Lubna Qasim
Today we are living in a period of modernization. The effect of modernization and technological advancement reflects in everyday life. Our lifestyle also has changed a lot. Food intake is becoming more concentrated on sugar, fast food and soft drinks and less on healthy & traditional fare. This unhealthy food habits and lack of exercise leads to many diseases in females like Polycystic Ovarian Syndrome. Polycystic Ovarian Syndrome (PCOS) is a complex, poorly understood, and underdiagnosed endocrine disorder in women. It is the major endocrine related disorder in women of reproductive age. Physical appearance, menstrual irregularity as well as infertility are the sole cause of mental distress affecting health-related quality of life. It is basically a complex condition which is characterized by elevated androgen levels, menstrual irregularities, and /or small cysts on one or both ovaries. The disorder can be morphological (polycystic ovaries) or predominantly biochemical (hyperandrogenemia). Hyperandrogenemia, a clinical hallmark of PCOS, can cause inhibition of follicular development, micro cysts in the ovaries, anovulation, and menstrual changes.
PCOS can be described as an oligogenic disorder in which the interaction of a number of genetic and environmental factors determine the heterogeneous, clinical, and biochemical phenotype. Although the genetic aetiology of PCOS remains unknown, a family history of PCOS is unclear. Nonetheless, the current literature suggests that the clustering of PCOS in families resembles and autosomal dominant pattern. It affects about 5-10 per cent of the female population who are in the age group of 12-45 years and produces symptoms in approximately 5 per cent to 10 per cent of women of reproductive age and is thought to be one of the leading causes of infertility.
Causes: The exact cause of PCOS is unknown; most experts think that several factors, including genetics play a major role: High level of androgens (Male sex hormone), high level of insulin, weakened immune system, hormonal problem, bad dietary choices, lifestyle environmental changes, inflammation, stress are some of the causes that can lead to PCOS. Obesity is a major risk factor for PCOS, and as such realistic and achievable weight loss can be sufficient to restore regular ovulation and improve fertility in obese women with this disorder.
Symptoms: The onset of symptoms is variable, with some women reporting them in parallel with the onset of menarche, while as others do not receive a diagnosis until they experience difficulty in conceiving. The most common symptoms include:
o Irregular menstruation is defined as a menstrual cycle that continuously falls outside the expected cycle length of 24-38 days. This may be accompanied by heavy bleeding when menstruation does as the uterine lining grows thicker if not shed regular.
o Excess hair growth on the body is referred to as hirsutism, caused by excess amount of androgens. Conversely, hair on the scalp may become thinner and fall out.
o Acne typically presenting as inflamed cysts around the jaw-line, cheeks, and chin. This results from an excess of testosterone which causes over activity of sebaceous glands.
o Weight gain affects up to 80 per cent of women with PCOS and tends to develop in abdominal area.
o Darkening of skin, particularly along neck, in the groin, and underneath breasts.
o Skin tags, which are small excess flaps of skin in the armpits or neck area.
There are links between PCOS and other health problems including: Diabetes, High blood Pressure, Unhealthy cholesterol, Sleep apnea, depression and anxiety, endometrial cancer.
The leading problem that PCOS can cause is the infertility or we can say the problems during pregnancy (for mother and the baby). Women with PCOS have higher rates of miscarriage, Gestational diabetes, Preeclampsia (high blood pressure after 20 weeks of pregnancy), cesarean section(c- section).
DIAGNOSIS: There is not a single test to diagnose PCOS. To investigate the PCOS and rule out causes and symptoms, the doctor collects the medical history and do physical investigation and different tests like: physical examination [to measure body mass index, blood pressure, waist size, excess hair on face, acne etc].
” Pelvic examination [to sign of extra male hormones example an enlarged clitoris, and to examine if ovaries are enlarged or swollen].
” Pelvic ultrasound [uses sound waves to examine ovaries for cysts and to check endometrium (lining of the uterus or womb)].
” Blood tests [to check androgen hormone levels and other hormones that can cause PCOS.
Management: Polycystic Ovary disease requires ‘control’ rather than ‘cure’ and the focus of treatment changes with the age of the women seeking treatment. Management and treatment approaches are directed also to address specific symptoms such as acne, excess hair growth, menstrual problems and infertility. To prevent long-term complications, the treatment can be individualized. Home treatment measures can help you manage the symptoms of polycystic ovary syndrome (PCOS) and live a healthy life. Because the primary cause of PCOS is unknown, treatment is directed at the symptoms. Weight reduction for obese patients with PCOS is beneficial in many ways. Weight loss helps to decrease androgen, luteinizing hormone (LH), and insulin levels. It also helps to regulate ovulation, thereby improving the potential for pregnancy. Laparoscopic ovarian drilling is an outpatient surgical intervention in which multiple perforations are created in the ovarian surface and stoma. This method destroys the androgen-producing tissues, which should lead to decrease androgen levels. There are certain medications also through which we can treat the PCOS and its symptoms like: Hormone birth control pills (make the menstrual cycle more regular and decreases the risk of endometrial cancer), Anti-androgen medicines (block the effect of androgens and help to reduce scalp hair loss, facial and body hair growth), Tablet Metformin (often used to treat type 2 diabetes and may help some women with PCOS symptoms.
Walking, swimming, yoga and exercise can also help to reduce the chances of PCOS. Eating good nutritious food, plenty of green leafy vegetables, steamed and boiled food and avoid sugar, cheese, oily and fried food can also help a women to reduce the symptoms of PCOS. Having PCOS does not mean the women can’t get pregnant. PCOS is one of the common, but treatable, causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation), but the women is prescribed by some of medications and by maintaining the good lifestyle can help her to decrease the risk of infertility.
Polycystic ovarian syndrome (PCOS) is one of the most important endocrine disorders that affects females in the reproductive age but if not diagnosed and managed at a right time may lead to serious complications including infertility.
(The writer a student of Nursing from Anantnag).