sweetened cereals, trans fats (French fries), heavily processed cheese, yogurt and ice-cream.
A meta-analysis of studies on PCOS published by the Cochrane Reviews shows that lifestyle intervention helps to improve the free androgen index (FAI), weight and BMI in women with PCOS. Some important measures include moderating alcohol consumption and smoking, exercising regularly, and getting a hold on stress. “Along with a good diet, practicing ways to manage depression, anxiety, poor sleep quality through meditation and yoga also helps,” concludes the doctor.
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