The most common endocrine disorder in a woman of reproductive age, it affects up to 10% of women of reproductive age.
It is a set of symptoms related to an imbalance of hormones that can affect women and girls of reproductive age. Defined and diagnosed by a combination of signs and symptoms of androgen excess/ovarian dysfunction/polycystic ovarian morphology on ultrasound. In PCOS condition, woman has an imbalance of a female sex hormones. It may lead to menstrual cycle changes/cysts in the ovaries/ trouble getting pregnant /and other health factors/ issues.
According to Ayurveda, PCOS is closely related to artava- kshaya vyadhi. And according to types, it is of two types : one is kapha pradhana and other pitta vataja.
Polycystic Ovarian Syndrome: Symptoms
- Symptoms of PCOS include changes in period(menstrual cycle).
- Irregular periods, that sometimes maybe light/heavy.
- No period after had one/normal ones during puberty ( secondary amenorrhea).
- PCOS can cause to develop male-like characteristics, virilization. It includes symptoms like-
- Body hair growing on the chest/ belly/ face/ around the nipples.
- Decreased breast size
- Enlargement of the clitoris.
- Thinning of the hair on the head = male pattern baldness.
- Deeper voice/acne that gets worsen.
- Dark/ thick skin markings and creases around the armpits/groin/ neck/breasts.
- Dermatological Features - hirsutism/ oily skin/ balding/ skin discoloration/ acne.
- Menstrual Disorders - amenorrhea/ oligomenorrhea/ menorrhagia.
- Polycystic Ovaries - enlarged ovary/ excessive follicles.
- Metabolic - obesity/metabolic syndrome/ Insulin resistance, type 2 diabetes.
When To See Your Doctor For PCOS Disease?
When irregular/heavy/ missed periods occur due to missed ovulation and with the above-mentioned signs and symptoms appear, then you should consult doctor for proper diagnosis and treatment.
Polycystic Ovarian Syndrome: Causes
Generally, PCOS is linked to changes in the level of certain hormones: estrogen and progesterone, female hormones and small amount of androgens in women.
The reason behind PCOS syndrome is not completely understood. Changes make it harder for a woman’s ovaries to release fully grown (=mature) eggs/ovaries. Normally, one/ more eggs are released during a woman’s period, called ovulation. In PCOS/PCOS, mature eggs are not released from the ovaries, instead, they form small-sized cysts in the ovary.
It can lead to infertility. Other symptoms that appear are due to the hormone imbalances occur. Some doctors believe that high levels of male hormones prevent the ovaries from producing hormones and disturb the ovarian functions. Genes/insulin resistance/ inflammation also linked to excess androgen production.
Polycystic Ovarian Syndrome: Diagnosis
Diagnosis is based upon the presence of any two of the following three criteria considered basically :
[American society for reproductive medicine (ASRM)/or European society of human reproduction and embryology (ESHRE, 2003)].
1) Oligo and / anovulation
2) Hyperandrogenism (clinical/ biochemical)
3) Polycystic ovaries.
Lab Investigations: estrogen, LH, FSH, Blood sugar, lipid profile, vaginal ultrasound.
Ultrasonography: USG showing necklance appearance of ovaries. Ovary enlarged with multiple cysts.
Serum: high level of free estrogen in serum.
Polycystic Ovarian Syndrome: General Tips / Preventive Measures
- Maintain a healthy weight/normal BMI.
- Change your lifestyle = moderate exercise activities + suitable diet plan.
- Weight loss can reduce insulin and androgens levels and can restore ovulation.
- Exercise and YOGA regularly.
- Regular exercise patterns prevent insulin resistance and help to keep your weight in control.
- Limit your carbohydrate diets.
- Vigorous exercise- asanas/ pranayama.
What To Avoid?
- High calorie / carbohydrates/ fat rich diet.
- Bakery items/ junk foods.
- Avoid excessive sleeping.
- Pastries/ white bread/ fried foods.
- Sugary beverages = soda or energy drinks.
- Processed meats/ hot dogs/ sausages.
- Solid fats = margarine/lard
- Excessive red meat = steaks/ hamburgers/ pork.
What To Eat?
- Low-calorie diet.
- Low glycemic index food like - whole grains/ legumes/ nuts/ seeds/ fruits/ starchy vegetables/ unprocessed low carbohydrate foods.
- Berries/ leafy greens
- Extra virgin oil
- Natural/ unprocessed foods.
- Spinach/ dark/ leafy greens.
- Broccoli/ cauliflower.
- High fiber foods.
- Avocados/ coconuts.
- Dried beans/ other legumes.
- Walnuts/ almonds/ pistachios.
- Turmeric/ cinnamon.
Polycystic Ovarian Syndrome: Questions And Answers
Q.1) What physical signs will suggest PCOS ( Polycystic Ovarian Syndrome) ?
Ans.- On examination with women, the following findings suggest PCOS:
- Virilizing signs.
- Acanthosis nigricans.
- Hypertension
- Enlarged ovaries, etc.
Q.2) What are the other signs of PCOS?
Ans.- Other signs include infertility, oily skin, patches of thickened, velvety, darked skin called acanthosis nigricans, skin tags, obesity/weight gain.
Q.3) How does PCOS affect health?
Ans.- It can cause other problems including metabolic syndrome, high blood pressure, excess body fat around waist, abnormal cholesterol levels, can cause cardiovascular disease/ strokes/ diabetes, type-2 diabetes, endometrial hyperplasia, cancer risk factors, gestational diabetes, miscarriage/ premature birth, liver inflammation, sleep apnea, mental health issues( depression/anxiety/ eating disorders).
Q.4) Is PCOS syndrome a lifelong condition?
Ans.- The hormone imbalance of PCOS and the symptoms can be persist throughout life if not treated in a proper time. If signs and symptoms occur, then you should consult doctor immediately to make it more critical situation.
Q.5) What are the clinical features of PCOS?
Ans.- Clinical features include:-
- Patient complaints of increasing obesity ( abdominal- 50%), menstrual abnormalities (70%) in the form of oligomenorrhea, amenorrhea/ dysfunctional uterine bleeding/ infertility. Presence of hirsutism /acne are the important features considered (70%). Virilism is rare. Often characterized by acanthosis nigricans/ HAIR-AN syndrome.
Q.6) How serum levels give result in PCOS ?
Ans.- For better investigation of PCOS, Doctor suggest serum test. Serum values that suggest PCOS include:-
- Elevated LH levels/ LH:FSH > 2:1
- Raised level of estradiol and estrone.
- Hyperandrogenism
- Raised serum testosterone/ DHEA( dehydroepiandrosterone sulfate) marginally elevated.
- Raised fasting insulin levels.
Q.7) What causes androgen levels to raise in PCOS?
Ans.- Abnormal regulation of the androgen forming enzyme P450 C17 is thought to be the main cause for excess production of androgens from the ovaries and adrenals. The principal source of androgens are - ovary, adrenal, systemic metabolic alteration.
Q.8) How management of PCOS occur?
Ans.- Management of PCOS needs individualization of the patient. Present symptoms of patient is generally noted. Treatment is primarily targeted to correct the biochemical abnormalities on pcos/pcod. In obese patients, first line of treatment includes weight reduction, It improves the metabolic syndrome and reproductive function.
Q.9 ) Why insulin level increases in PCOS? What are its causes?
Ans.- Women having PCOS also have insulin resistance - a condition that leads to high glucose levels and leads to prediabetes / type 2 diabetes. The pancreas in our body produces insulin along with other functions. Typically insulin is secreted in response to increased blood levels of glucose, a small sugar molecule. Insulin allows cells in our body to take glucose for energy from carbohydrates. When someone has insulin resistance, the body does not respond to insulin as efficiently/ quickly which leads to high glucose levels in the blood and low energy. Therefore, Insulin level increases as the body begins to deal differently with sugar.
Q.10) What are the various treatment available in Ayurveda for PCOS?
Ans.- Principles of Treatment in Ayurveda is mainly depended on kapha pradhana/ pitta pradhana type. According to which, snehana, vamana, virechana, yoga basti; panchakarma procedures included. For Shamana, weight loss treatment, exercise and diet along with some classical and proprietary formulations is given to the patient.
References
1) Longmore, Wilkinson, Davidson, Foulkes, Mafi, Oxford Handbook of Clinical Medicine 8th Edition.
2) Ayurveda Prasuti Tantra evum Stree Roga, Prof.Premvati Tiwari 2nd edition.
3) Hiralal Konar, DC Dutta’s Textbook of Gynecology 7th Edition.
4) Charak Samhita Volume-2, by Acharya Vidyadhar Shukla and Prof. Ravi Dutt Tripathi.