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Dr Alka Jha
Polycystic ovary syndrome (PCOS) is an endocrinal disorder that is increasingly affecting Indian women. Around 18 per cent of women in India are suffering from this problem and number is rising. It is one of the most common problems affecting women in the reproductive age group. It is characterised by small painless cysts in the ovaries as well as high levels of testosterone that can cause irregular or absent menstrual cycle, infertility, acne, excess of hair on face and body and weight gain.
The disorder can happen due to genetic and/or environmental factors causing imbalance of hormones. Excess production of ovarian androgen, a male hormone, is responsible for most of the above mention manifestations.
Lasting for life
This disease is not just confined to adolescent and reproductive age group but has a lifelong impact. A majority of women with PCOS develop insulin resistance. Insulin is a key hormone for proper disposal of blood glucose in our body, any functional abnormality of this hormone can lead to development of pre-diabetes, diabetes and gestational disease (diabetes in pregnancy). It can even cause hypertension and heart disease later in life.
Insulin resistance is a condition where insulin is not able to act on tissues. To compensate that pancreas produce more insulin causing hyperinsulinemia. Most of the PCOS patients are obese because of the weight-gain issues. Obesity, insulin resistance and hyperinsulinemia further aggravate the underlying hormonal imbalance.
A recent study in the Journal of Clinical Endocrine and Metabolism, in which 80,000 patients with PCOS with no previous history of diabetes were followed for 11 years, showed that women with PCOS are four times more likely to develop diabetes than women without PCOS. The study also found that the age at which a PCOS patient developed diabetes was younger than those without. Women with PCOS were diagnosed with diabetes at an average age of 31, while the average age in women without PCOS was 35 years.
Additional dangers
Other major threat associated with PCOS cholesterol is that it increases the level of LDL cholesterol (the bad cholesterol) and lowers the level of HDL cholesterol (Considered good cholesterol). These women are also at a greater risk for developing hypertension and their risk of heart attack is four to six times higher than women who don’t have PCOS. Women with PCOS are generally overweight or obese and can also develop obstructive sleep apnea, where breathing stops repeatedly during sleep. This condition can worsen the insulin resistance and cardiovascular problems of women with PCOS.
This disorder is not curable but it is manageable. The treatment is usually symptomatic with anti-androgen medication or medication to improve insulin sensitivity. The cornerstone of treatment, however, remains lifestyle modifications like weight reduction and regular exercise. PCOS requires lifelong treatment and lifestyle changes and need regular monitoring to check and prevent, if possible, associated conditions like diabetes, hypertension and heart disease.
—The writer is an endocrinologist, Fortis C DOC, Vasant Kunj, New Delhi.
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