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Are you suffering from PCOS problem? You’re not alone. It is estimated that nearly 20% of all Indian women, that is, about 1 out of 5 women in the country, suffer from PCOS.
What is PCOS?
Polycystic Ovarian Syndrome (PCOS) as a syndrome manifested by amenorrhea, hirsutism, and obesity associated with enlarged polycystic ovaries.
It is the Clinical features of in a woman of reproductive age.
CAUSES
This heterogenous disorder is characterized by excessive androgen production by the ovaries mainly. PCOS is a multifactorial and polygenic condition. Dysregulation of the CYP 11a gene, upregulation of enzymes in androgen biosynthetic pathology have been suggested. Insulin receptor gene on chromosome 19p 13.2 is also involved.
The exact cause of PCOS problem remains unclear. Doctors believe that PCOS can have both genetic and environmental causes. PCOS is often associated with -
- An unhealthy diet
- A sedentary lifestyle
- Pollution
- Hormone altering medication
- Several OTC (over the counter) medications and supplements
In many cases, the PCOS problem runs in families and is also considered hereditary. Researchers point to several physiological causes that may increase your risks of developing PCOD/PCOS –
- Excess Insulin Production – Insulin is a natural hormone produced by the pancreas. It helps regulate the metabolic functions of the body and regulate blood sugar levels. Doctors believe that a high insulin level is one of the key drivers of PCOS. Excess insulin also prompts the body to increase the production of androgen (male hormone), which inhibits ovulation.
- Inflammation – Several physiological reasons may cause low-grade inflammation in the body. Mild forms of autoimmune diseases can also cause inflammation in the body’s tissues. This, in turn, again increases the androgen levels in the body.
- High Androgen Levels – The male hormone is associated with increased facial and body hair, acne outbreaks, skin issues, and a higher risk of developing cardiovascular diseases.
Clinical Features
The patient complains of
- Increasing obesity (abdominal 50%),
- Menstrual abnormalities (70%) in the form of oligomenorrhea (irregular and inconsistent menstrual blood flow), amenorrhea (absence of menses) or dysfunctional uterine bleeding (DUB) and infertility.
- Presence of Hirsutism and acne are the important features (70%)
- Acanthosis nigricans is characterized by specific skin changes due to insulin resistance. The skin is thickened and pigmented (grey brown). Commonly affected sites are nape of neck, inner thighs, groin and axilla.
- HAIR-AN syndrome in patients with PCOS is characterized by hyperandrogenism, insulin resistance and acanthosis nigricans. Internal examination reveals bilateral enlarged cystic ovaries which may not be revealed due to obesity.
Pathophysiology
Exact pathophysiology of PCOS is not clearly understood.
Hyperandrogenism, ovulatory dysfunction, aberrant gonadotropin‐releasing hormone (GnRH) pulsation and the resulting abnormal gonadotropin secretion, and insulin resistance comprise the vicious cycle that underpins the pathophysiology of PCOS. The abnormalities in the ovarian function of women with PCOS include the hypersecretion of androgens and ovulatory dysfunction, which causes PCOM. The hypersecretion of androgens is caused by intrinsic dysfunction of theca cells and/or the hypothalamus‐pituitary‐ovarian axis, while hyperandrogenism causes abnormal GnRH pulsation and gonadotropin secretion through the aberrant negative or positive feedback of progesterone and oestrogen. The abnormal gonadotropin secretion in patients with PCOS is characterized by a high luteinizing hormone (LH)/follicle‐stimulating hormone (FSH) ratio, which induces ovarian dysfunction, including the hypersecretion of androgens. In addition, the high concentration of anti‐Müllerian hormone (AMH), which is secreted by the pre−/small antral follicles that accumulate in the ovaries of women with PCOS, further exacerbates the ovarian dysfunction by having deleterious effects on the follicular microenvironment and/or GnRH pulsation. Hyperandrogenism is further aggravated by hyperinsulinemia, which develops secondary to insulin resistance. Hyperinsulinemia causes an increase in androgen secretion by theca cells and an inhibition of the production of sex hormone‐binding globulin (SHBG) in the liver, thereby increasing the circulating concentration of bioactive free testosterone. Insulin resistance develops in tissues such as liver and muscle, and is associated with visceral adiposity and adipocyte dysfunction, which are exacerbated by hyperandrogenism.
Investigations
- Sonography: Transvaginal sonography is especially useful in obese patient. Ovaries are enlarged in volume (>10 cm3). Increased number (>12) of peripherally arranged cysts (2-9 mm) are seen.
- Blood tests can be used to identify characteristic changes in hormone levels, although these changes are not universal. Women with polycystic ovary syndrome may have elevated levels of:
- Testosterone (an ovarian androgen hormone that influences hair growth);
- Oestrogen (an ovarian hormone that stimulates growth of the womb lining (endometrium);
- Luteinising hormone (LH, a pituitary hormone which influences hormone production by the ovaries and is important for normal ovulation);
- Insulin (a hormone that is principally involved in the utilization of energy from food)
- Anti-müllerian hormone (which measures the fertility level of the ovaries).
- Ratio of LH:FSH is >2:1.
- SHBG (sex hormone binding globulin) level is reduced.
Diagnosis
Polycystic ovary syndrome is diagnosed by the presence of any two of the following three criteria {Rotterdam criteria}
- Oligo and/or anovulation (self-reported menstrual cycle length of >35 days or <10 menstrual period per year)
- Hyperandrogenism (clinical and/or biochemical, such as hirsutism, acne, androgenetic alopecia, hormonal imbalance, etc.).
- Polycystic ovaries (>12 follicles measuring 2-9mm in diameter and/or an ovarian volume >10ml in at least one ovary)
Management of PCOS
- Management of PCOS needs individualization of the patient. It depends on her presenting symptoms, like menstrual disorder, infertility, obesity, hirsutism or combined symptoms.
- Patient counselling is important.
- Treatment is primarily targeted to correct the biochemical abnormalities.
- Weight reduction in obese patients is the first line of treatment. Body mass index (BMI) <25 improves menstrual disorders, infertility, impaired glucose intolerance (insulin resistance), hyperandrogenemia (hirsutism, acne), and obesity. Weight reduction (2-5%) improves the metabolic syndrome and reproductive function.
- Exercise
Diet for PCOD
- Diet should be dominated with lots of fruits and vegetables on a daily basis. Avoid dairy products as much as possible.
- Lean cuts of chicken and fish can be taken. But avoid red meat.
- Hydrate yourself well by having a minimum of 2-3 liters water/day, coconut water, buttermilk, vegetable soups, and smoothies. Avoid aerated drinks and sugary foods.
- Eat unsaturated fats and delete saturated and hydrogenated fats from your diet. Always check the label of the product while buying them.
- Binge on whole wheat products like wheat pasta, wheat poha and avoid maida, suji.
- Brown rice in and white rice should be out of your diet. Red rice is also found to be rich in antioxidants which can be used as a substitute for white rice.
- Include natural herbs in your diet like flax seeds, methi seeds, coriander, cinnamon.
- Include millets like barley, ragi, quinoa, and oats. They are known to cool your body.
- Say Yes to walnuts, almonds and no to cashews
Whole pulses like skinned green moong dal, chana dal, yellow moong dal, whole pulses to be included in various preparations.
Case Study
She is a 28-year-old woman who has been enduring irregular menstrual cycles since 2019. The discomfort of this irregularity was somewhat alleviated by oral contraceptive pills (OCPs). However, the relief was short-lived, as by February 5, 2022, her menstrual cycles had once again become erratic. She had to give up her workout routine in January due to academic commitments, resulting in distressing weight gain, particularly around her abdomen, along with unwanted facial hair growth. Although her periods were short and painless, they often arrived 8-10 days late, further complicating her situation.
In May 2022, Karishma decided to seek homeopathic treatment with Dr. Rashmi after struggling with PCOD since 2019 and feeling hopeless with allopathic treatments. She has a history of malaria and typhoid, and her family has a history of diabetes and high blood pressure. She experiences a poor appetite but craves rice. Her thirst is low, consuming about 2 litres of slightly cold water daily. Her urine and bowel movements are normal. She sometimes suffers from headaches, especially when she hasn’t eaten for a while. She likes spicy and salty foods. But inside, she feels angry because of everything she’s been through. Her weight is 61.5 kg, which reminds her every day of the struggles she faces.
Medical records from 18/6/22 shows FSH: 6.08, LH: 15.32, AMH: 7.83, Iron: 42, Prolactin: 15.69, Thyroid profile: within normal limits (WNL)
Despite not having her periods for the first two months of treatment, Dr. Rashmi encouraged her to persist and reevaluate the case thoroughly. She adopted a healthy diet and exercise routine, and her periods resumed in July 2022. Although they ceased again for two months, Dr. Rashmi continued to support her and suggested consulting an endocrinologist if necessary. She remained committed to the treatment, and by October 2022, her periods had regularized, and she began losing weight. She feels happy and grateful for Dr. Rashmi’s support and treatment.