Q. What are the symptoms of PCOS?

Polycystic ovarian syndrome (or PCOS) has a wide spectrum of symptoms from irregular/no menses to obesity and excessive weight gain, ovarian cysts, hirsutism, acne, male pattern baldness, depression, anxiety, skin tags and infertility.

Q. What are the diagnostic criteria for PCOS?

It is not definitive. The tests include:

  • Day 2 assays for hormones
  • Fasting insulin blood test
  • Cholesterol panel
  • Testosterone
  • Cortisol
  • DHEA
  • Pelvic scan for visible cysts

Q. How does PCOS lead to infertility?

In PCOS, levels of leutinizing hormone (LH) are elevated. This reverses the LH/FSH ratio due to which although FSH stimulates many follicles to start their development but the low levels do not allow any one of the follicle to mature. Therefore the numerous follicles that have started growing gradually become atretic and form cysts which are why the ovaries appear polycystic.

As no follicle mature, ovulation does not take place and the cycle remains anovulatory thereby leading to infertility.

How do you treat PCOS?

1. The treatment of PCOS is symptomatic and a combined approach is needed. The following medications are most commonly used:-

  • Oral contraceptive (Birth Control) pills:-

    indicated for women who need to regularise their menstrual cycles, clear acne, hirsutism etc by decreasing the levels of male hormones. However, once these are stopped, the problems might recur.

  • Medication to decrease insulin resistance:–

    Oral anti diabetics like metformin (glycophage)- improves the blood glucose levels, decreases the production of male hormone (testosterone), slows down the abnormal hair growth, decreases body mass index (BMI) by improving cholesterol levels. As a result ovulation may return within a few months.

  • Fertility medications:-

    Include clomiphene citrate alone or with Gonadotropins (usually FSH) for inducing ovulation. In resistant cases, IVF is a viable option for achieving a conception.

2. Surgery- Laparoscopy is a good option for patients with resistant PCOS who do not respond to medical treatment. During laparoscopy, the enlarged ovaries are drilled which increases the chances of ovulation and therefore pregnancy by 70-80%.

3. Life style modification- PCOS is usually associated with obesity – Dietary restrictions along with exercise are important in restoring the hormonal milieu of the body. With even a 10% loss in body weight, ovulation could be restored and regularity of her menstrual cycle maintained.

Q. What is the other health risks associated with PCOS?

Women with PCOS are at a greater risk of having chronic ailments like type 2 diabetes, cardiovascular diseases and cancer. Therefore the problem should be addressed from a young age