Know the harmful effects of polycystic ovarian syndrome
January 18, 2018 | 10:14 AM
by Dr Pankaj Shrivastav
A fitness regime is very important to balance out the calories.

Let’s start with explaining what Polycystic Ovarian Syndrome ( PCOS) is. ‘Poly’ means many, ‘cystic’ means cysts or hollow growths existing, ‘ovarian’ means affecting a woman’s ovaries and finally ‘syndrome’ is a collection of symptoms that present which are all characteristically seen in the disorder. In PCOS, the ovaries are plagued by several cysts or polycystic.

As mentioned before, PCOS is a syndrome and so there are several symptoms seen typically in a woman affected by this. Of these the principle one is menstrual irregularities. At a young age the major effects are cosmetic like darkening of skin around the neck in the groin and armpits, skin tags, stubborn and resistant-to-treatment acne, hirsutism or excessive facial and body hair, thinning of scalp hair and male pattern of balding and weight gain.

Because of the physiology (workings of the disorder) side-effects of PCOS are infertility (either difficulty in conceiving or recurrent miscarriages) and metabolic syndrome which itself carries an associated risk of diabetes. Diabetes in turn then puts you at high risk of developing strokes and heart disease. The weight gain that is common in PCOS women results in sleep apnoea, which is difficulty in breathing while sleeping.

High levels of oestrogen (the female hormone produced by the ovary) is a result of the PCOS physiology and this excess oestrogen can lead to cancer of the uterus lining (endometrium) in later stages of a woman’s life. Last but definitely not the least, depression, psychological disturbances and low self-esteem are consequences of the androgenic symptoms of PCOS i.e. skin darkening, hirsutism, scalp hair loss, acne and weight gain. [Androgen is the male hormone which is produced in excess in PCOS.

PCOS is a metabolic disease with genetic predisposition with environmental overlay. If you have a history of diabetes in your family you are more prone to developing insulin resistance through genetics. What is insulin resistance? Insulin is a hormone secreted from a pancreas which helps control sugar levels. So after a meal, sugar levels go up in the blood and so the hormone produces insulin. In insulin resistance, the body is “blind” to the insulin being produced by the pancreas. This tricks the pancreas into thinking it hasn’t produced enough insulin to control the sugars and so it goes into overdrive producing very high levels of insulin to help control the sugar. At very high levels of insulin the sugar gets under control but this excessive and enormous amount of insulin has adverse effects on the ovaries that begin to produce male hormones or androgens. These result in irregular periods, hirsutism and the skin conditions.

Obesity makes insulin resistance worse because there’s greater strain on the pancreas to produce more insulin to control the circulating sugar.

The Gulf region on a whole has seen a rise in PCOS and this is where it can be attributed to the ‘environmental overlay’ i.e. an unhealthy way of living with little or no physical activity. This environmental overlay is slowly but surely causing a switch in our genetic make-up to ‘flip’ and more and more women are becoming prone to developing PCOS. The science behind this is complex but simply put, in countries of the Middle East and in countries like the USA and UK, PCOS is definitely directly linked to an unhealthy lifestyle.

PCOS is a syndrome of androgen excess. The androgen excess brings a ‘male’ effect to the woman and the most notable one of this is the irregular menstrual cycles. To control their periods and regularize the cycles, girls are put onto the pill. While they’re on the pill these women get regular periods and their skin lesions are also under control. Once the pill is stopped the symptoms of PCOS are unmasked and that’s why they find that the adult acne begins to appear. It’s not that they have developed a new problem it’s just that it was suppressed while they were taking the pill and the symptoms reappear on discontinuation.

There aren’t any unexpected side-effects because almost all the symptoms and effects of PCOS are documented and so on that front we are forewarned by being forearmed with the knowledge.

Men and women are biologically different especially in their fat distribution. Women have fat predominantly in the areas of hips, thighs and buttocks. When there is excess fat, the fat cells in these first enlarge to store more fat per cell and then as the fat keeps increasing new fat cells in these areas form increasing the number of cells existing. Fat deposition in the waist is a later manifestation of weight gain. There is some suggestion that women with PCOS have a slower metabolic rate and this may be one of the reasons why they may find it more difficult to lose weight.

The good thing about PCOS is that it can easily be managed by the woman herself. Even a 5% weight loss can take a woman from anovulatory (i.e. not ovulating or making eggs) to ovulatory (or making eggs) and start having menstrual cycles. A fitness regime is very important to balance out the calories. It also requires a woman to be careful about not just how much she eats but also what she eats. Opt for low glycemic index foods. Consult a nutritionist.

Walk/cycle to work if possible especially in the cooler months of the year. Take the stairs and time yourself. Make it a little competition. When the weather is good go for a jog on the beach. The fresh air and cardio will do wonders for your mind and body. Try not to take the car everywhere – see if you can walk to the grocery store down the block. Because of the hot humid weather we don’t even walk/cycle to work or run errands.

Because of the metabolic and endocrine abnormalities a large number of women with obvious PCOS have irregular menstrual cycles and don’t make eggs. This would directly cause them to be infertile. By reversing the metabolic and hormonal abnormalities, by medication and lifestyle changes one can to some extent reprogram the ovary and regulate the menstrual cycle. PCOS consequences include diabetes and obesity. These in turn if uncontrolled puts a woman at high risk of developing heart disease and strokes. The excessive oestrogen drive from PCOS makes women vulnerable to developing endometrial (uterine lining) cancer.

Depression is another serious health adversity that arises from the cosmetic disturbances to a woman’s appearance. The advice I would give to women is be aware of the symptoms of PCOS, educate themselves and if at all they have even one of the symptoms to visit a specialist physician for an early diagnosis. This gives them the advantage to make the necessary changes to their lifestyles and keep the ill-effects of PCOS at bay. [email protected]

Dr Pankaj Shrivastav is director and founder of Conceive, The Gynaecology & Fertility Hospital in Sharjah

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