What is PCOS?: Meaning, Symptoms, Causes and Treatment

Polycystic Ovarian Syndrome, or PCOS, is a hormonal disorder caused by women's ovaries (organs that produce and store eggs) when they develop more male hormones (androgen) than normal. This condition causes small cysts (fluid-filled sacs) to grow on the ovaries. Women with this condition have irregular periods, making it difficult for them to conceive a child.

In most cases, a female will start seeing the symptoms around the time of her first period. However, the following signs and symptoms of PCOS may also be noted:

1. Irregular menstruation (Oligomenorrhea)
2. Skipped menstruation or no menstruation (Amenorrhea)
3. Heavy menstrual bleeding (Menorrhagia)
4. Excessive unwanted hair (face, body - including on back, belly, and chest)
5. Acne (face, chest, and upper back)
6. Weight gain
7. Hair loss
8. Darkening of the skin colour
9. Headache
10. Infertility

The causes of PCOS are not precisely clear, but it is believed to be a combination of the below-mentioned factors:

1. Excess insulin production: High insulin levels in the body can increase androgen production, which ultimately affects the ovulation process.
2. Excess androgen hormone production: The ovaries generate unusually high levels of androgen hormones, which can cause acne and hair growth on the face and body (hirsutism).
3. Chronic low-grade inflammation: Women with PCOS have low-grade inflammation because of the increased prevalence of insulin resistance and related disorders. Elevated serum levels of CAM (cellular adhesion molecules) reflect low-grade inflammation. 
4. Heredity: Studies have shown that women with PCOS have a genetic link that may be traced back to their ancestors.

The following are the probable risk factors for PCOS that might put a female at a higher chance of developing the disease: 

1. Obesity
2. Type 1 Diabetes
3. Gestational Diabetes
4. Family history
5. Sedentary Lifestyle

There might not be a proven way to prevent PCOS. However, some of the below-mentioned measures can help reduce the risk of PCOS.

1. Regular exercise
2. Weight loss
3. Eating nutritious food
4. Doing yoga
5. Get enough sleep
6. Maintain good hygiene practice

There is no definitive test to diagnose PCOS. Depending on symptoms like irregular periods, unwanted male-pattern hair growth, acne, or thinning of scalp hair, the doctor will ask about:

1. Medical history
2. Take your weight and blood pressure
3. Eating and drinking habits
4. Consumption of any prescription or over-the-counter medications, including vitamins and supplements

However, in a few cases, the gynaecologist may suggest the following additional tests to confirm the presence of PCOD or PCOS:

1. Physical examination of the reproductive organs for lumps, anomalies, or any growth.
2. Blood tests measure hormonal levels, glucose tolerance, fasting cholesterol and triglyceride levels.
3. An ultrasound imaging exam assesses the size of the ovaries, uterine lining, and cysts in the ovaries.

If a female has been diagnosed with PCOS, the gynaecologist may also suggest additional tests to check for complications. These tests include:

1. Anxiety and depression screening.
2. Obstructive sleep apnea (OSA) testing.

How to prepare for the doctor's consultation?

1. List down symptoms including any that may seem unrelated to the condition.
2. List down the relevant events that may be related to the condition.
3. The patient must tell the doctor about the medications and supplements that she takes.
4. Provide information about the menstrual cycle including how often they occur, how long they last and how heavy they are.
5. The following questions should be asked the doctor:
   1. What tests do you recommend?
   2. How does PCOS affect my chance of getting pregnant?
   3. Are there any medicines that might help improve my symptoms or chance of getting pregnant?
   4. What lifestyle changes can improve symptoms?
   5. How will PCOS affect my health in the long term?
   6. I have other medical conditions. How can I best manage them together?

Treatment of PCOS depends on several factors, including age, the severity of the symptoms and overall health. Considering these factors, the gynaecologist may suggest one of the following methods for treating PCOS:

PCOS treatment by lifestyle changes

Treatment for PCOS starts with changing the lifestyle of the woman. The doctor may recommend the following lifestyles changes:

1. Weight Loss
2. Eating healthy diet
3. Exercising

Losing 5 to 10% of the body weight can help regulate the menstrual cycle and improve PCOS symptoms. Weight loss also can improve cholesterol levels, lowers insulin and reduce the risks of heart diseases.

PCOS treatment by medications

Medication might be used to regulate the hormones and menstrual cycle. Some of the treatment modalities include:

1. Oral medications and injections to induce ovulation 
2. Fertility medications to treat infertility.
3. Diabetes medications to lower insulin resistance.
4. Medications to get rid of excessive hair growth.
5. Medications for acne and pigmentation skin treatments.

PCOS treatment with surgery

Depending on the intensity of the symptoms and the condition, a patient may need to undergo surgery to remove the cysts. Following are some surgical procedures to treat PCOS:

1. Ovarian Cyst Surgery: a surgical procedure done to remove cysts from the ovaries that cause discomfort or pain, that are suspected to be cancerous, and that are greater than two and a half inches in diameter.
2. Laparoscopic Ovarian Drilling: a surgical procedure done to stimulate ovulation in women with PCOS. This procedure involves puncturing the membranes surrounding the ovary with a laser beam or a surgical needle using minimally invasive laparoscopic procedures. 
3. Laparoscopic Ovarian Cystectomy: a minimally invasive procedure performed to remove cysts from ovaries. 

Untreated PCOS can lead to many more serious health conditions, and the disorder's symptoms can cause significant distress. The risks and complications of PCOS include:

1. Infertility
2. Gestational diabetes or pregnancy-induced high blood pressure
3. Miscarriage or premature birth
4. Type 2 diabetes or prediabetes
5. Metabolic Syndrome (cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol that increase your risk of cardiovascular disease)
6. Sleep apnea
7. Nonalcoholic steatohepatitis (severe liver inflammation caused by fat accumulation in the liver)
8. Depression, anxiety and eating disorders
9. Abnormal uterine bleeding
10. Cancer of the uterine lining (endometrial cancer)

When to see a doctor?

The patient can consult the doctor if she:

1. Is worried about her periods
2. Is having trouble getting pregnant
3. Is having signs of excess androgen
4. Is having new hair growth on her face and body, acne and male-pattern baldness

Diet plays a crucial role in maintaining the good health of an individual. Taking a healthy and balanced diet helps reduce the risk of developing PCOS. Below mentioned are some dietary habits that will help women with PCOS.

Foods to Avoid

Food items that contain refined carbohydrates cause inflammation and exacerbate insulin resistance. Food items that need to be avoided include:

1. White bread
2. Muffins
3. Breakfast pastries
4. Sugary desserts
5. Anything made with white flour

Foods to Eat

Fibre-rich food help in reducing insulin resistance by slowing down digestion and reducing the effect of sugar on the blood. Some of the food items that are rich in high fibres are:

1. Cruciferous vegetables, like broccoli, cauliflower, and Brussels sprouts
2. Greens, including red leaf lettuce and arugula
3. Green and red peppers
4. Beans and lentils
5. Almonds
6. Berries
7. Sweet potatoes
8. Winter squash

Food items that also help reduce inflammation are also beneficial. These food include:

1. Tomatoes
2. Kale
3. Spinach
4. Olive oil
5. Fatty fish high in omega-3 fatty acids, like salmon and sardines