Are you taking right treatment for PCOS..??

By Dr. Shobha Gupta

Some Facts-

• 1 in 10 woman has PCOS in India
• 50% of women don’t even know that they has it 
• Every second patient in Delhi are suffering from PCOS
• Ovarian drilling in PCOS can destroy your eggs permanently

PCOS – Polycystic Ovarian Syndrome is an incurable disorder that affects 1 in 10 women and over 50% do not know that they have it unless and until they go for a checkup. Poly-Cystic Ovarian Syndrome (PCOS) is the most common hormonal imbalance disorder which causes irregular menstrual cycle in women, obesity, unwanted hair growth and infertility. It mostly affects women of reproductive age from puberty to menopause i.e. 12-45 years old. 

Every second patient, I treat in Delhi has PCOS. In PCOS patients there are sufficient number of eggs which helps in conceiving but PCOS patients do not have that capacity where their eggs develop itself for pregnancy. In a research by USA, few years ago it was found out that via laparoscopy or key-hole surgery the ovaries are punctured with a small needle carrying an electric current or using laser to voluntarily breech the ovarian capsule. This surgery can lower male hormone levels and help with ovulation. But it indeed needs lot of alertness by the doctors as there are various risks are associated with it like infections from the incision, bleeding from the incision, pain after the procedure etc.

But the biggest risk associated with the ovarian drilling surgery is that it could destroy too much of the ovary and causes your egg supply to diminish at a young age, sending you into early menopause.

I can recall a case of my patient Rashmi Khanna(name changed on request), a management professional married at the age of 28 has planned to conceive after 2 years of her marriage. Her world seems to have scattered when she got to know that she is suffering from infertility caused by PCOS. She went for an ovarian drilling procedure which causes the diminished egg supply. After much hassles and lot of stress she is now going for IVF procedure with a donor egg.

So, it is very important for women to know and get aware that they should not go for ovarian drilling in PCOS treatment especially if they have not been a mother single time. Otherwise they would have need egg donor and could not become mother with their own eggs.

Signs and Symptoms of PCOS:

• Irregular periods

• Unwanted hair growth on face, chest, abdomen, thighs

• Oily skin and acne

• Type 2 diabetes

• Obesity

• Increased cholesterol

What causes PCOS?

High levels of the insulin have also been linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen.

Being overweight or obese is another major and contributory cause of PCOS. However, if you are overweight or obese, excess fat can make insulin resistance worse. This may then cause the level of insulin to rise even further. High levels of insulin can contribute to further weight gain.

Since obesity, central obesity and insulin resistance are strongly implicated in its etiology and reduction of these risk factors should be a central treatment focus. 

The first-line treatment is to educate the patient about weight loss.

Weight loss has been consistently successful in reducing insulin resistance and restoring ovulation and fertility. Current conservative treatment should emphasize sustainable weight loss through dietary modification and exercise. Modifying additional lifestyle factors, including alcohol consumption, psychosocial stress and smoking, are also crucial in long-term treatment of PCOS.

Treatment for PCOS:

Life style management and weight optimization- There have been numerous studies that have showed that lifestyle management alone -- ie, weight loss has been very effective in the managing the disease. A healthier lifestyle will also reduce their long-term risks for diabetes, hypertension, dyslipidemia, and cardiovascular disease.

Medicine for increased hair growth - If a woman is not trying to get pregnant there are some other medicines that may reduce hair growth. Other non-medical treatments such as electrolysis or laser hair removal are effective at getting rid of hair. A woman with PCOS can also take hormonal treatment to keep new hair from growing.

Ovarian drilling is only advised for women whose fertility problems stem from PCOS. It is also only indicated for women with PCOS who have not had success with other fertility treatments.  

IVF treatment should be there first priority for infertility caused by PCOS.