A Review of Polycystic Ovarian Syndrome (PCOS)
It was previously believed that PCOS only affects women of reproductive ages. However, recent research suggests that PCOS affects the whole life of a woman. It starts inside the womb, showing clinical symptoms during puberty and progressing during adulthood. Symptoms of PCOS affect the quality of life and put women at risk for the development of multiple morbidities, including obesity, insulin resistance, type II diabetes, cardiovascular morbidities, infertility, cancer, and psychological disorders such as depression and mood swings. Therefore, early diagnosis and treatment are crucial to prevent a threat to mental and physiological well-being.
The wide range of symptoms makes the diagnosis of PCOS difficult. These symptoms may vary by age, but PCOS symptoms typically manifest as an abnormal production of male hormones (hyperandrogenism), menstrual irregularities, and the presence of cysts in ovaries. Individuals with all three symptoms are at the most risk of developing comorbidities and should be frequently screened. Other symptoms include excessive body hair (hirsutism), excessive acne on the face, and premature puberty. Furthermore, younger women mainly complain about reproductive and psychological problems while older women complain about metabolic and chronic morbidities.1
Diagnosis is especially difficult in adolescence. Normal physiological events related to puberty tend to mimic signs and symptoms of PCOS.1 For example, a natural increase in male hormone (testosterone) levels during puberty can be mistaken with the abnormal elevation of the hormone, characteristic of PCOS. Furthermore, diagnostic criteria for excessive body hair do not take into consideration individual and ethnic variabilities, and the presence of acne is common in individuals undergoing puberty. This complicates early clinical diagnosis and treatment.
They have a saying for the treatment of PCOS: it takes a village! Management of PCOS targets the range of symptoms that patients usually present with. This can include visits to a family practitioner, a gynecologist, an endocrinologist, a dermatologist, a pediatrician, a psychiatrist, and a psychologist. Oral contraceptives (OCPs) are usually considered the first line of treatment for PCOS. OCPs are effective in lowering male hormone levels. They attenuate menstrual disturbances, help in the management of excess body hair, and prevent thinning of scalp hair.
However, the use of OCPs is controversial. Individuals undergoing OCP treatment might develop a range of side effects and need to be screened for possible side effects. OCPs might negatively affect the cardiovascular profile of the individual and can increase the risk of complications such as coronary artery blockage and heart attack.2 OCPs might also worsen the metabolic profile of the individual, cause accumulation of adverse fats in the blood (hyperlipidemia), decrease the action of insulin, and increase the risk for development of type II diabetes.3 Furthermore, women often become aware of their PCOS diagnosis when they face barriers to becoming pregnant. Oral contraceptives prevent conceiving and therefore, cannot be used by individuals planning to get pregnant.
Inositol supplements hold promising grounds for the management of PCOS. Emerging research suggests that the use of D-chiro-inositol and Myo-inositol manage excess hair, acne, female-pattern hair loss, irregular menses, male hormone production, infertility, and insulin resistance.4 Management of insulin resistance alone is effective in preventing many cardiometabolic diseases including obesity, type II diabetes, hypertension, whole-body inflammation, metabolic and cardiovascular disorders. Women with PCOS may also take advantage of topical acne treatment and physical hair removal modalities. Doing so can improve body image and increase the self-confidence of the individual.
Lifestyle modification with increased physical activity and attention to healthful eating patterns are a crucial part of the management of PCOS-derived chronic comorbidities such as obesity, type II diabetes, ovarian cancer, and atherosclerosis. Women undergoing an exercise intervention (3 weekly sessions of 45min moderate aerobic activity) concurrent with a diet intervention (protein-rich diet with 800kcal daily deficiency) benefit from a significant decrease in body weight, improved menses, improved lipid profile, decreased diabetic symptoms, as well as better physical capacity and quality of life.4
Author: Parsa Nafari, Bachelor of Science, Kinesiology
Reviewed by: Dr. Pari Saharkhiz, M.D.
Reference as they appear in the article
1 Hayek, S. E., Bitar, L., Hamdar, L. H., Mirza, F. G., & Daoud, G. (2016). Poly Cystic Ovarian Syndrome: An Updated Overview. Frontiers in Physiology, 7. doi:10.3389/fphys.2016.00124
2 Stampfer, M. J., Willett, W. C., Colditz, G. A., Speizer, F. E., & Hennekens, C. H. (1989). A Prospective Study of Past Use of Oral Contraceptive Agents and Risk of Cardiovascular Diseases. Studies in Family Planning, 20(3), 181. doi:10.2307/1966576
3 Hee, L., Kettner, L. O., & Vejtorp, M. (2012). Continuous use of oral contraceptives: An overview of effects and side-effects. Acta Obstetricia Et Gynecologica Scandinavica, 92(2), 125-136. doi:10.1111/aogs.12036
4 Wojciechowska, A., Osowski, A., Jóźwik, M., Górecki, R., Rynkiewicz, A., & Wojtkiewicz, J. (2019). Inositols’ Importance in the Improvement of the Endocrine–Metabolic Profile in PCOS. International Journal of Molecular Sciences, 20(22), 5787. doi:10.3390/ijms202257875 Yildiz, B. O. (2016). Contraceptives, exercise and diet — are all three needed in PCOS? Nature Reviews Endocrinology, 12(8), 438-440. doi:10.1038/nrendo.2016.106