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Polycystic ovarian syndrome (PCOS)

Polycystic ovarian syndrome (PCOS)

Also known as PCOS, Functional ovarian hyperandrogenism, Hyperandrogenic anovulation, Polycystic ovary disease, Ovarian hyperthecosis, Stein-Leventhal syndrome and Sclerocystic ovary syndrome

Overview

Polycystic ovary syndrome (PCOS) is a hormonal disorder in which ovaries produce large amount of male sex hormones or androgens which interfere with the development and release of the eggs. Some of these eggs develop into cysts, which are the little sacs filled with liquid, hence the name, polycystic ovary syndrome. However, some women suffering from PCOS do not develop cysts, while some women not having this disease might develop cysts due to some other conditions.

The exact PCOS causes are not known yet. However, it has been observed that most women with PCOS have insulin resistance. Another factor that can affect the occurrence of PCOS is obesity, as it can result in high levels of inflammation in the body, leading to higher levels of androgen. PCOS is also mostly thought to be hereditary, running through the genes, into different generations. 

Women suffering from this condition may experience irregular menstrual cycles, excess growth of facial hair, hair thinning, acne, and sleep disorder. PCOS can also increase the risk hypertension, high cholesterol, diabetes, heart diseases, and endometrial cancer.

The symptoms of PCOS are manageable under proper medical guidance. Medications that regulate the menstrual cycle can help to ovulate, reduce hair growth and also help to manage other PCOS symptoms. Along with the help of a nutritious diet, a healthy lifestyle, and regular exercising, one can maintain healthy blood glucose levels and a healthy weight. These go a long way in the management of PCOS.

Key Facts

Usually seen in
  • Women between 20 to 30 years of age
Gender affected
  • Women
Body part(s) involved
  • Ovaries
Prevalence
  • Worldwide: 3.4% (2016)
  • India: 20% (2019)
Mimicking Conditions
  • Hyperprolactinaemia
  • Thyroid disorder
  • Endocrine disorders
  • Ovarian cancer
  • Adrenal hyperplasia
Necessary health tests/imaging
Treatment
Specialists to consult
  • Gynecologist
  • Endocrinologist
  • Reproductive endocrinologist

Symptoms Of Polycystic Ovarian Syndrome (PCOS)


The symptoms of PCOS vary among women as per their age. While younger women experience irregular, light, or missed menstrual periods along with mood swings; older women suffer from metabolic disorders such as weight gain and insulin resistance. The severity of the symptoms also varies as per one’s health.

Some of the common signs and symptoms of polycystic ovarian syndrome (PCOS) include the following:


1. Hair growth 

Most women affected with PCOS experience excessive hair growth on their face and body due to excess male hormone androgen. The issue of excess hair growth, known as hirsutism, can occur on their face, belly, back, and chest.


2. Acne

The presence of increased androgen levels also result in oil breakouts which in turn can cause oily skin and acne on the face and the upper body.


3. Skin darkening

Women with PCOS may also experience a condition called acanthosis nigricans. It is characterized by patches of thick, dark and velvety skin, especially in the skin folds and creases like neck, under the breast, and in the groin area due to insulin resistance.


4. Weight gain

One of the most evident symptoms of PCOS is sudden weight gain. Insulin resistance, which occurs due to PCOS, increases the levels of male hormones called androgens. High androgen leads to weight gain. 


5. Headache

Hormonal imbalances may also cause headaches and a feeling of heaviness in the head. Although, it is difficult to differentiate if a headache is caused due to PCOS.


6. Irregular menstrual cycle

Women with PCOS ovulate only occasionally, hence their uterine lining does not shed every month, causing irregular or missed menstrual periods. Because of lack of ovulation, polycystic ovary syndrome is one of the most common causes of infertility in women.


7. Sleeping disorders

Women with PCOS may also experience sleeping disorders such as feeling sleepy throughout the day, finding it difficult to fall asleep at night, or waking up frequently in the middle of the night due to disturbed sleep.


8. Mood swings

Due to hormonal imbalances, women suffering from PCOS tend to experience sudden mood changes and feel low. This could include sudden episodes of feeling irritated or depressed.


9. Fatigue

PCOS can also result in low levels of energy and a feeling of tiredness in women. This can majorly be experienced at night with pain in the calves and arms.


10. Pelvic pain

It is a less common symptom of PCOS which is attributed to the presence of cysts in ovaries. It usually causes a dull, sharp pain in the lower abdominal area which often comes and goes.


11. Infertility

Lack of ovulation from a long time can cause difficulty in getting pregnant and thus, infertility. 

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Causes Of Polycystic Ovarian Syndrome (PCOS)


The exact causes of PCOS are not known yet. However, hormonal imbalances are considered the most potential cause of this medical condition. Following are some of the probable PCOS causes that have been proposed as the major factors resulting in the occurrence of PCOS in women after their puberty.


1. Hormonal imbalance

Hormonal imbalance is considered as one of the most probable causes of PCOS. Women suffering from the following hormonal imbalances may experience PCOS during their reproductive age.

  1. Increased prolactin levels: Prolactin is the hormone that stimulates the production of milk in the breast glands. Increased prolactin levels may cause PCOS.

  2. Increased testosterone levels: Testosterone is a male hormone that is usually present in small quantities in women. Higher levels of testosterone in women may result in PCOS.

  3. Increased luteinizing hormone (LH) levels: Luteinizing hormones are meant for stimulation of ovulation; their presence in increased amounts may cause heavy bleeding and irregular menstrual periods.

  4. Decreased sex hormone-binding globulin (SHBG) levels: SHBG is a protein that binds testosterone in blood to reduce its effect. The presence of SHBG in decreased amounts may result in an increased concentration of testosterone in women.


2. Genes

It is believed that PCOS may pass from one generation to another because this condition has been observed among women with a family history of the disease. Researchers have not yet identified the exact genes which causes PCOS. However, the role of genes is considered one of its potential causes.


3. Inflammation

Inflammation is a normal phenomenon of the body’s immune system to fight infections by producing white blood cells. It has been seen that women suffering from PCOS have low grade inflammation in their bodies, causing polycystic ovaries to produce excessive amounts of the male hormone. However, the link between inflammation and PCOS has not been established concretely yet.

Risk Factors For Polycystic Ovarian Syndrome (PCOS)


Several factors can increase your risk of having PCOS. Some of the notable factors which accelerate your risk quotient towards the medical condition are as follows: 


1. Family history of PCOS

You may have a higher risk of getting PCOS if your sister, mother, or grandmother had it. A woman is most likely to have PCOS if her mother or sister suffers from the same. However, the severity of this medical condition may vary on an individual level.


2. High stress levels

Psychological stress is another factor that exposes women to the risk of developing PCOS. It is often observed that women suffering from PCOS also experience depression, anxiety, and frequent mood swings.


3. Higher insulin levels

An increased amount of insulin in the body also puts women at a higher risk of suffering from PCOS. This is because higher insulin levels may stimulate increased production of androgen in the body.


4. Obesity

It is observed that women who are obese or are overweight are more likely to suffer from PCOS. This happens because obesity can cause imbalance in hormonal levels. It has been seen that the risk of suffering from PCOS complications is low if you manage your weight.


5. Use of birth control pills

The use of contraceptive pills also puts women at an increased risk of getting bilateral polycystic ovaries due to altered hormonal activities in the body. It is a condition that involves infrequent, irregular, or extended menstrual cycles. Women who may not have any problems might experience some PCOS symptoms after discontinuing the contraceptive pill.


6. Endocrine disrupting chemicals

PCOS may be related to or worsened by exposure to endocrine disrupting chemicals such as bisphenol A (BPA) and certain phthalates.

Diagnosis Of Polycystic Ovarian Syndrome (PCOS)


Polycystic ovary syndrome is one of the common causes of infertility and pelvic pain in women. It can also trigger diabetes if left untreated. If you are experiencing specific symptoms such as irregular or missed periods, frequent mood changes, or abnormal hair growth on your face or upper body, then consult a doctor to ensure whether or not you are suffering from PCOS. 

Your doctor may ask you to get the Polycystic ovarian disease panel done, which includes the following tests to ascertain the presence of the medical condition.

  1. Fasting glucose level: In this test, a blood sample is collected after overnight fasting. A test result of less than 100 mg/dL is considered normal whereas, results ranging between 100 and 125 mg/dL indicate that the individual is prediabetic, and the presence of 126 mg/dL or more shows that the person has diabetes. Women are prone to high glucose levels if they suffer from PCOS.

  1. Insulin fasting: This test measures the level of insulin in the body and thus, diagnoses if the individual is insulin resistant or not. This test also requires overnight fasting before sample collection. A typical insulin level ranges between 2.6 - 24.9 mcIU/mL. Insulin resistance is common in women with PCOS.

  1. Luteinising hormone (LH): This test measures the amount of the luteinizing hormone in the blood to check the normalcy of the woman’s menstrual cycle. The amount of luteinizing hormone increases in the body with ovulation. Higher levels may indicate PCOS.

  1. Testosterone total: This test helps your doctor know the testosterone level in your blood, which is the primary sex hormone present in males. High levels of testosterone may indicate the presence of PCOS.

  1. Thyroid stimulating hormone (TSH): This blood test measures the thyroid-stimulating hormone (TSH) in the blood. PCOS is associated with a high incidence of hypothyroidism or low thyroid level. 

  1. Follicle stimulating hormone (FSH): This test measures the level of the FSH in your blood which plays a significant role in the control of menstruation and growth of eggs in women. If you have PCOS, then your FSH level may be lower than normal.


Other tests

  1. Gynecologic ultrasonography: This imaging test specifically looks for small ovarian follicles. According to the Rotterdam criteria, which are widely used for diagnosis, 12 or more small follicles should be seen in an ovary on ultrasound examination. More recent research suggests that there should be at least 25 follicles in an ovary to designate it as having polycystic ovarian morphology (PCOM) in women aged 18–35 years. 

  2. Laparoscopic examination: This may reveal a thickened, smooth, pearl-white outer surface of the ovary. This would usually be an incidental finding if laparoscopy were performed for some other reason, as it would not be routine to examine the ovaries in this way to confirm a diagnosis of PCOS.

Celebs affected

Sonam Kapoor
National Award Winning Bollywood actress Sonam Kapoor shared the story of her fight against PCOS. She shared how she decided to become fit, how she changed her diet, gave up sugar, and practiced yoga and meditation to manage her condition.
Sara Ali Khan
In a chat show in 2018, the popular Bollywood Actress, Sara Ali Khan, shared her story about PCOS with all her fans. She told how she gave up junk food, incorporated a healthy diet, and followed a disciplined lifestyle, added sports and workouts to her routine to manage her condition.
Victoria Beckham
The former Spice Girl, Victoria Beckham, has always been open about her diagnosis of PCOS and her irregular menstrual cycles. The mother of 4 kids also publicly talked about how PCOS can be easily managed with a nutritious diet, healthy lifestyle, and regular exercising.

Prevention Of Polycystic Ovarian Syndrome (PCOS)


Following are a few tips and tricks which can help you prevent and manage PCOS.


1. Make healthy changes to your diet

A nutritious and healthy diet helps you manage PCOS symptoms and complications. The right diet changes help you regularize your menstrual cycle as you keep away abrupt mood changes by helping you maintain your hormonal levels. Following diet changes can help you with the PCOS issues. 

  • Add anti-inflammatory foods: To keep a check on the inflammation in your body, you should increase the intake of anti-inflammatory foods such as tomatoes, leafy greens, olive oil, and tree nuts in your diet.

  • Increase your iron intake: Some women experience heavy bleeding while battling PCOS, resulting in a lack of iron in the body, causing anemia. Thus, you must up your iron intake with iron-rich food like eggs, spinach, beans, seafood, peas, and dried fruits in your diet.

  • Balance carbohydrates and proteins: Right amounts of carbohydrates and proteins help you stimulate your insulin production. To manage PCOS symptoms, you must balance low carbs with high protein intake to optimize your energy and hormone levels.

  • Add whole foods: Whole foods are unprocessed and free from added sugars and preservatives. You must add whole foods like fruits, nuts, legumes, and green vegetables to your diet to maintain your hormone and sugar levels.

  • Increase fiber intake: Fiber-rich foods help you with digestion and keep a check on your metabolism. To avoid PCOS symptoms, you must include fiber-rich foods like nuts, bananas, curd, broccoli, sprouts, and avocados.

  • Reduce caffeine consumption: Caffeine affects the hormonal activities in your body. You can substitute your caffeine intake with herbal tea, green tea, or lemon-ginger water.

2. Maintain a healthy weight

The right body mass index (BMI) helps you regulate your insulin levels and menstrual cycle. Therefore, you must aim at maintaining a healthy weight to get some relief from the PCOS symptoms. However, you must note that you should not work out too much also as the same can hamper your hormonal functions. You can try some gentle exercises such as pilates, yoga, light aerobics, and swimming.


3. Have at least 8 hours of sleep

Your sleep routine significantly affects your stress and energy levels. It also affects your hormones. You must try to get 8-9 hours of sleep every day. Setting a routine for your sleep can be beneficial. You may go to bed light on your stomach to help with a sound sleep.


4. Avoid stress

Stress is not good for your health, especially if you are suffering from polycystic ovarian disease. Stress adversely affects your hormonal balance and state of mind. To avoid stress, you can practice meditation, yoga, or go for a walk. You can also keep your stress levels low by taking sound sleep and cutting down your coffee consumption. Another way of navigating yourself from stress includes becoming a part of social support groups.

Check out our range of stress management products.

Specialist To Visit


Mild PCOS symptoms can be treated with the help of lifestyle changes. However, if you are experiencing severe symptoms or even mild symptoms of polycystic ovaries from a prolonged period, you must consult a doctor. Specialists who can help you with PCOS symptoms and issues include:

  1. Gynecologist

  2. Endocrinologist


Here is a list of types of gynecologist you can consult.

Treatment Of Polycystic Ovarian Syndrome (PCOS)


PCOS treatment depends on various factors such as your symptoms, medical family history, other health conditions, and whether you want to get pregnant or not. PCOS can not be cured but can be treated with the help of medications and lifestyle changes.


1. Weight control and healthy diet

Before the treatment using hormonal birth control, doctors advise changes in diet and lifestyle to improve overall health. Dietary changes aid in maintaining healthy glucose levels and a healthy weight, which in turn helps regulate menstruation.


2. Medications to regulate ovulation

Pharmacological treatments are reserved for derangements such as anovulation, hirsutism, and menstrual irregularities. First-line medical therapy usually consists of an oral contraceptive to induce regular menses.

If symptoms such as hirsutism are not sufficiently alleviated, an androgen-blocking agent may be added. The first-line treatment for ovulation induction when fertility is desired are letrozole or clomiphene

Medications used in the management of symptoms of PCOS include the following:

3. Ovarian drilling

It is a surgical process that stimulates ovulation by removing ovarian tissues that produce the male hormone androgen in females. This surgery is recommended for women who do not ovulate even after weight reduction and trying fertility treatments. 


4. Supplements

Certain supplements such as inositol are often prescribed to help improve ovarian function and regulate periods, which makes it easy to conceive. Inositol is a vitamin-like substance found in citrus fruits, beans, brown rice, and wheat bran. Omega 3 supplements are also recommended to reduce the risk of inflammatory diseases and depression. Chromium supplements are prescribed to help reduce blood sugar levels and increase insulin sensitivity. 

Quit smoking and alcohol to keep your hormone levels stable
Consumption of tobacco or nicotine adversely affects your endocrine system. Thus, you must quit or refrain from smoking and consuming alcohol to keep your insulin and hormone levels undisturbed. Women can double their chances of conceiving each month if they quit smoking. Check out our smoking cessation products.

Home-care For Polycystic Ovarian Syndrome (PCOS)


PCOS is a complex health condition that requires immediate attention and complete care. It is possible to take care of your loved one suffering from PCOS at home with the help of the following do’s and don’ts.

Do’s

  • Exercise at least thrice a week to keep a check on your weight.

  • Sleep well. Try to get around 8-10 hours of sleep and go to bed early every day.

  • Enrich your diet with fruits, leafy vegetables, grains, iron-rich foods, fiber, and anti-inflammatory foods like cucumber and curd.

  • Mediate for at least 20 minutes to keep your stress levels low.

  • Include antioxidants like nuts and avocados in your diet.

  • Increase the intake of low-fat dairy products.

Don’ts 

  • Do not smoke.

  • Do not consume alcohol.

  • Avoid consuming processed foods.

  • Reduce your consumption of carbohydrates.

  • Avoid stress.

Complications Of Polycystic Ovarian Syndrome (PCOS)


Unattended PCOS can lead to serious medical conditions and complications. These include:

1. Infertility: It is a medical condition of the reproductive system that affects the chances of a woman getting pregnant.

2. Miscarriage: It refers to a sudden loss of a woman’s pregnancy before the 20th week. It can cause both physical and emotional distress.

3. Premature childbirth: It refers to childbirth that happens before the 37th week of pregnancy. It can result in the birth of a child with immature vital organs like lungs, heart, etc.

4. Type 2 diabetes: It is a chronic medical condition under which the body either does not produce insulin at all or becomes insulin resistant.

5. Dyslipidemia or disorders of lipid metabolism: Dyslipidemia in women with PCOS may be common in women who are insulin resistant. 

6. Heart diseases: Common heart diseases include high blood pressure, heart failure, coronary artery disease, heart valve disease, and arrhythmia.

7. Depression and anxiety: These are common mental health conditions in which the individual generally experiences loss of joy.

8. Endometrial cancer: It is a type of cancer that affects the lining of the uterus (womb) in females.

9. Abnormal uterine bleeding: It refers to irregular and heavy bleeding between and/or during menstrual periods.

10. Stroke: PCOS is associated with significantly higher risk for stroke which is a condition in which the blood supply to the brain is disrupted. 

11. Sleep apnea: Patients with PCOS are at higher risk to develop sleep apnea. This condition is characterized by pauses in breathing while sleeping that last for a few seconds and can occur multiple times throughout the night, depending on the severity of the conditio.

12. Non-alcoholic fatty liver disease: It can be seen in women with PCOS,  particularly if they are obese.

Alternative Therapies For Polycystic Ovarian Syndrome (PCOS)


Home remedies for PCOS

Following are some of the home remedies which you can try for treating PCOS.

  1. Fenugreek (Methi): Fenugreek can help reduce the cyst size and regulate the menstrual cycles in females. You can have fenugreek by boiling it in water and then straining its grains. You can also add methi leaves to your vegetables or parathas.

  2. Cinnamon (Dalchini): Cinnamon is a known ingredient for regulating menstrual irregularities. You can have cinnamon powder with a spoon of honey. You can also have it with lukewarm water.

  3. Flax seeds (Alsi): These are small seeds that are high in fiber, protein, and omega 3 fatty acids. Flax seeds consumption helps in the reduction of testosterone levels in the body.

  4. Cumin seeds (Jeera): Jeera is an Indian spice that is an excellent antioxidant. It also helps manage the blood glucose levels in the body.

  5. Green tea: It is full of antioxidants, green tea helps in relaxing the hormone levels in the body. It is known to be effective for PCOS symptoms.

  6. Apple cider vinegar: It helps you manage PCOS symptoms by regulating the insulin levels in the body. You can mix one teaspoon of apple cider vinegar in lukewarm water and have it empty stomach. It also helps in losing and controlling weight.


Yoga for PCOS

Symptoms of bilateral polycystic ovaries can also be treated with the help of the following yoga asanas.

  1. ​​Garland pose, also known as malasana, helps strengthen the pelvic and abdominal muscles. 

  2. Bridge pose, also called setu bandhasana, helps in PCOS by reducing stress levels and anxiety.

  3. Bow pose, popularly known as dhanurasana, helps relieve pelvic pain and menstrual discomfort by stimulating normal menstrual flow.

  4. Cat-Cow pose also known as the chakravakasana, helps relieve muscle pain.

Eat fermented foods to up the count of good bacteria
If you are suffering from polycystic ovaries, you must eat fermented foods to accelerate the number of good bacteria in your body. According to research, women with PCOS have a lesser number of healthy gut bacteria. You can consume probiotics to speed up the production of good bacteria and positively affect your metabolism, hormones, and weight. Here are 7 more reasons to add prebiotics to your diet.

Living With Polycystic Ovarian Syndrome (PCOS)


Living with PCOS is not easy. The abrupt mood swings, fatigue, and physiological distress further add to the agony caused by hormonal and menstrual disturbances. However, its effects can be managed and reduced with simple lifestyle changes if you are experiencing mild PCOS symptoms. It includes: 

  1. Eat a filling breakfast: Breakfast is the first meal of the day, and it must be a good one so that you can keep yourself energized the entire day.

  2. Substitute cups of coffee with green tea: Today, green tea is available in a wide array of flavors to meet the different taste preferences of different individuals. Choose your favorite flavor and start substituting your high caffeine consumption with it.

  3. Supplement your food with curd, yogurt, and probiotics: These dairy products are rich in fiber, which ease your digestion process and enhance the number of good bacteria in your gut.

  4. Go for a morning walk: You can begin by walking for 15 minutes and then gradually translating it into 30 minutes or in an hour. If a morning walk is not possible, try going for short walks after meals. Alternatively, you can also start running on a treadmill.

  5. Get a hobby: Hobbies are one of the finest and most effective ways of keeping yourself happy and in a good mood. For this, you can sing, dance, or join a sport of your choice. 

  6. Join a support group: This is where you can meet others suffering from the same condition. Sharing your experiences with them will provide emotional support. 


If you have been suffering from polycystic ovaries for a long time and have not experienced any improvement in the condition, it would be prudent to consult a doctor and seek professional advice to get some relief from the physical and emotional discomfort.

Long term PCOS affects the psychological health of women, too. It increases the risk of depression, anxiety, bipolar disorder, and obsessive-compulsive disorder. It is, therefore, essential to follow a personalized mental healthcare program that will help women deal with their psychological issues and lead a healthy life. 

They could consult a psychiatrist who may prescribe antidepressants or anti-anxiety medications to control their anxiety symptoms. Or, they could try alternate therapies such as acupuncture, yoga, mindfulness techniques, guided relaxation techniques, and breathing exercises that help control the mind and reduce symptoms of anxiety and depression.  

Frequently Asked Questions

References

  1. StatPearls [internet]. [Internet]. National Center for Biotechnology Information. U.S. National Library of Medicine; [cited 2022Jan29].External Link
  2. NHS choices. NHS; [cited 2022Jan29].External Link
  3. Polycystic ovary syndrome (PCOS) [Internet]. Johns Hopkins Medicine. [cited 2022Jan29].External Link
  4. Richard Scott Lucidi MD. Polycystic ovarian syndrome [Internet]. Practice Essentials, Background, Etiology. Medscape; 2022 [cited 2022Jan29].External Link
  5. PCOS symptoms and treatment: Why are some symptoms more severe? [Internet]. Medical News Today. MediLexicon International; [cited 2022Jan29].External Link
  6. TSH (thyroid-stimulating hormone) test: Medlineplus medical test [Internet]. MedlinePlus. U.S. National Library of Medicine; 2020 [cited 2022Jan29].External Link
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