PolyCystic Ovary Syndrome (PCOS) is a common hormone disorder among women, affecting between 5% and 10% of women of reproductive age worldwide. While being the leading cause of infertility in women, identifying this condition becomes complex, as this Syndrome has several symptoms and one doesn’t have to exhibit all or a consistent set of them to be diagnosed with PCOS.
While the term “PolyCystic Ovary” refers to multiple ‘cysts’ in the ovaries, which is one of many symptoms associated with this disorder, Mensural Dysfunction and Hyperandrogenism are also considered as the significant conditions indicating PCOS during the diagnosis.
Symptoms triggered by polycystic ovaries, chronic anovulation and hyperandrogenism leads to prevalent health issues in women like irregular menstrual cycles, hirsutism, acne and infertility.
Irregular periods (Mensural Dysfunction)
Infrequent menstrual cycles that are longer than normal menstrual cycles (Oligomenorrhea) or prolonged lack of menstrual (Amenorrhea) are the most common among symptoms of PCOS.
The irregularities in menstrual cycle are caused by to the fuss in the ovulation process due to the altered hormonal environment.
Excess androgen (Hyperandrogenism)
Elevated androgen (male hormone) levels is the most important one among the various criteria to diagnose PCOS. Elevated levels of androgen in women may cause excess growth of terminal hair in the face and body (hirsutism), and sometimes severe acne and male-pattern baldness (androgenic alopecia).
Increase in the androgen levels are produced as the result of biological synthesis of steroids (Steroidogenesis) occurring within the ovary and the adrenal. Other organs that may be affected by PCOS include the liver, pancreas, muscle, fat and blood vasculature.
When size of one or both ovaries is increased, the ‘cysts’ seen in enlarged ovaries are actually the follicles or eggs that have matured but were not released at ovulation.
In a normal menstrual cycle, one egg matures and is released each month through ovulation. PolyCystic Ovaries the multiple cysts with fluid-filled sacs stay in the ovary, giving the appearance of multiple small cysts.
While the exact cause of PCOS is unknown, conditions that are found commonly to play a role includes insulin resistance, Obesity, Low-grade inflammation and Heredity
Insulin resistance and compensatory increase in the levels of insulin circulating in the blood, makes it difficult for women with PCOS to control blood sugar levels, as the pancreas has to secrete larger amounts of insulin to keep blood sugar at a normal level. Insulin resistance affects 50%–70% of women with PCOS leading to one or more concurrent additional disorders including metabolic syndrome, hypertension, dyslipidemia, glucose intolerance, and diabetes.
Obesity increases the risk of developing PCOS and enhanced androgen production in an expanded fat mass. Alterations in secretion of Luteinizing Hormone (LH) play an important role in predicting increase in free testosterone in women who are obese.
Research studies have shown that increase in both low-grade inflammation and insulin resistance is associated with increased central fat excess rather than PCOS condition. The term ‘low-grade inflammation’ is used to describe white blood cells’ producing of substances to fight various infections. The lack of significant evidence on association of low-grade inflammation with androgens suggests that PCOS is not independently associated with low-grade inflammation.
Although repeated cases of PCOS in families support the role of heredity in the development of the condition, heterogeneity of its features in different families and even within the same family increases the influence and contribution of the environmental conditions.