polycystic ovarian syndrome
Polycystic Ovarian Syndrome or PCOS affects 1 in 10 US women.
In the UK 1 in 5 will have the condition.
Currently, there are no available stats for South Africa.
COMPARE THIS TO OTHER DISEASES:
Breast cancer will affect 1 in 8 women.
Cervical cancer will affect 1 in 41 South African women.
Even though PCOS is not directly lethal, it is common and can have a significant impact on the lives of women in general.
IT IS THE LEADING CAUSE OF INFERTILITY IN THE WESTERN WORLD
What is PCOS?
This is a medical condition that involves a dysregulation in the hormonal system of the body. It results in an imbalance of the pituitary hormones called FSH(follicle stimulating hormone) and LH(luteinizing hormone).The spinoff is no ovulation. NO EGG . NO PREGNANCY.
Other hormonal problems that occur at the same time are high testosterone levels , high insulin levels and high estrogen levels relative to progesterone.
What are the hallmarks?
Most commonly , irregular periods
Cycles longer than 35 days…
Less than 8 periods a year…
No period for 4 months or longer…
Very heavy or very light periods when they do happen
Features of high testosterone(androgen) levels
Too much facial and body hair… hair removal attempts often don’t work too well.
Acne…..even adult acne
Thinning hair ….in other words …male pattern baldness
Features of high insulin levels
Difficulty in keeping weight off or loosing weight….obesity can be a problem
Stubborn weight around your middle….
Discoloured patches on your skin called acanthosis…
Making the diagnosis
Your doctor will look for all the signs and symptoms already described. Other aspects needed to make the diagnosis are:
Blood tests –
- a ratio of LH:FSH hormone of at least 3:1
- high testosterone levels
- high insulin levels
- evidence on ultrasound of multiple small cysts on the ovary(not all women will have this – as much as 25% of women will have normal ovaries)
We don’t really know what causes it but we do know that there are some links….
It runs in families: Daughters of sufferers are likely to have it too. Genetic research is ongoing. Soon we may be able to identify a PCOS gene.
It is related to inflammation: Research has shown that women with PCOS have continuous low-grade inflammation . Inflammation is a protective process that is triggered when we expose ourselves to certain foods or environmental toxins. It is a way for our immune systems to heal our bodies. Unfortunately for us, too much of this inflammation can also harm our bodies. In the case of PCOS, inflammation stimulates the ovaries to make androgens. More androgens mean less ovulation.
It is related to high carbohydrate diets: Insulin is a hormone in the body that allows our cells to use glucose (sugar)as an energy source. With PCOS the body is resistant to the effects of insulin so levels go higher to compensate. This higher level further pushes up androgen levels and interferes with the ovaries ability to produce eggs or ovulate. High insulin also promotes more inflammation.
Not only do PCOS sufferers find it difficult to fall pregnant, the risk of miscarriage is also higher if hormone levels are not properly controlled.
Living with PCOS also puts you at risk of other complications , especially when obesity is also present:
- Type 2 Diabetes
- High blood pressure
- High Cholesterol
- Metabolic Syndrome (a series of medical conditions that increase risk of hearty disease)
- Sleep apnea
- Depression and anxiety
- Abnormal uterine bleeding
- Pregnancy induced Diabetes
- Cancer of the uterine lining(from the continuous high levels of estrogen)
It all sounds very gloomy right?
Fortunately there are many ways that all the problems and complications can be tackled and even avoided….
Remember you have the power within you to change things…
How?
Get the right kind of help…
Get informed…..
Find out what the options are…..
Be an active participant in the decision-making regarding your treatment…
Treatments
Before you get to the medical therapies always modify your lifestyle in a way that works!
Add medication if necessary.
Exercise works! Keep moving. Regular and consistent exercise helps to control weight, prevent insulin resistance, and will make you feel more energized to tackle everything else.
Watch what you eat! It Works! Low fat , high carbohydrate diets are bad news for people with PCOS. You want to focus on low carbohydrates (low GI). Foods high in fiber will promote a more stable insulin level.
Cut out sugars. Read labels. Be careful of hidden sugars.
Eat foods as close to their natural state as possible. If you don’t recognize the original food group it came from, don’t eat it. Avoid preservatives where you can.
There are many foods that are anti inflammatory. Include them in your daily meals and snacks.
Remember, this is not a temporary diet. It is a lifestyle modification.
Keeping your weight in check works! Use smaller plates, reduce portion sizes and resist the urge for “seconds”. I have seen first hand how my patients reverse their PCOS just by loosing kilograms.
Medication
The choice of medication depends on the need to be pregnant or not.
If pregnancy is not needed immediately, then a combined oral contraceptive pill that contains both estrogen and progesterone is used. This will regulate periods. A patch or even a vaginal ring that has both these hormones can be used as an alternative.
After at least six months of regular use, body hair will reduce and acne will improve.
In some cases, where a combination of hormones is not indicated, progesterone on its own, may be prescribed for 10 to 14 days of every cycle.
Metformin (Glucophage) can also be used when insulin levels are high. This allows for easier weight loss when used in conjunction with diet changes and
exercise. It helps to improve insulin resistance and drop insulin levels.
When pregnancy is required, medication to trigger ovulation is recommended. Commonly used medication is clomiphene citrate. Letrozole (Femara) is an alternative.
In patients who don’t respond, hormone injections consisting of FSH and LH are used. This usually happens in a unit specializing in infertility. Regular ultrasounds to monitor progress is advised in these cases.
PCOS is a very complicated condition that usually involves a team approach.
You..
Your doctors…usually an endocrinologist and a gynaecologist
Your support system….family and friends… fellow sufferers and support groups
REMEMBER YOU CAN ACHIEVE SUCCESS
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