Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

Reviewed by SIAHMSR medical team.

PCOS is a syndrome involving a group of hormones in women and is characterized by lack of ovulation, irregular menstruation, hair loss from scalp, excessive body hair growth, acne & comedones on face with or without obesity. PCOS may leads to infertility in women.

 Polycystic ovarian syndrome [PCOS] is a common problem affecting women of reproductive age.PCOS often run in families. Genetic factors as well as environmental factors such as sedentary life style, lack of physical activity, over eating, obesity lead to PCOS.

How does PCOS develop in women?

   Normally, in women of reproductive age, every month [28-32 days cycle] ovary releases a mature ovum and it reaches fallopian tube. Ovum is released from an ovary between the 14-17th day after last menstrual cycle in every women. If this ovum fertilize with male sperm after sexual intercourse, pregnancy happen. If fertilization doesn’t happen and do not progress to pregnancy the ovum is lost with menstruation. But menstruation doesn’t happen in women having PCOS.

    In women suffering from PCOS, the ovaries produce unusually high levels of male sex hormones called androgens.

Due to high androgen levels egg [ovum] is not released from ovaries in every menstrual cycle.  So irregular ovulation can also cause small, fluid-filled sacs to develop on the surface of ovaries.

This excessive androgen production may cause an imbalance in other reproductive hormones of females as hormonal production and release are interconnected.

High androgen levels may also cause acne and excess body hair growth in women.

  Obesity is seen in PCOS women and it may lead to insulin resistance and hormonal imbalance. Obesity and insulin resistance is closely connected to Polycystic ovarian syndrome.

Insulin resistance is a condition in which body produces insulin but it is not used by cells and tissues to remove blood sugar. So blood glucose level as well as insulin level remains high. An increase in insulin levels is the prime cause which makes your ovaries to produce and release male hormones excessively.

 PCOS  is associated with obesity. However PCOS appears in lean women also. Many studies have shown that both lean and obese women with PCOS have insulin resistance.

   Insulin resistance is the most important issue in PCOS which leads to excessive androgen or male hormone production and other symptoms and signs of PCOS. The exact cause of insulin resistance is thought to be genetic.

The insulin resistance in at least 50% of PCOS women appears to be related to excessive serine phosphorylation of the insulin receptor. Serine phosphorylation appears to modulate the activity of the key regulatory enzyme of androgen biosynthesis, P450c17. It is thus possible that a single defect produces both the insulin resistance and the high androgen secretion in some PCOS women.

   Most of the PCOS women may have elevated triglycerides, LDL and decreased HDL in addition to insulin resistance. Increased level of bad [LDL] cholesterol and elevated triglycerides enhances the risk for heart attack and stroke in women having PCOS.

  Dark or thick skin patches appear on the back of neck, in the armpits, and under the breasts in women with insulin resistance and PCOS.

How is PCOS diagnosed?

PCOS is often clinically diagnosed with missing or irregular periods or when failure to conceive happens. Obesity with acne and comedones, facial hair growth, dark patches on various parts of body etc. also may raise the suspicion of having PCOS. However, ultra-sonogram of pelvis with hormonal assays is needed to confirm the diagnosis along with clinical symptoms manifested.

                                      SIAHMSR                                                          

How does PCOS affect women’s health?

   The impact of PCOS on women’s health is tremendous if left untreated. PCOS is a syndrome affecting multiple hormones in women with impact on various organ systems in the long run if proper treatment and lifestyle modifications are not adopted.The outcome of these interventions or changes in lifestyle is very good and they can definitely reduce the symptoms and prevent PCOS associated complications. Therefore women need not be scared of this disorder if they are ready to adopt a healthy life style.

    The complications associated with PCOS begin from insulin resistance. Although PCOS is having a genetic cause and it runs in families, the role of obesity and insulin resistance resulting from it cannot be ignored. Insulin resistance is associated with metabolic syndrome [obesity, high blood pressure, high cholesterol] also.

PCOS and insulin résistance may eventually lead to diabetes, obesity, high blood pressure and high cholesterol. These are the complications of PCOS.

Obesity further enhances the health risk for diabetes, cancers, heart attack and stroke in women.

   PCOS affects cholesterol metabolism and thyroid gland functions also. Cholesterol accumulation also increases the risk of cardiovascular diseases such as heart attack, stroke and arteriosclerosis [clot formation] of blood vessels. Diabetes, another complication of PCOS further enhances the risk. 

 Elevated levels of male hormones [androgens] in PCOS women may cause hirsutism or excessive growth of body hairs. Cosmetic treatment is available for removing body hair.

   Female pattern alopecia or hair loss from scalp, acne, and acanthosis nigricans [velvety growth on various parts of skin due to insulin resistance] are associated with PCOS. That means, PCOS cause hair thinning.  Medications may help to manage hair loss and insulin resistance along with life style modifications.

    PCOS may lead to infertility as it prevents ovulation or release of eggs and associated androgen hormone production disrupts the hormonal balance in the body of a woman.

    In some women anxiety and depression are observed, although it is not clearly understood how PCOS leads to depression. Most probably it might be resulting from the androgen excess and consequent female hormone imbalances. PCOS leads to obesity and acne, comedones which can trigger low self-esteem and depression.

   PCOS increases the risk of endometrial cancer due to the prolonged exposure of the uterine endometrium [inner lining of uterus] to unopposed action of estrogen. This is caused by absence of ovulation from high level of androgens in women with PCOS. This prolonged exposure can cause endometrial hyperplasia and may lead to endometrial cancer.

                           SIAHMSR                                    

How to manage PCOS?

    A healthy diet and more physical activity can help to lose weight and reduce PCOS symptoms. They can also help to reduce the impact of insulin resistance. Body can use insulin more efficiently if physical activity is improved and obesity is reduced, particularly fat over the central part of the body such as abdomen and chest.

Physical activity, exercise and modified dietary patterns can definitely lower blood glucose levels, and prevent progression to diabetes. All these changes in life style can help normal ovulation also.

    Medications are also available in modern medicine to cause ovulation. Diabetes is also controlled with medications. Fertility is achieved in most of the cases and in cases with poor results with medicine IVF is a better choice.

 Alternative and complementary medicine

Homeopathy

Homeopathy offers some medicinal treatment to regulate ovulation and menstrual cycle. Medicines are used to manage menstrual irregularities according to the symptoms and signs manifested in the patients.

Homeopathic medicines are prescribed in an individualized way. Acne, comedones, obesity, depression are treated with medications along with life style and dietary changes.

Role of physical activity & exercise

Physical exercise is recommended as a life time routine to be followed. Nourishing and weight loss promoting diets are suggested for women with PCOS as the disease can cause many obesity related and hormonal complications which may enhance the risk for heart problems ,infertility ,stroke and cancers.

Moderate physical activity and dietary modifications such as inclusion of Mediterranean and DASH diets are very effective in prevention as well as management of PCOS.

Diet planning

·       Choosing more low-glycemic carbohydrates. Not eliminating carbohydrates but choose whole grains, fibers etc. which do not cause a sudden spike in blood sugar level. Fiber also helps digestion as well as help to reduce bad LDL cholesterol, which is another impact of PCOS.

·       Include anti-inflammatory foods, such as berries, fatty fish, leafy greens, and extra virgin olive oil, which may reduce inflammation-related symptoms.

The Mediterranean diet for PCOS

  Mediterranean diet includes healthy foods which can help PCOS also. It includes natural, unprocessed foods, high-fiber foods;

Consume more fatty fish, including salmon, tuna, sardines, and mackerel; Also healthy fats, such as olive oil, as well as avocados and coconuts and nuts. These foods are rich in Omega-3 fatty acids containing fish, such as salmon, tuna etc.

For further reading about foods to manage PCOS please follow this link

https://siahmsrwellness.in/foods-to-manage-pcos 

Research studies supports Mediterranean &DASH diets for managing PCOS.

In 2020, a study [1] concluded that the Mediterranean and DASH diets improved the appearance of the ovaries. These diets were shown to reduce insulin resistance, hyperandrogenism or excess male hormone production and obesity, also causing satiety and weight loss in women. These diets appear to improve ovarian steroid hormone production and affect ovarian development by regulating follicle stimulation hormone (FSH).

Reduced beverage and sodium intake is recommended at DASH, which increases glucose regulation, reduces insulin resistance, and improves abdominal fat deposition of PCOS.

In 2019 study[2]  conducted in Italy examined whether the Mediterranean diet was related to PCOS ; found the therapeutic role of individual foods and nutrients of the Mediterranean diet helping to reduce the inflammatory condition that causes insulin resistance and excessive androgen production in PCOS. Diet has a very important role in the symptoms and laboratory findings of PCOS. 

DASH & Mediterranean diets have crucial role in reducing insulin resistance, sex hormonal imbalances, glucose levels and weight gain associated with PCOS.

High-sugar or glucose foods may be one of the triggers of PCOS, by causing intestinal flora imbalance and triggering chronic inflammation, insulin resistance, and production of androgen. Consumption of DASH diet for 8 week led to a significant reduction in serum insulin, triglycerides and very-low-density lipoprotein cholesterol and a significant increase in total antioxidant capacity [TAC] and glutathione GSH levels.

    Moreover, studies show that changes in the relative abundances of specific types of unhealthy gut microbiota or intestinal microbes can cause insulin resistance, which is closely linked to the occurrence of PCOS. The use of gut microbiota-targeted agents in the treatment of PCOS is still under discussion, not implemented [3].

written by dr sanjana vb[ copyright]

 References

1.  https://pubmed.ncbi.nlm.nih.gov/7671850/  
2.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387116/
3.  https://academic.oup.com/jcem/article/91/10/3878/2656479 
4.     https://www.sciencedirect.com/science/article/abs/pii/S1083318821000280    
5.  https://radiopaedia.org/articles/polycystic-ovaries  
6.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409808/#:~:text=According%20to%20the%20Rotterdam%20consensus,in%20at%20least%20one%20ovary).  
7.  https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos  
8.  https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos
9.    https://pubmed.ncbi.nlm.nih.gov/32629978/
10.    https://pubmed.ncbi.nlm.nih.gov/31547562
11.    https://pubmed.ncbi.nlm.nih.gov/32552864/
12.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8643565/
13.    https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos
14.    https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0034-1376990
15.https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01098545/related-content
16. https://pubmed.ncbi.nlm.nih.gov/9408743/
17. https://pubmed.ncbi.nlm.nih.gov/9408743/
 18.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181615/#:~:text=The%20major%20reason%20PCOS%20increases,may%20lead%20to%20endometrial%20cancer.