Asia ReView

Dr. Rishma Dhillon Pai

Polycystic ovary syndrome (PCOS) occurs when a woman's body produces high levels of androgen (male) hormones. Women with this disorder have a higher risk of becoming obese and developing diabetes, high blood pressure, and other health issues.

One out of every four girls suffers from the disease. It brings her all the problems that she detests most — weight gain, acne, facial hair growth and irregular periods. Even middle-aged women may be affected by PCOS, a hormonal disorder that often runs in families. Mothers and daughters may both be affected, as there is a strong genetic component in its inheritance. As the name suggests, it causes multiple cysts to develop in the ovaries.

DIAGNOSIS

Girls with PCOS, or Polycystic Ovarian Disease (PCOD) as it was earlier called, suffer from irregular periods (usually delayed), scanty or heavy flow and often have difficulty in conceiving. This is because the ovary does not produce eggs every month, a condition called as anovulation. Besides, excess of male hormone in the system causes acne and profuse facial hair growth.

One of the main problems in PCOD is resistance to insulin. Girls with high insulin levels usually have a tendency to gain weight and develop diabetes as they grow older. Not all girls with PCOS are overweight. Some may remain thin and not have acne, but the diagnosis is established if a sonography shows ovaries with multiple small water-filled cysts. Hormone checks will also show high levels of male hormone and of insulin.

Because of several years of abnormal hormones and irregular periods, these women have a higher chance of developing cancer of the womb.

TREATMENT

The treatment of PCOS depends on the symptoms that the patient has. The most important factor in obese patients is weight loss, as it significantly improves the entire picture. Lifestyle changes are necessary, and these include improvement in diet, increase in exercise and keeping the weight under control.

For a young lady with severe pimples, facial hair and irregular periods, the best treatment is the combined hormonal pill. Some of these drugs contain medicines that significantly reduce facial hair growth within a few months. The existing facial hair can be treated cosmetically, and new growth will reduce. Pimples will also clear out and periods will become regular with hormone treatment.

Treatment for women with infertility is entirely different, requiring medicines such as clomiphene or gonadotrophin injections to induce ovulation. Sonography is done to check if the egg is coming out every month. Patients can show a very erratic response to drugs — either no effect or an excessive number of eggs growing in response to normal dose of medicines. Hence great care has to be taken when they are treated for infertility. Many women become pregnant either with simple treatment or with test tube baby treatment (IVF), but there is also a high miscarriage rate in women with PCOS. A good drug in women with high insulin levels is metformin, an anti-diabetic drug, which improves metabolism and helps weight loss in obese PCOS patents even when their sugar levels are normal.

ALTERNATIVES

Another treatment for patients with many cysts in their ovaries is laparoscopic burning of the cysts with a thin needle through which a current is passed (laparo-scopic ovarian drilling). This is a simple, short procedure and requires two or three small (1 cm) cuts on the belly through which the laparos-cope and camera are passed. As the cysts are burned, the male hormone levels fall and the patient may begin to ovulate spontaneously. This is a good technique, especially in infertile patients for whom procedure to check the tube openings can be combined. The problem of polycystic ovaries is massive; the important point is to have a healthy lifestyle with a good diet and exercise that helps control this problem.

The writer is consultant gynaecologist, Lilavati Hospital, Jaslok Hospital, Mumbai