Polycystic Ovary Syndrome is a condition that affects about 27 per cent of women in their reproductive age (15-44 years). It is also a frequent cause of infertility. Between 70 and 80 per cent of women with PCOS have fertility problems.
Many women are not even aware they have the condition. In one study, up to 70 per cent of women with PCOS were undiagnosed. In our fertility practice, it was discovered that about one in six patients have PCOS.
As a rule, it is better to suspect every woman going through ovarian stimulation as a PCOS case because a surprise response can lead to complications. Women with PCOS usually suffer from lack of ovulation in their menstrual cycle. The ovaries of such women have multiple cysts in them, which are small, blister-like, immature follicles arranged like beads within the ovaries.
Physically, PCOS sufferers battle with excessive facial and body hair, as well as acne. This is because the condition causes a woman to produce higher-than-normal amounts of male hormones. The resulting hormonal imbalance causes them not to ovulate, skip menstrual periods and makes it harder to get pregnant. They also have insulin resistance, which limits the ability of their bodies to respond to the hormone, insulin, in controlling their blood sugar. PCOS can thus contribute to long-term health problems, such as diabetes and heart disease.
How PCOS develops
PCOS affects a woman’s ovaries, which are the reproductive organs that produce oestrogen and progesterone (hormones that regulate the menstrual cycle) and a small number of male hormones called androgens. Every month, under the influence of the hormones FSH and LH produced by the pituitary gland in the brain, the ovaries release an egg for fertilisation by a man’s sperm. This monthly release is called ovulation.
First, the FSH stimulates the ovary to produce a follicle (a sac that contains an egg). Then the LH triggers the ovary to release the egg when it matures from inside the follicle.
In PCOS, many of these follicles are stimulated. But instead of healthy eggs, which grow to maturity, the follicles are filled with fluid (become cysts) and immature eggs, which never mature enough to trigger ovulation. The word “polycystic” means “many cysts.”
The three main features of PCOS are cysts in the ovaries, high levels of male hormones and irregular or skipped periods.
The lack of ovulation alters the levels of oestrogen, progesterone, FSH, and LH. Oestrogen and progesterone levels are lower than usual, while androgen levels are higher than usual. Extra male hormones disrupt the menstrual cycle, and this is why women with PCOS get fewer periods than usual.
What causes PCOS?
The exact cause of PCOS is unknown. Doctors believe that high levels of male hormones, which prevent the ovaries from producing hormones and making eggs as they should, are the underlining factor. This factor is considered to be linked to:
Genes: Studies show that PCOS runs in families. It is likely that many genes, not just one, contribute to the condition.
Insulin resistance: Up to 70 per cent of women with PCOS have insulin resistance, meaning that their cells can’t use insulin properly. Insulin is a hormone produced in the pancreas to help the body to use sugar from foods for energy. When cells are unable to use insulin properly, the body’s demand for the hormone increases. The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones.
Obesity: A significant cause of insulin resistance. Both obesity and insulin resistance can increase your risk of type 2 diabetes.
Inflammation: Women with PCOS often have increased levels of inflammation in their bodies. Being overweight can also contribute to inflammation. Studies have linked excess inflammation to higher androgen levels.
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