A common disorder inflicting more and more women, polycystic ovarian syndrome is one ugly monster not to be ignored. Woman This Month outlines the pesky problems this disorder brings about and how to tackle them.
As women, we may experience annoying flare-ups of acne or delayed menstruation at some point in our lives. But if these problems persist over time, they might just be the telltale signs of polycystic ovarian syndrome (PCOS).
Touted to be the most common female endocrine dysfunction, affects a significant percentage of women. Read on to be aware of this niggling problem and avert the long-term repercussions it brings.
What is PCOS?
Our expert: Dr Alka Gupta, American Mission Hospital
As per Dr Gupta, PCOS is a metabolic disorder, referred to as a syndrome because it is a set of conditions. Polycystic ovaries, infertility, hirsutism and insulin resistance are all a package deal.
“The ovaries take turns to produce one dominant egg each month. An imbalance of hormones hinders the follicle to mature fully and rupture before the egg makes its way to the uterus. The immature eggs do not ovulate, but merely stay in the ovary. Over a period of time, many such follicles collect in the ovaries. This is what is called polycystic ovaries,” she explains.
This disorder is a fairly new concept affecting teenagers and women of child-bearing age, which was not so common around 20 years ago. The doctor attributes this to contemporary lifestyle. The exact pathology behind this disorder remains unknown. But, this could be blamed on unhealthy weight and a sedentary way of life.
A simple ultrasound and blood test can diagnose PCOS, but its exact cause is difficult to pinpoint. It is safe to say that the main villain here is obesity, which could lead to a hormonal imbalance, which in turn leads to polycystic ovaries, hirsutism, hair loss and skin eruptions. However, PCOS can wreak havoc in the lives of slim women as well.
The long-term repercussions of PCOS
Our expert: Dr Kiran Bijlani, Royal Bahrain Hospital
Medical practitioners observe that signs of PCOS are not taken as seriously as they should be. Indifference in treating this potentially harmful disorder can cause multiple problems in the long run. The most glaring problem that PCOS causes is infertility due to insufficient ovulation.
“PCOS patients take longer to get pregnant and may need assistance to conceive,” says Dr Kiran. PCOS left untreated can also pose the risk of miscarriage.
In case, the patient has conceived naturally, she faces a 45 percent risk of miscarriage. The reason is poor quality of the follicles, owing to the abnormal hormonal milieu. She may experience gestational diabetes, which leads to a gamut of other concerns.
“The baby may be very big, the need for a C-section may increase and once born, the baby develops related disorders as well,” Dr Kiran adds.
The syndrome must be treated at an early stage, not only from the point of view of fertility, but also for preventing other complications later in life. PCOS patients have higher than normal levels of insulin, but the insulin works less efficiently to utilise sugars. This high insulin then causes excess deposition of fat in the body. This ultimately results in obesity and diabetes.
Being obese ups the ante for life-threatening illnesses like hypertension, cholesterol and cardiac problems. Due to anovulation, the protective effects of the hormone called progesterone are not received. This makes them susceptible to developing endometrial and breast cancer.
“Higher levels of male hormones cause fat to be distributed in a male pattern, where ladies sport the masculine apple shape rather than the feminine pear shape,” she explains. Needless to say, such cosmetic problems associated with PCOS, including severe acne, hair loss and hirsutism cause major self-esteem issues.
Dealing with PCOS
Our expert: Dr Huda Al-Jufairi, Ibn Al Nafees Hospital
“Not all PCOS patients approach us with the same complaint,” says Dr Huda. “The goal of each patient differs; it could be to cure amenorrhea, skin problems or infertility.”
The treatment plan is tailor-made as per the requirement of the patient. The downside is that there is no permanent cure for PCOS. Patients need to follow-up to keep it in check and may need differing treatment depending on their life stage.
As usual PCOS patients are generally overweight, the first issue to be tackled is maintaining a healthy weight. PCOS can be controlled better with weight management. Once a healthy body mass index is achieved, symptoms reduce drastically due to better hormonal balance. Contrary to popular belief, it is not more difficult for PCOS patients to lose weight. It depends on the individual’s motivation and perseverance.
There are various drugs to counter-effect the problems. The age, body type and goal of the patient are major factors in choosing the appropriate course of treatment.
“If a patient needs to control her hirsutism, or severe acne, and is not interested to get pregnant, then oral contraceptives are administered,” says the expert. “On the other hand, if she wants to conceive in the near future, then metformin can be used for treatment.”
Metformin is a wonder drug that is primarily used as an anti-diabetic, and also allows for normal ovulation, thereby regularising the menstrual cycle and facilitating fertility for those hopeful to conceive. As patients with PCOS are likely to have or develop diabetes, this drug has a two-pronged approach towards the problem. When common drugs do not help in conception, then other measures (like IVF and ovarian drilling) are resorted to.
Dr Huda advocates a healthy diet, free of artificial additives as the first step in alleviating this problem. Junk food is loaded with synthetic hormones, which only makes PCOS worse.
Our experts see scores of PCOS patients in Bahrain. Timely treatment and control allows for good health and a better quality of life.