Polycystic Ovarian Syndrome (PCOS)
After sharing with you about endometriosis, let’s look at Polycystic Ovarian syndrome (PCOS). These two conditions have a few things in common. Both conditions are gynecological conditions affecting women in the reproductive age group (15–44 years). They also lead to significant infertility issues. They are also quite common; 1 in 10 women in the reproductive age group will suffer from PCOS, just as in endometriosis.
I know this condition might sound new to you, but that is probably because we don’t have a lot of research materials and statistics for this condition in our country. Most of the information, studies, statistics, and treatments options we have access to are from the developed countries.
The three main features of PCOS are; cysts in the ovary, high levels of male sex hormones (androgens) and irregular or skipped periods (anovulation).
In my attempts to find relatable studies and activities around PCOS, I came across one foundation right here in Kenya called PCOS foundation Kenya. It was formed in 2019. The founder, Ann Waichigo, was diagnosed with PCOS before getting married. The pressure that she experienced after getting her diagnosis was unimaginable. In one of her interviews, she shared her journey and struggle with PCOS. She championed the foundation and thanks to her, a lot of women in the country can now access information about PCOS and seek help. She provides a support group for women with the same condition (Cysters).
Getting a diagnosis with such a long name can make one feel alone. One would be mistaken to think that they are probably one in a hundred women suffering from this condition. The truth is you are not really alone. Studies show that 1 in 10 women in the US suffer from this condition. Do not let the long name trick you into thinking that it is a rare or foreign disorder.
What exactly is PCOS
This condition was first described by Stein and Leventhal in 1935. Polycystic means ‘many cysts’. A cyst is simply a fluid filled sac. PCOS is a syndrome, which means that it is a combination of many symptoms. The three main features of PCOS are; cysts in the ovary, high levels of male sex hormones (androgens) and irregular or skipped periods (anovulation).
The exact cause of PCOS is not known, but a few risk factors have been demonstrated i.e., excess insulin, genetics, low grade inflammation, excess androgen etc.
A Few Facts about PCOS
PCOS is the most common hormonal disorder in women of reproductive age (15–44 years). It affects up-to about 27% of women in the child bearing age. A lot of women, 70% to be precise, have this condition, but they don’t even know it. Only less than half are diagnosed correctly.
It is also one of the leading causes of infertility among women. However, this does not mean that women with PCOS cannot get pregnant. A common misconception about PCOS is that women diagnosed with this condition can never get pregnant. This is not entirely true. PCOS makes it hard for them to get pregnant. It is therefore a common but manageable cause of infertility. Ann for instance is a mother of two despite the struggle.
Signs and symptoms
- Irregular or infrequent periods
I am not talking about one or two missed periods. These patients usually get less than 8 periods in one year. They can also have abnormally heavy periods or more than 35 days between cycles.
- Excess Androgen
Some signs that imply excess male sex hormone levels include; excess facial or body hair (hirsutism), male pattern baldness, and occasionally severe acne.
- Polycystic ovaries.
These patients have enlarged ovaries that contain follicles with immature ova. These follicles never mature, hence they are not ovulated. This explains why the patients get irregular periods.
- Some women with PCOS also experience headaches.
- PCOS also affects a woman’s life emotionally. Women can experience clinical depression and anxiety. This is probably because it is associated with severe acne, excess body and facial hair; some women even develop a moustache. This can impact a woman’s self-esteem and self-image. One other thing that can cause emotional turmoil in a woman with PCOS is difficulty in conceiving. Women with this condition can go for a long time without getting pregnant and this, especially to the African woman, is not a thing to be taken lightly. The societal and family expectations can be too much to deal with.
The signs and symptoms are usually severe if the woman is obese or overweight.
What is the relationship between weight and PCOS?
Approximately, 80% of women with PCOS are usually overweight or obese. Most women with PCOS present with complaints of increasing obesity. This does not mean that all obese women have PCOS.
The relationship between PCOS and weight has to do with the ability of the body to use insulin properly. Insulin is a hormone released by the pancreas and is involved in the uptake of glucose into the body cells. When there is insulin resistance, it means that the cells can’t utilize insulin to absorb glucose from the blood. This leads to an increase in the level of glucose in the blood, which in turn triggers production of more insulin from the pancreas. Increased insulin levels also trigger the production of the male sex hormones. The excess insulin will often lead to symptoms of diabetes.
A study by Clark et al., demonstrated that a mean weight loss of 10.2 kg in a group of obese infertile women (of whom 80% had PCOS) resulted in spontaneous medically unassisted pregnancy in a third of the study group within 6 months.
In simpler terms, a lot of women with PCOS will be overweight or obese (abdominal) and obesity also makes the symptoms of PCOS worse. This is why loss of weight is an effective strategy in treating irregular menstrual cycles in women with PCOS. Loss of weight can help the patient get regular periods.
Can PCOS be treated?
There is no definite cure for this condition, but it can be well managed. Early diagnosis and treatment along with weight loss can help to reduce the risks of long term complications.
When should you seek medical advice?
- If you have missed periods and you are not pregnant. Some women “enjoy the break” and forget that it is unusual.
- If you have symptoms suggesting increased levels of male hormones such as excessive hair growth on your body/face, severe acne, male pattern baldness.
- If you have had unsuccessful attempts at getting pregnant for more than 12 months.
- Any symptoms that are suggestive of diabetes such as excessive thirst or hunger, frequent urination, blurred vision, unexplained weight loss etc.
