Polycystic Ovary Syndrome, or PCOS, is a health condition that affects about 5 to 10 % of women. It can cause irregular periods, high levels of certain hormones that may lead to acne, extra hair growth, or thinning hair on the scalp, and small cysts on the ovaries. Women with PCOS are also at higher risk for other health issues like type 2 diabetes, sleep problems, liver issues, and depression. Here’s more to this condition and how I manage it.
What causes PCOS?
The exact cause of PCOS is still unclear, but it seems to be related to hormone imbalances. People with PCOS often have higher levels of certain hormones that disrupt normal ovary function. Additionally, many have issues with how their body uses insulin, which might also play a role.
How is PCOS diagnosed?
Diagnosing PCOS involves looking at symptoms, doing a physical exam, and running some tests. Typically, you need to have at least two of these: irregular periods, signs of high hormone levels (like acne or extra hair growth), and polycystic ovaries seen on an ultrasound. Doctors will also check to rule out other conditions that could cause similar symptoms.
What are the common symptoms of PCOS?
Common symptoms include irregular or missed periods, extra hair on the face or body, acne, thinning hair on the scalp, weight gain, and difficulty getting pregnant. These symptoms can begin around puberty or later in life. Sometimes there could also be dark patches in the armpits or around the neck region.
Can PCOS affect fertility?
Yes, PCOS can impact fertility by causing irregular ovulation, meaning that the ovaries don’t consistently release eggs. This irregularity makes it harder to predict the best time to conceive. Many people with PCOS need specific treatments to help with this as explained below.
What treatments are available for PCOS?
While there is no cure for PCOS, it can be effectively managed based on your specific symptoms and health goals. The treatment plan is highly personalized, as symptoms can vary from person to person and may change throughout different stages of life. For instance, if acne is the primary concern, treatment will focus on skin care. If infertility is the issue, the approach will target reproductive health. Since concerns can shift over time, management is always tailored to address your current needs. Here are some treatment options commonly used to address various PCOS symptoms:
Weight Loss: Shedding even a small amount of weight—around 5-10% of your body weight—can have a significant impact on managing PCOS symptoms. Weight loss can help regulate hormones, improve insulin sensitivity, and restore more regular menstrual cycles. It may also reduce acne, excess hair growth, and the risk of long-term health issues like diabetes and heart disease. Achieving weight loss is often done through a combination of a balanced diet, regular exercise, and healthy lifestyle changes. In some cases, if these methods aren’t effective or if someone has a higher BMI, weight loss surgery might be considered as an option to improve overall health and better manage PCOS symptoms.
Birth control pills:Â These can help regulate menstrual cycles, making periods more predictable, lighter, and less painful. They also help reduce acne and control excess hair growth. Alternatives such as hormonal patches or vaginal rings offer similar benefits for managing PCOS symptoms.
Anti-hair growth medications: Medications like spironolactone are commonly prescribed to reduce excess hair growth on the face or body and can also help with acne. It works by blocking hormones that contribute to unwanted hair and oily skin. However, it’s important to note that it takes time—typically a few months—to see noticeable results, and it’s often combined with treatments like birth control pills for better effectiveness. Since spironolactone is not safe during pregnancy, your doctor will discuss alternative options if you’re planning to conceive.
Metformin:Â This medication helps your body use insulin more effectively, which can lower blood sugar levels. It’s often recommended for people with PCOS, especially if they have insulin resistance-which is a common consequence of PCOS. When combined with a healthy diet and regular exercise, metformin can help regulate menstrual cycles and may also support weight loss. It works gradually, so you’ll need to stick with it over time to see the benefits.
Progestin: This hormone is used to trigger menstrual periods in people with PCOS, especially when they go long periods without menstruating. It’s important to have at least 4 periods a year to reduce the risk of complications, like uterine cancer, which can occur if the lining of the uterus builds up for too long without shedding. Progestin can be taken as a pill, used as an intrauterine device (mirena), or given as an injection, depending on what’s most suitable for your needs. This helps regulate your cycle and protect your long-term health.
Fertility treatments: If you’re looking to get pregnant with PCOS, starting with simple weight loss can often make a big difference in helping you ovulate and conceive. Many people find success with medications like letrozole or clomiphene, which stimulate ovulation. If those options don’t work, hormone injections called gonadotropins might be recommended to encourage your ovaries. In more challenging cases, in vitro fertilization (IVF) can be an option, where eggs are fertilized in a lab and then transferred to your uterus.
Another possibility is ovarian drilling, a minor surgical procedure that can help improve ovulation by reducing cysts on the ovaries. Your doctor will work with you to find the best approach based on your unique situation and how your body responds to treatment. It’s important to remember that it may take multiple attempts, but there are many paths to help you on your journey to pregnancy.
Are there long-term health risks with PCOS?
Yes, PCOS can lead to several long-term health concerns. For instance, many people with PCOS face an increased risk of developing type 2 diabetes due to insulin resistance, which is quite common with this condition. There’s also a heightened risk of heart disease because factors like high blood pressure and cholesterol levels can be more pronounced. Additionally, sleep problems, such as sleep apnea, can affect those with PCOS, impacting overall well-being.
To help manage these risks, it’s important to focus on maintaining a healthy weight through a balanced diet and regular exercise. Keeping up with regular health check-ups is also key; these visits can help catch any potential issues early and allow for timely treatment. By being proactive and informed about your health, you can significantly reduce the long-term effects of PCOS and improve your quality of life.
How can someone manage PCOS effectively?
Managing PCOS effectively often involves a mix of lifestyle changes and medical support. Focusing on a healthy diet, staying active, and maintaining a healthy weight can really help. Regular check-ups with your healthcare provider are also important—they can tailor your treatment plan to fit your needs and keep an eye on your overall health.
The Writer, Dr Joan Okemo, is a Consultant Obstetrician Gynaecologist at Aga Khan University Hospital Nairobi.
