Polycystic ovary syndrome (PCOS), previously known as “polycystic ovary disease” (PCOD), is a hormonal disorder that is common among women of childbearing age. The cause of polycystic ovary syndrome is still unknown. Women with polycystic ovary syndrome may have unusual or prolonged menstrual periods or have high male hormone levels (androgen). The ovaries may have small, large sets of fluids (Follicles) and fail to secrete them regularly. Early diagnosis and treatment combined with weight loss reduce the risk of long-term complications of polycystic ovary syndrome.
What is PCOS?
PCOS affects women of childbearing age (15 to 44 years). Between 2.2 and 26.7% of women have polycystic ovary syndrome, which produces more male hormones than normal women. Hormone imbalances cause irregular menstrual periods, disturb the period’s rhythm, and reduce pregnancy chances.
Polycystic ovary syndrome affects the female reproductive organs; the reproductive organs produce estrogen and progesterone. The ovaries produce a small amount of male hormones called androgen. Ovulation controls follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH stimulates the ovary to produce a follicle, and LH destroys mature eggs. Polycystic ovary syndrome affects ovulation and ovaries. Its three main features are:
- High levels of male hormones
- Irregular or skipped periods
- Cysts in the ovaries
In polycystic ovary syndrome, small, fluid-filled sacs grow inside the ovaries. The word “polycystic” means many cysts. These sacs are follicles, each one containing an immature egg. The absence of ovulation changes estrogen, progesterone, FSH, and LH levels. In this disease, estrogen and progesterone levels are lower than normal, androgen levels are higher. Excess male hormones disrupt the menstrual cycle, so women with polycystic ovary syndrome have fewer periods than usual.
Symptoms
Some women experience symptoms from the time of their first period. Others notice this syndrome when they gain a lot of weight, and others when they have trouble getting pregnant. The most common symptoms of PCOD are:
- Irregular periods: Lack of ovulation prevents the uterine mucosa from shedding every month. Some women with polycystic ovary disease have less than eight cycles a year.
- Hair growth: Over 70% of women with this disease grow hair on the face, body, back, abdomen, and chest. The overgrowth of hair is called hirsutism.
- Heavy bleeding: Because there is no regular menstruation, the lining of the uterus accumulates for longer, so periods are usually heavier than normal.
- Acne: Male hormones can make the skin more oily than usual and cause acne on the face, chest, and upper back.
- Weight gain: 80% of women with PCOS are overweight or obese.
- Darkening of the skin: Dark spots can cause wrinkles on the body, such as the neck, under the breasts, and groin.
- Headaches: Hormonal changes in polycystic ovary syndrome can cause headaches in some women.
- Fertility problems: Many women with polycystic ovary syndrome have trouble getting pregnant.
- Mood changes: Having PCOS can increase the likelihood of mood swings, anxiety, and depression.
- Pelvic pain: Pelvic pain may be accompanied by periods of heavy bleeding.
- Sleep problems: People with polycystic ovary disease often report problems such as insomnia or lack of sleep. Many factors can affect sleep, but PCOS is associated with a sleep disorder called sleep apnea.
Causes
The cause of polycystic ovary syndrome is unknown, but there are possible causes.
Insulin resistance
About 85% of all women with PCOS have insulin resistance. Insulin is a hormone produced in the pancreas that allows sugar to enter and be used by cells. If cells resist insulin, blood sugar levels rise, and the body may produce more insulin. Too much insulin may increase androgen production and make ovulation difficult.
Insulin resistance is partly caused by lifestyle factors, including being overweight due to diet or a sedentary lifestyle. But insulin resistance can also be caused by genetic factors and can occur in women of any weight range.
Family history
It is unknown if any gene is responsible for PCOS, so it will likely involve several genes. Women with PCOS are 50% more likely to have a mother, aunt, sister, or daughter with polycystic ovary syndrome. Type 2 diabetes is also common in families with PCOS.
Androgens
Androgens, sometimes known as “male hormones,” are commonly found in men and women but are much lower in women. All women produce small amounts of androgens in body tissues, including the ovaries and adrenal glands. Elevated androgen levels in women with polycystic ovary disease cause symptoms such as excessive body hair growth, hair loss, and acne. They also help with symptoms such as irregular menstruation and irregular ovulation.
Lifestyle
PCOS can occur in thin and overweight women. However, women with PCOS are more at risk of being overweight or obese. Being overweight increases insulin resistance. A healthy lifestyle, nutrient intake, and physical activity can help treat PCOS and reduce symptoms.
Low-grade inflammation
Low-grade inflammation refers to the production of white blood cells to fight infection. Research has shown that women with polycystic ovary syndrome have a mild inflammation that stimulates polycystic ovaries to produce androgens, which can lead to cardiovascular problems.
How PCOS affects the body?
Having polycystic ovary syndrome can affect the body. These effects include:
- Infertility: Every woman needs to ovulate to get pregnant. Women who do not ovulate regularly do not release the number of eggs that are fertilized. Polycystic ovary disease is one of the leading causes of infertility in women.
- Metabolic syndrome: Up to 80% of women with polycystic ovary syndrome are overweight or obese. Obesity and PCOS increase the risk of high blood sugar, blood pressure, and cholesterol. These factors are called metabolic syndrome and increase heart disease risk, diabetes, and stroke.
- Sleep apnea: Sleep apnea is when frequent pauses in breathing during the night interrupt sleep. Sleep apnea is more common in overweight women, especially if they also have polycystic ovary disease. The risk of sleep apnea in obese women with polycystic ovary syndrome is 5 to 10 times higher than in women without the syndrome.
- Endometrial cancer: During ovulation, the lining of the uterus is destroyed. If ovulation does not occur every month, the uterus thickens’ it’s lining, and the risk of endometrial cancer increases.
Depression: Hormonal changes, along with other annoying symptoms, can have a negative effect on emotions. Many people with this syndrome experience depression.
Diagnosis
There is no test to diagnose polycystic ovary syndrome definitively. The doctor will ask about medical history, including menstrual periods, weight changes, physical exams, and examinations for hair growth symptoms, insulin resistance, and acne.
A pelvic exam
Gynecologist visually and tactilely examines the reproductive organs for masses, growths, or other abnormalities.
Blood tests
In a blood test, the amount of hormones is checked. Blood tests may also be done to check for glucose tolerance, cholesterol, and triglyceride levels.
Ultrasound
Ultrasound examines the condition of the ovaries and the thickness of the uterine wall. In this method, ultrasonic waves are used to create the image. If the doctor confirms the syndrome, he or she may recommend the following tests:
- Periodic checks of blood pressure, cholesterol, glucose tolerance, and triglyceride levels
- Screening for depression and anxiety
- Screening for obstructive sleep apnea
Pregnancy and polycystic ovary disease
Polycystic ovary disease interrupts the normal menstrual cycle and makes pregnancy more difficult. Between 70 and 80 percent of women with this syndrome have fertility problems, which can also increase the risk of pregnancy complications. Women with PCOD are twice as likely as women without the disease to have a preterm birth. They are also at higher risk for high blood pressure, gestational diabetes, and miscarriage.
However, women with PCOD can become pregnant using fertility treatments that improve ovulation, lower blood sugar levels, and lose weight to improve the chances of having a healthy pregnancy.
Polycystic ovary disease can cause problems for both mother and baby during pregnancy. Women with the syndrome have a higher percentage of the following conditions:
- Miscarriage
- Gestational diabetes
- Preeclampsia
- Cesarean section
Four major treatment options for PCOS or Pcod
Various strategies can be used to treat and reduce the symptoms of polycystic ovary syndrome. Medication and lifestyle modifications are treatments for PCOS. The most effective treatments include:
1- Birth control methods
Using oral contraceptives is the most effective and convenient way to manage the symptoms of PCOD. There are two types of oral contraceptives, combination pills, and progesterone-only pills. These pills can cause the following changes:
- Ovulate
- Have regular periods
- Reduce cramping
- Have clearer skin
- Have lighter periods
- Reduce extra hair growth
Lower risks for endometrial cancer, ovarian cancer, and ovarian cysts.
Some women taking birth control pills may experience mood swings, possible weight gain or loss, headache, nausea, sore breasts, and some spots.
Combination pills contain estrogen and progestin, two synthetic hormones similar to those made by the ovaries. The amount of hormones is different in different brands. The doctor prescribes the appropriate medication dose according to the patient’s condition. . For example, low-dose combination pills contain about 20 micrograms of estrogen, while high-dose birth control pills usually contain between 30 and 35 micrograms of estrogen.
Progestin-only pills, known as mini-pills, are a good option for women who cannot take combined birth control pills. Progestin-only pills increase progesterone levels, reducing the risk of endometrial cancer through regular menstrual periods.
Another way to treat polycystic ovary disease is to use a contraceptive patch. The patch contains a thin layer of plastic that contains estrogen and progestin. Wear the patch for 21 days, remove it for seven days to allow for a period, then replace it with a new patch.
The contraceptive ring can also be used as a soft, flexible plastic ring inserted into the vagina. Wear for 21 days, leave for seven days to allow for a period and then, with the ring, replace it next month.
2- Spironolactone
If birth control pills do not stop hair growth after six months, the doctor may prescribe spironolactone (Aldactone). They reduce androgen levels. But if pregnant or planning to become pregnant, you should not take it, as it can cause birth defects.
3- Metformin
Metformin is a medication used to treat type 2 diabetes. It can also be useful in treating polycystic ovary syndrome by improving insulin levels. Metformin enhances the ability of insulin to lower blood sugar and can reduce insulin and androgen levels. After a few months of use, metformin may help start ovulation, but it usually has little effect on acne and excess facial or body hair. Metformin may have other positive effects, including improving cholesterol levels and lowering body mass.
4- Weight loss
PCOD treatment usually begins with lifestyle changes such as weight loss, diet, and exercise. Losing only 5 to 10 percent of body weight can help regulate the menstrual cycle and improve PCOS symptoms. Weight loss can also improve cholesterol levels, lower insulin and reduce the risk of heart disease and diabetes. All diets that help lose weight can also help treat the syndrome, but some diets have more benefits.
Low-carb diets are good for both weight loss and lowering insulin levels. A low glycemic index diet that gets the most carbohydrates from fruits, vegetables, and whole grains helps regulate the menstrual cycle better than other weight-loss diets. 30 minutes of moderate-intensity exercise at least three days a week can help women with Poodle weight. Weight loss with exercise also improves ovulation and insulin levels. So diet and exercise can increase the speed of weight loss and reduce the risk of disease.
Natural Ways to Help Treat Polycystic Ovary Syndrome
Insulin resistance and hormonal imbalance are the main causes of polycystic ovary syndrome. Lifestyle changes reduce symptoms and aid the healing process.
Diet changes
Eating the right foods and avoiding certain foods may help manage symptoms. A nutritious diet can help regulate hormones and the menstrual cycle. Whole foods that lack artificial sugars, hormones, and preservatives. Fruits, vegetables, whole grains, and legumes are complete foods that people with this syndrome should add to their diet. Adding anti-inflammatory foods such as olive oil, tomatoes, leafy vegetables, fatty fish such as mackerel and tuna, and nuts can help improve symptoms.
Some women with PCOD experience heavy bleeding during their period. This can lead to iron deficiency or anemia. Adding iron-rich foods such as spinach, eggs, and broccoli can help with iron deficiency. Reducing caffeine intake and increasing soy intake can also help.
Probiotics
Probiotics do not only help digestion and gut health. They can also reduce inflammation and regulate sex hormones such as androgens and estrogen. People with polycystic ovary disease should include probiotic supplements and probiotic foods such as kimchi and kombucha.
Practice good sleep
Sleep affects stress levels and helps regulate cortisol for hormone balance. Get eight to ten hours of sleep daily, have a regular bedtime routine, and avoid stimulants and fatty foods before bed.
Reduce stress
Reducing stress can regulate cortisol secretion. Doing yoga, getting enough sleep, and reducing caffeine can all help reduce stress levels.
When to see a doctor
If you notice the following symptoms, you should see a doctor:
- Missed period but no pregnancy
- Have symptoms of PCOS, such as hair growth on the face and body
- Trying to get pregnant for more than 12 months but haven’t been successful
- Symptoms of diabetes, such as excessive thirst or hunger, blurred vision, or unexplained weight loss
Polycystic ovary syndrome is a disease that affects the level of female hormones and causes disorders in a woman’s menstrual cycles, thus making pregnancy more difficult. In addition, it causes symptoms in the body that are unpleasant. Lifestyle interventions are the first to be done for treatment, including losing weight, following a balanced diet, and exercising regularly. If unsuccessful, medication is replaced after lifestyle changes.
Arjang Naim, MD is a specialist in treating polycystic ovary syndrome. After performing the necessary examinations and obtaining a complete history from the patient, he prescribes solutions and, if necessary, medications to reduce the patient’s symptoms and, if desired, provide the conditions for pregnancy.
Additional questions
- What is the role of FSH?
The pituitary gland produces follicle-stimulating hormone (FSH) in the brain. It is an important hormone for the normal functioning of the reproductive system in men and women. In women, FSH helps control the menstrual cycle and the production of eggs by the ovaries.
2. What are the five criteria for metabolic syndrome?
- Abdominal obesity
- High blood pressure
- Impaired fasting glucose
- High triglyceride levels
- Low HDL cholesterol levels
3. What is the most serious side effect of metformin?
Under certain circumstances, a metformin overdose can cause lactic acidosis. The symptoms of lactic acidosis are severe and come on quickly, and usually occur when other health problems not related to the medicine are present and very severe, such as a heart attack or kidney failure.
4. Does PCOS affect the baby?
Women with polycystic ovary syndrome (PCOS) are at increased risk for certain problems or complications during pregnancy. Additionally, babies born to mothers with PCOS are at increased risk of spending time in the neonatal intensive care unit or dying before, during, or soon after birth.
5. Is PCOS worse after pregnancy?
It’s important to remember that some PCOS symptoms, such as hormonal imbalances and associated weight gain, can return and even worsen after pregnancy — and that being pregnant and having a successful delivery doesn’t mean PCOS is gone.
References
https://www.healthline.com/health/womens-health/natural-treatment-pcos#talk-with-your-doctor
https://www.jeanhailes.org.au/health-a-z/pcos/symptoms-causes
https://www.webmd.com/women/what-is-pcos#1
https://www.healthline.com/health/polycystic-ovary-disease#when-to-see-a-doctor
