Polycystic Ovarian Syndrome (PCOS): Everything You Need To Know About This Condition

What happens if a woman has PCOS? Do polycystic ovaries go away? Can PCOS be treated? Can a woman get pregnant if she has PCOS?

What is PCOS and why do many women struggle with it? Learn more about this condition that can affect your chances of conceiving.

Irregular menstrual cycles and acne are common problems young women suffer from. However, many do not realise that these seemingly trivial symptoms may be due to a more serious underlying condition.

Polycystic ovarian syndrome (PCOS) is the most common endocrine (hormonal) disorder affecting young women. It is estimated that up to 10 per cent of women in Singapore may have PCOS.

PCOS Meaning

Hormones are impacted by the prevalent illness known as polycystic ovarian syndrome. It results in infertility, excessive hair growth, acne, and irregular menstrual cycles.

Women with PCOS may often but not always have multiple cysts in their ovaries or have hormonal imbalances such as excess androgens (male hormones) and insulin resistance. In PCOS, ovulation does not occur regularly, resulting in menstrual irregularities.

It can manifest with a wide variety of symptoms, and many may not be aware of their condition and go undiagnosed.

Whether or not you want to get pregnant will affect your PCOS treatment. Those who suffer from it may be more susceptible to diseases like diabetes and high blood pressure.

What Causes PCOS

There is no known cause for PCOS. However, there is proof that genetics are involved. The following other factors may also contribute to having polycystic ovaries:

1. Higher levels of androgens, a type of male hormone

High androgen levels impede ovulation, which results in irregular menstrual periods. Small, fluid-filled sacs can also form in the ovaries as a result of irregular ovulation. Acne and excessive hair growth are further effects of high androgen in women.

2. Insulin resistance

Elevated insulin levels trigger the release of male hormones from the ovaries (androgens). Increased levels of male hormones subsequently prevent ovulation and worsen other PCOS symptoms.

The way your body uses glucose (sugar) for energy is regulated by insulin. Because of improper insulin processing, which results in insulin resistance, your blood glucose levels are elevated.

Although not all people with insulin resistance have diabetes or high blood sugar, insulin resistance can cause diabetes. Insulin resistance can also be influenced by being obese or overweight. Even if your blood glucose is normal, a high insulin level may indicate insulin resistance.

3. Low–grade inflammation

PCOS sufferers frequently have low-grade inflammation. C-reactive protein (CRP) and white blood cell measurements can be done through blood tests by your doctor to determine how much inflammation is present in your body.

4. Genetics

Polycystic ovaries can run in families in some cases. You are frequently at a higher chance of acquiring PCOS if any of your relatives, such as your mother, sister, or aunt, do.

Although particular genes linked to this condition have not yet been discovered, this shows that the disorder may have a hereditary component.

Who Is At Risk for PCOS

While PCOS can occur in women of all body sizes, several factors can increase the risk of developing this condition. Understanding these risk factors is essential for early detection and appropriate management. Here are the key factors that contribute to the risk of PCOS.

1. Being overweight or obese: Carrying excess weight, particularly in the abdominal area, increases the risk of developing polycystic ovaries. Excessive fat tissue can disrupt hormonal balance and insulin function, contributing to the development of PCOS.

2. Family history of PCOS: Having a close family member, such as a mother, sister, or aunt, with PCOS increases the likelihood of developing the condition. Genetic factors play a role in the development of PCOS, and individuals with a family history should be vigilant about monitoring their symptoms.

3. Weight-related issues: Apart from being overweight or obese, weight-related issues such as insulin resistance and metabolic syndrome can increase the risk of PCOS. These conditions are often associated with excess weight and contribute to hormonal imbalances that lead to PCOS.

4. Hormonal imbalances: PCOS is characterised by hormonal imbalances, particularly elevated levels of androgens (male hormones). Women with higher-than-normal androgen levels may experience irregular menstrual periods, acne, excess hair growth (hirsutism), and hair loss.

5. Age after puberty: PCOS can occur at any age after puberty. However, most women discover they have PCOS in their 20s and 30s when they experience difficulties getting pregnant and seek medical advice.

It’s important to note that while these factors increase the risk of developing PCOS, the condition can still occur in individuals without any of these risk factors.

PCOS Symptoms

What are the first signs of PCOS? If you’ve never been diagnosed before, how will you know if you have it?

One of the typical symptoms of PCOS is an irregular menstrual cycle, often with long intervals between periods (oligomenorrhea) or missed periods.

Symptoms like acne, hirsutism (increased facial and body hair), and male pattern hair loss are a result of excess male hormones.

Other symptoms are:

• Darkening of the skin: Dark skin patches, particularly in the folds of your neck, armpits, groyne (between the legs), and under the breasts. Acanthosis nigricans is the term for this.
• Cysts: Many PCOS sufferers have little fluid-filled sacs in their ovaries.
• Skin tags: Skin tags are tiny skin flaps that protrude. In PCOS-afflicted women, they are frequently located on the neck or in the armpits.
• Thinning hair: People with PCOS may experience balding or bald spots on their heads.
• Infertility: The most frequent factor contributing to female infertility is PCOS. Lack of ovulation or decreased ovulation frequency can prevent conception.

While obesity is common amongst women who suffer from PCOS, it is important to note that many women with PCOS in Singapore actually have a normal BMI.

What Are The Possible Complications Of PCOS

PCOS complications can include:

• Infertility

PCOS is a very common cause of infertility. Since women with PCOS do not ovulate regularly, they may run into difficulties conceiving.

• Miscarriage or premature delivery

Those who successfully conceive are at higher risk of complications during pregnancies, often suffering from gestational diabetes.

• Gestational diabetes or high blood  pressure brought on by pregnancy

Insulin resistance seen in women with PCOS places them at a higher risk of certain diseases such as Type 2 Diabetes and cardiovascular disease.

• Uterinary lining cancer (endometrial cancer)

There is also an increased risk of endometrial (uterine) cancer due to hormonal imbalances.

• Non-alcoholic steatohepatitis

This is a serious liver inflammatory condition brought on by the accumulation of fat in the liver

• Anxiety, depression, and eating problems

It can be psychologically distressing and women may also suffer from anxiety and depression related to acne, excess hair, hair loss, body weight concerns, or infertility.

How To Diagnose Polycystic Ovarian Syndrome

If you have symptoms suggestive of PCOS, your doctor may ask you to undergo further blood tests and scans.

PCOS is diagnosed through a combination of clinical symptoms in the form of a history of irregular menses, hormonal blood tests to look for excess levels of male hormones, and imaging, usually an ultrasound scan of the pelvis to look for the presence of multiple cysts in the ovaries.

PCOS Treatment and Management

You can play a crucial role in keeping your PCOS in check.

Based on your symptoms, medical history, other health concerns, and whether you wish to get pregnant, your healthcare professional will decide on the best course of action. Medication, lifestyle modifications, or a mix of the two may be used as treatments.

A healthy lifestyle with a good diet and exercise can help to reduce the symptoms of PCOS. If you are overweight, just reducing your body weight by 2 to 5% can help with the return of normal menstrual cycles and reduce your risk of diabetes, heart disease and other illnesses.

How To Cure PCOS Permanently

The medical treatment is tailored to suit your symptoms and needs.

Treatment options, if you don’t want to get pregnant, include:

• Hormonal birth control methods

This includes oral pills, vaginal rings, patches, shots, and intrauterine devices (IUD). Hormonal birth control aids in acne improvement, excess hair growth reduction, and menstrual cycle regulation.

• Insulin-sensitizing drugs

Metformin is a diabetes medication. It functions by aiding insulin metabolism in your body. Some PCOS sufferers experience improvements in their menstrual cycles once their insulin levels are under control.

• Medications that block the effects of androgens

Some medications can block the effects of androgens. This aids in reducing acne or hair development brought on by PCOS. Find out if they are a good fit for you by speaking with your healthcare physician.

• Change in lifestyle

Eating a nutritious diet and losing weight can both lower insulin levels.

Treatment for PCOS involves the following if you wish to get pregnant now or in the near future:

• Ovulation-inducing medications

Ovulation is the first step in a healthy pregnancy. It has been demonstrated that several medications can cause ovulation in PCOS women. While gonadotropins are administered intravenously, the medicines clomiphene and letrozole must be taken orally.

• Surgery

By eliminating structures in the ovaries that are releasing androgen hormones, ovarian drilling surgery can cause ovulation to occur. Surgeons now infrequently conduct this operation due to the availability of newer drugs.

• In vitro fertilization (IVF)

Your partner’s sperm and your egg are fertilised in a laboratory before being transported to your uterus. When taking medicine doesn’t help with ovulation, PCOS women have this option.

PCOS Diet: How To Lose Weight With PCOS

Women with PCOS may struggle to lose weight.

A balanced diet may help people lose weight. A few vitamins might also be beneficial. Additionally, lifestyle needs to be taken into account. 

Remember these key points that will help you lose weight while dealing with PCOS:

• Adopt a mindful eating habit

Weight loss may be aided by mindful eating, which raises awareness of internal eating triggers. Women with PCOS may find it particularly beneficial because they are significantly more likely to develop eating issues.

• Avoid undereating

Your metabolism may slow down if you restrict your calories frequently, which could result in weight gain. Instead of restricting your diet, try switching to a diet high in whole, unprocessed foods to aid in weight loss.

• Cut back on your carb intake

A low-GI, low-carb diet may lower insulin levels in PCOS-afflicted women. This might therefore facilitate weight loss.

• Consume a lot of fibre

A diet rich in fibre may benefit PCOS-afflicted women with their weight loss efforts, insulin sensitivity, and excess body fat.

• Consume enough protein

Following a meal, protein promotes feelings of fullness and helps to balance blood sugar. A higher protein consumption may accelerate weight loss, particularly for PCOS-affected women. Consider enhancing your diet with nutritious, high-protein foods like eggs, almonds, and seafood.

• Consume healthy fats

Including a lot of healthy fats in your diet may help you combat weight loss and other PCOS symptoms while also making you feel more content after meals.

Olive oil, coconut oil, nut butters, avocado, and other types of healthful fats are a few examples. The filling effects of meals and snacks can be further increased by combining a healthy fat with a protein source.

• Consume fermented foods

It’s possible that women with polycystic ovaries have fewer healthy gut microbes. Consuming probiotic-rich meals or taking a probiotic pill may help your gut bacteria, which will help you lose weight.

• Cut back on added sugars and processed foods

Blood sugar levels are raised by processed foods, such as refined carbohydrates and added sugars, which can result in weight gain.

• Try anti-inflammatory foods

Obesity and inflammation have been related in women with PCOS. An anti-inflammatory diet that emphasises whole foods, especially fruits and vegetables, may be beneficial.

• Get enough sleep

Obesity is related to poor sleep. Increasing your overall amount of sleep may help you lose weight and reduce body fat, according to studies on healthy adults.

• Manage your stressors

Managing your stress can help you control your weight because stress is a risk factor for weight growth.

Chronic stress is associated with high cortisol levels, which are connected to insulin resistance and belly obesity. Yoga, meditation, and time spent outside can all help you relax and reduce your cortisol levels.

• Exercise regularly

Exercises that involve both aerobic and weightlifting may help PCOS patients lose body fat and increase insulin sensitivity.

• Take supplements

Several vitamins may aid in controlling weight and symptoms if you have polycystic ovaries.

A dietary supplement called myoinositol may help PCOS-afflicted women lose weight. A B vitamin-related substance called inositol aids in enhancing insulin sensitivity. A particular kind of inositol is called myoinositol.

Polycystic ovarian syndrome is more common than you think and can cause significant health complications. It is important not to overlook or dismiss possible symptoms of PCOS. If any of these symptoms sound familiar to you, it may be best to make an appointment with your doctor to get them checked out.

This article was contributed by Dr Grace Huang. She is the resident doctor at DTAP Clinic Robertson, a general practice clinic with a special interest in men’s and women’s health, and sexual health.

Updates from Matt Doctor

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