Dipti is 29, has been married for 4 years, and she has plans to conceive this year but after a couple of months, she found out about her PCOS. 

She realized, her acne, body weight, and her menstrual irregularities were hinting at her health big time, but she was not aware of PCOS-associated infertility. The root cause of her infertility is PCOS. Dipti is keen to understand PCOS and find a cure for her infertility. 

This is the story of one in five Indian women today!

What is PCOS and what are the symptoms?

Polycystic ovarian syndrome or PCOS is a clinical situation when you are diagnosed with numerous ovarian cysts accompanied by:

• Irregular periods 
• Oligo anovulation or anovulation (lack of ovulation)
• Facial hair
• Acne
• Weight gain or obesity
• Insulin resistance or diabetes
• Hypertension (high blood pressure)
• Darkening of skin
• Fatigue, irritability
• Headaches

PCOS is identified with an ultrasound diagnosis primarily to confirm ovarian cysts. A serum androgen level test will also support a good diagnosis. 

PCOS can hamper the circadian rhythm, and hence, it exhibits metabolic syndromes like insulin resistance, diabetes, and hypertension.

There is also a mild form of PCOS where women do not show the symptoms of PCOS but might still have hyperandrogenism and polycystic ovaries and still maintain ovulatory function. However, some women with this disorder do not have cysts while some women without the disorder have cysts. (Polycystic Ovary Syndrome (PCOS) | Johns Hopkins Medicine, n.d.)

Why did I get PCOS?

The scientific reason for PCOS is the excessive production of androgens. Before you search for the meaning of androgens, let me break it up for you. 

Androgens are steroid hormones that regulate the development and maintenance of male characteristics. But what is the role of androgens in a female body? 

Androgens maintain muscle tone, reproductive health, bone mass retention, brain function, and maintain cardiac health in both genders. Androgens regulate the menstrual cycle in women. Testosterone is a primary androgen made in the testicles of a man and the ovaries of a woman. (Bianchi et al., 2021)

Just as testosterone deficiency can be demotivating for a man, testosterone in excess in women can put down their hormonal balance.

Excessive androgens are found in the following cases:

• Family history (oligogenic or autosomal dominant gene): 

Studies have shown that multiple genetic factors can lead to PCOS. Any one parent carrying the gene will influence the occurrence of PCOS in the offspring. However, it is said that other environmental and lifestyle factors accompanying these genetic mutations make PCOS a more prominent occurrence confirming it as a multifactorial disease. (Prapas et al., 2009)

• Epigenetics:

If your genetics play the role of a gun, your lifestyle is known to be the trigger! In simple words, your lifestyle can hugely impact your gene expression affecting the phenotype. Epigenetic factors explain that there are gene mutations due to mutagens like alcohol, tobacco usage, lack of a sleep routine, consumption of high carbohydrate and fatty-rich foods, lack of physical activity, and consuming sugary treats/drinks. All these habits become lifestyle changes that trigger your somatic genes leading to ‘turning on’ or ‘turning off’ the PCOS gene. (Stener-Victorin & Deng, 2021)

• Obesity

Obesity can be a genetic or lifestyle factor. The number of fat cells increases during obesity or weight gain, leading to excessive circulating androgens (testosterone), creating an imbalance in your endocrine hormones. Excessive androgen production leads to irregular menstrual cycles, facial hair or hirsutism, insulin resistance, inflammation, and anovulation or oligo anovulation, which we see in PCOS. 

• Environmental pollutants:

Toxic agents are found in plastics, radiation, cooking vessels, and cosmetics. Exposure to hazardous chemicals and metals can accumulate toxins in the body. If these chemicals are not flushed out of the system, there is a risk of endocrine disruptions leading to gene mutations and variations in gene expression. A high serum Bisphenol A (BPA) is a major endocrine disruptor leading to hyperandrogenism. (Srnovršnik et al., 2023)

Can PCOS cause hair loss?

Hair loss is a common symptom of PCOS. This is due to excessive androgens produced in the body that leads to hair thinning. Can you regrow lost hair?

Hair regrowth might not happen naturally, but medications and a healthy lifestyle can mask hair loss and prevent further hair loss. 

Are PCOS and PCOD the same?

PCOS and PCOD (polycystic ovarian disorder) project similar clinical symptoms but have different etiologies.

Immature eggs are released in case of PCOD that eventually develop into cysts. Unlike PCOS, PCOD does not release high amounts of male hormones. There will be noticeable symptoms and infertility. However, the symptoms can be controlled with lifestyle changes, diet, and medication. 80% of women achieve successful conceptions with minimal assistance and medication with PCOD.

(Do PCOD and PCOS Mean the Same Thing or Are They Different | UNICEF India, n.d.)

Can PCOS be reversed?

PCOS is a serious condition and an endocrine disorder that leads to infertility, diabetes, insulin resistance, high blood pressure, heart disease, and obesity. PCOS cannot be reversed but can be managed with a healthy lifestyle and exercise. Pharmacotherapy (medication) is the primary intervention accompanied by a healthy diet and a stress-free life.

Remedial measures for women suffering from PCOS are:

• Stabilizing hyperandrogenism (excessive androgen levels), thyroid function, and other endocrine functions is an active intervention for PCOS.

• Women with PCOS are also advised to take inositol to improve ovulation rate and regulate menstrual cycles. (How to Improve Fertility in Women with Anovulatory Polycystic Ovary Syndrome (PCOS). – GREM – Gynecological and Reproductive Endocrinology & Metabolism, n.d.)
• Maintaining adequate levels of vitamin D and B12 levels is very crucial. 
• Limited usage of plastic, radiation, and other hazardous chemicals is highly recommended.
• Controlling and monitoring blood sugar levels either with diet or metformin (diabetic medication) is a precautionary step with PCOS. 
• Melatonin supplements can improve sleep and oocyte quality.

Can PCOS be Cured?

The symptoms of PCOS may vary from person to person. Some women have extreme symptoms while others might have mild symptoms. Although there is no permanent cure for PCOS, symptoms can be managed with:

• Maintaining sleep hygiene – prioritize quality sleep. 
• Avoid alcohol and tobacco usage.
• Seek professional help to relieve stress and pain in the body. This can be done through various physical activities like yoga, dance, walking, running, physiotherapy etc. 
• Monitor body weight and eating habits.
• Consider a dietitian to map your meals to suit your health goals.
• Monitor your blood glucose, lipid profile, and vitamin and mineral levels. 
• Address your symptoms and deficiencies with therapy and medication. 

Can PCOS patients get pregnant?

PCOS is often linked to early pregnancy loss (EPL). Early pregnancy loss is one of the high risks of PCOS owing to insulin resistance and endometrial dysfunction. 

Women with PCOS are at more risk of having miscarriages during their early months of pregnancy. 

It is observed that diabetes and insulin resistance are the major culprits playing a role in early miscarriages. Some challenges for pregnant women suffering from PCOS are:

• Early loss of pregnancy
• Gestational diabetes
• Preeclampsia
• Pregnancy-induced blood pressure
• Preterm birth

Can PCOS lead to infertility?

Infertility is imminent with women suffering from polycystic ovarian syndrome. It is hard to conceive without medical assistance. Lack of ovulation is one of the primary reasons for infertility. Studies have shown that women suffering from PCOS often suffer a loss in their early pregnancy stage. And women who make it to the advanced stages of pregnancy suffer from various health complications.

• Women with PCOS are recommended for Assisted Reproductive Technology (ART) which includes various fertility treatments to support conception. 
• In Vitro Fertilization (IVF) is the most common type of ART that is used to help women with PCOS.
• Laparoscopic ovarian drilling is a surgical treatment for PCOS that destroys the parts of ovaries that are responsible for producing androgens in excess. This step improves fertility rates. (Gomel & Yarali, 2004)
• Managing weight and regulating blood sugar should be primary interventions.
• Studies have shown that a combination of clomiphene-citrate and metformin works efficiently by increasing the ovulation rates for successful pregnancies.  (Dasari & Pranahita, 2009)
• Metformin is commonly used as an insulin sensitizer. It is observed that metformin acts on androgen and luteinizing hormone levels and can stabilize pregnancy output.(Kamalanathan et al., 2013)

(Polycystic Ovary Syndrome - Treatment - NHS, n.d.)

How much does a PCOS surgery cost?

• Laparoscopic ovarian drilling (LOD) is a dependable surgery alternative to clomiphene for women suffering from PCOS. LOD is a simple procedure performed on an outpatient basis and involves the destruction of androgen-producing stroma in the ovaries. 
• The pregnancy success rates range from 50-80%. 
• This procedure will cost from ₹30,000 - ₹ 100,000 depending upon multiple factors.
• However, this procedure involves complications like adnexal adhesions in a few cases. (Gomel & Yarali, 2004)

Can PCOS cause cancer?

PCOS has a risk of ovarian cancer, breast cancer, and endometrial cancer. Chronic exposure to estrogen is a probable risk factor for PCOS-associated cancers. However, studies have shown that the cancer risk should be confirmed by considering external factors like obesity, hypertension, diabetes, and other co-morbidities. 

Hence, it is important for all women to undergo cancer screening to be monitored regularly for any risk. (Carmina & Lobo, 1999)

Can PCOS cause bleeding after intercourse?

Bleeding after intercourse happens in cases where:

• There are cervical polyps. 
• Uterine polyps
• Trauma and tears in the vaginal walls.
• An infection 
• Inflammation in the cervix.
• Pre-cancer or cancer of the cervix, vagina, or endometrium.

Cysts on the ovaries might rupture when you ovulate, and this can cause light bleeding or spotting. 

PCOS alone does not cause excessive bleeding after intercourse. There can also be underlying issues. It is always advisable to get professional help.

Can PCOS patients drink milk?

There is no evidential support to infer that dairy has a negative effect on PCOS as there are very few studies conducted on this topic. Researchers observed that there is no proper evidence to say if there is any correlation between dairy and PCOS. 

Researchers also stated that there is no improvement in PCOS with fat-free or low-fat dairy products. Hence, it is mostly a personal choice depending on their symptoms. 

(Rajaeieh et al., 2014)

Can PCOS cause weight loss?

Women who do not see weight gain in spite of having PCOS are known to have lean PCOS. The symptoms and the diagnosis are the same. Women with lean PCOS have irregular periods, acne, infertility, insulin resistance, and excessive growth of coarse body and facial hair.

Women suffering from lean PCOS often have delayed diagnosis and long-term health consequences similar to people with overweight PCOS. 

The treatment approach to lean PCOS is similar to non-lean PCOS, considering their symptoms regardless of their weight. (Toosy et al., 2018)

References

• Bianchi, V. E., Bresciani, E., Meanti, R., Rizzi, L., Omeljaniuk, R. J., & Torsello, A. (2021). The role of androgens in women’s health and wellbeing. Pharmacological Research, 171. https://doi.org/10.1016/J.PHRS.2021.105758
• Carmina, E., & Lobo, R. A. (1999). Polycystic Ovary Syndrome (PCOS): Arguably the Most Common Endocrinopathy Is Associated with Significant Morbidity in Women. The Journal of Clinical Endocrinology & Metabolism, 84(6), 1897–1899. https://doi.org/10.1210/JCEM.84.6.5803
• Dasari, P., & Pranahita, G. K. (2009). The efficacy of metformin and clomiphene citrate combination compared with clomiphene citrate alone for ovulation induction in infertile patients with PCOS. Journal of Human Reproductive Sciences, 2(1), 18. https://doi.org/10.4103/0974-1208.51337
• Do PCOD and PCOS mean the same thing or are they different | UNICEF India. (n.d.). Retrieved May 7, 2024, from https://www.unicef.org/india/stories/do-pcod-and-pcos-mean-same-thing-or-are-they-different
• Gomel, V., & Yarali, H. (2004). Surgical treatment of polycystic ovary syndrome associated with infertility. Reproductive Biomedicine Online, 9(1), 35–42. https://doi.org/10.1016/S1472-6483(10)62107-4
• How to improve fertility in women with anovulatory polycystic ovary syndrome (PCOS). – GREM – Gynecological and Reproductive Endocrinology & Metabolism. (n.d.). Retrieved March 7, 2024, from https://gremjournal.com/journal/04-2020/how-to-improve-fertility-in-women-with-anovulatory-polycystic-ovary-syndrome-pcos/
• Kamalanathan, S., Sahoo, J. P., & Sathyapalan, T. (2013). Pregnancy in polycystic ovary syndrome. Indian Journal of Endocrinology and Metabolism, 17(1), 37. https://doi.org/10.4103/2230-8210.107830
• Polycystic ovary syndrome - Treatment - NHS. (n.d.). Retrieved May 7, 2024, from https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/
• Polycystic Ovary Syndrome (PCOS) | Johns Hopkins Medicine. (n.d.). Retrieved March 7, 2024, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos
• Prapas, N., Karkanaki, A., Prapas, I., Kalogiannidis, I., Katsikis, I., & Panidis, D. (2009). Genetics of Polycystic Ovary Syndrome. Hippokratia, 13(4), 216. https://doi.org/10.1016/s1472-6483(11)60572-5
• Rajaeieh, G., Marasi, M., Shahshahan, Z., Hassanbeigi, F., & Safavi, S. M. (2014). The Relationship between Intake of Dairy Products and Polycystic Ovary Syndrome in Women Who Referred to Isfahan University of Medical Science Clinics in 2013. International Journal of Preventive Medicine, 5(6), 687. /pmc/articles/PMC4085920/
• Srnovršnik, T., Virant-Klun, I., & Pinter, B. (2023). Polycystic Ovary Syndrome and Endocrine Disruptors (Bisphenols, Parabens, and Triclosan)—A Systematic Review. Life, 13(1). https://doi.org/10.3390/LIFE13010138
• Stener-Victorin, E., & Deng, Q. (2021). Epigenetic inheritance of polycystic ovary syndrome — challenges and opportunities for treatment. Nature Reviews Endocrinology 2021 17:9, 17(9), 521–533. https://doi.org/10.1038/s41574-021-00517-x
• Toosy, S., Sodi, R., & Pappachan, J. M. (2018). Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach. Journal of Diabetes and Metabolic Disorders, 17(2), 277. https://doi.org/10.1007/S40200-018-0371-5
• https://www.topdoctors.co.uk/medical-articles/why-i-bleed-after-sex#
• https://www.replens.com/fab-blog/what-causes-post-coital-bleeding-after-sex.aspx#:~:text=If%20you%20have%20PCOS%2C%20you,irritate%20already%20sensitive%20uterine%20tissue.