PCOS Awareness : Why it matters and why it's a crisis in disguise

  

Polycystic Ovarian Syndrome, aka, PCOS can successfully be categorised among the long list of problems ignored by our society even after being widely prevalent and ever-rising(22.5% by Rotterdam's criteria and 10.7% by Androgen Excess Society criteria) [1]. Today I try to delve into the issue and bring together research on PCOS. 

Although there is no universally accepted definition of PCOS, a widely accepted one is understood as PCOS being an abnormality in the signalling that happens between the hypothalamus and the pituitary which exist in the brain and how the communication with hormones such a Luteinizing hormone (LH) and Follicle Stimulation Hormone(FSH) communicate with the ovaries and facilitate ovulation with an LH surge mid-cycle. It is most commonly associated with the overproduction of androgens and insulin resistance[2]. 

Effects/Symptoms of PCOS

Another major issue with women who suffer from PCOS includes Androgen excess. Some clinical symptoms of Androgen excess (an excess of male-type hormones like Testosterone) include acne, hirsutism and hair loss/male pattern balding.  Other such effects include loss of scalp hair, oily skin and Acanthosis nigricans that causes a dark discolouration in body folds and creases. It typically affects the armpits, groin and neck.
Risk of heart disease, diabetes, stroke and Endometrial cancer are other complexities that come with PCOS. 

Diagnosis of PCOS :

The PCOS includes a wide spectrum of clinical symptoms and signs. Three different diagnostic classifications exist to define this condition :

A. NIH/NICHD Criteria: Published in 1990, this method requires the simultaneous presence of Oligomenorrhea(less than 6-9 menstrual cycles per year), clinical Hyperandrogenism(Androgen excess) and Polycystic Ovaries on UltraSound(12 Antral Follicles in one ovary or an ovarian volume > 10cm^3) [3].

B. Rotterdam Criteria: Proposed by an expert panel, in 2003, in a conference in Rotterdam, this criteria requires the presence of any two of three indicators of PCOS (Menstrual Irregularities, Androgen excess and Polycystic ovarian morphology detected by transvaginal morphology).

C. Androgen Excess Society: Finally, published in 2006, added new criteria requiring Hyperandrogenism and one other factor to diagnose PCOS.

Health Risks of PCOS : 

1. Impaired glucose tolerance and diabetes: PCOS women have multiple risk factors for diabetes including obesity, a family history of type-2 diabetes[4]. Insulin resistance combined with abdominal obesity is thought to account for the higher prevalence of obesity and type-2 diabetes in PCOS[5].

2. Cardiovascular diseases and Hypertension: Hypertension appears to be the main reason for the increased cardiovascular risk of women with PCOS. Several studies conclude that women with PCOS are at an increased risk of cardiovascular diseases.[6  7]

3. Breast Cancer: Obesity, Hyperandrogenism and infertility are features known to be associated with the development of breast cancer. Although, it seems there is a positive association between PCOS and family history of breast cancer. [8]

       

Mental Health issues : 

The aspect of PCOS which has received the least amount of attention has to be how PCOS affects the quality of life and mental health of PCOS women. What makes this discussion even more important is the fact that 28% to 39% of Indian PCOS women have clinical anxiety and 11% to 25% suffer from depression [9] [10]. PCOS often leads to self-esteem and body-image issues. Effects of PCOS such as infertility and alopecia are associated with anxiety while acne and hirsutism have been associated with depression. [11]

      

What can be done? 

Health experts suggest some remedies to deal with PCOS. Studies show that losing about 10% body weight can help regulate the symptoms of PCOS. 

According to some experts, regular 45 minutes of exercise and a proper diet helps reduce insulin levels and improve cholesterol levels. Several lines of studies have proven that low-carb diets are more effective than low-fat diets [12]. Proper therapy counselling is suggested for PCOS patients and there is medical help other than self-care. Please consult a medical expert for the best method for you, different treatments work for different people depending on their specific condition. 

    

Conclusion

There is an immediate need for awareness programs and more research on PCOS so that PCOS women can come forward and break the stigma around an issue that affects women on all levels. Timely therapeutic intervention can help with and that needs to be encouraged. 

Let's do our little and help spread awareness.