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Polycystic Ovary Syndrome (PCOS)

Written and reviewed by
DGO, MBBS, Diploma in Reproductive Medicine (Germany)
Gynaecologist, Delhi  •  38years experience
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Hello friends,

I am Dr. Shakuntla Shukla, senior consultant Gnaecologist at Apollo Cradle and Fortis La Femme, GK 2. I am the medical director of Aastha Medical Centre, Lajpat nagar. Today I will be talking about Polycystic ovary syndrome (PCOS), the most common hormonal disorder of women of reproductive age which is 15 to 45 years. Today is the era of PCOS, this is called thief of womanhood there is a lot of scare, a lot of confusion, a lot of dilemma among young girls about it. Doctor am I having PCOS? Do I have a cyst on my ovaries? There is a lot of confusion that PCOS does not get cured, it is a lifestyle disorder it ever remains. People do not conceive, they become infertile so a lot of queries and confusion among the young crowd so let us talk and clarify confusion about what is PCOS? PCOS is a hormonal imbalance. There are 2 important hormones in female body estrogen and progesterone and because of imbalance in these hormones polycystic ovary develops. Now, a little bit about the physiology of polycystic ovary. Girls ovary are bestowed with millions of eggs, these eggs they mature and one of them gets optimum size every month and gets released.

In PCOS because of imbalance in the hormones these eggs they do not mature and they do not reach the optimum size they remain halfway through and thus the ovary gets studded with these immature follicles and they become big, these big ovaries are called polycystic ovary. What happens to the woman of polycystic ovary? These ovaries are discovered on ultrasound and this clinical picture affects her heart, her fertility, her menstrual cycle and appearance. How do we suspect a girl whether she has a polycystic ovary or she is having a hormonal imbalance? These girls they look big, muscular, their voice is heavy like male voice, they have pimples marks on their face and crowd of pimples on their back, they have abnormal or excess hair growth on unwanted areas like the chest, face, chin and neck, they give history of hairfall, history of menstrual irregularities and fertility becomes an issue, they find difficult to conceive and at times they are infertile also.

With these multiple problems, these girls come to us with some degree of depression. This polycystic ovary syndrome is associated with some kind of health problems, most of these girls develop gestational diabetes we call it GDM or diabetes mellitus during pregnancy and 30 to 40% of these women develop diabetes mellitus in later life, they suffer from cardiovascular disorders, high blood pressure, dyslipidemia, the bad cholesterol in their body is high and thus they suffer from heart attack and stroke, they come with the gall bladder stones, GI issues and these women in the later life should be screened for body carcinoma uterus, endometrial cancer which is common again due to hormonal imbalance. What causes PCOS? It is said to have some kind of genetic predisposition. Mothers, daughters, sisters having PCOS so it goes in the family having genetic predisposition.

Second is environmental we see the typical example of girls they take education in villages, small cities and then they come to metros all the while during schooling they do lots of physical activities like cycling, go to school, do the hard work and when they come to metros for higher education, for preparing for competition or when they get a job in multinational companies their lifestyle totally changes, they eat lots of junk, sitting with the computer all the time, preparing for exams and in a lot of stress, lifestyle becomes sedentary so their periods start becoming irregular, they start putting on weight or becomes obese and they start having hairfall, acne, abnormal hair growth and their metabolic disorder begins so with metabolic disorder they become full-blown PCOS, this is the typical picture of PCO girl who comes to us in dy-to-day OPDs. How do we help them? Since this is a lifestyle disorder the treatment remains lifestyle modification, it is very simple to say but it is very difficult to follow.

There has to be a lifestyle modification in the form of strict diet schedule, judicious and healthy eating and second is some kind of physical activity in the form of a brisk walk in the morning or yoga or some kind of gyming, one has to follow these 2 things religiously to maintain the weight. The second part is the treatment of symptoms and prevention of complications. Symptoms should be treated if the girl is obese she needs to be put on anti-obesity drugs, if she is having cycle irregularities he need to be put on cycle regulators, for fertility issues she has to take fertility drugs and for acne and hirsutism she has to take anti-androgens, with the help of anti-androgens hair growth stops, gradually starts decreasing and finally it is stopped when the metabolism is corrected, for correction of metabolism some medicines are required they are either nutraceuticals or they are in the form of insulin sensitizers. The protocol of treatment remains 1st 3 months she follows some medications, insulin sensitizers, nutraceuticals, medicines for symptoms and after 3 months when the weight has come under control she just follows the lifestyle and no more drugs. So the mantra of treatment is healthy and judicious eating and some kind of physical activity is the treatment of polycystic ovary syndrome.

Thank you very much.

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