What is PCOS/PCOD?

Polycystic ovarian disease (PCOD) is a disorder characterized by the presence of multiple cysts in the ovaries and is developed due to hormonal imbalance in young and middle-aged females. PCOD is very commonly found in clinical practice and affects about 10-15% of young females. Polycystic Ovarian Syndrome (PCOS) is the metabolic and systemic disturbance associated with PCOD and has long-term clinical implications. It is seen that in many patients they co-exist, and hence these terms are often used interchangeably in clinical practice.

What are the symptoms of PCOS?

The classical manifestations of PCOS are irregular menses, unwanted hair (hirsutism), acne, hair fall, darkening of skin at the knuckles and nape of neck (acanthosis), and weight gain. Patients may also present with difficulty conceiving, frequent miscarriages, etc. also. The presence of cysts in the ovaries may also be detected in patients who have had an abdominal scan for an unrelated cause.

PCOS is a condition of hormonal and metabolic imbalance and affects the body in multiple ways on different systems. In the young, it may result in acne, hirsutism, and irregular menses. In a married woman, the disease may affect the lack of ovum release, leading to infertility in addition to the above complaints. In the middle-aged and elderly, the disease may lead to an increased risk of developing lifestyle disorders like diabetes, hypertension, obesity, and high cholesterol.

What causes PCOS?

The exact reason for the development of PCOS is not clearly elucidated in the studies so far. However, there are many reasons postulated to lead to the development of this condition. Firstly, children born with low birth weight have a higher risk of developing PCOS as adults. Patients who have a strong family history of diabetes are at a higher risk of having PCOS. Many genetic changes are responsible for the dysfunctional release of the hormones, leading to the production of excess insulin and androgens (male hormones) in the body. Moreover, environmental factors are also implicated in the excess use of chemicals and plastics that modify the internal environment of the fetus during the developmental stage.

When to Visit an Endocrinologist?

It is important to understand the disease and be aware of its natural history of the disease in order to mitigate the adverse consequences. Patients are advised to visit an endocrinologist if they have any of the symptoms as mentioned above and get a detailed hormonal evaluation. The awareness about the disease also helps in keeping the disease manifestations under check and also practises adequate lifestyle modifications to prevent the disease-related consequences.

There is an ethnic predisposition to the development of PCOS. Females of South Asian, Hispanic, and African descent have a higher risk of PCOS when compared with the Caucasian population. Hence, any female in India is considered to have a higher risk of developing PCOS due to the defective mechanisms in insulin and glucose metabolism.

What are the PCOS mimickers?

PCOS is a diagnosis of exclusion, thereby meaning that we need to rule out many other conditions that have a similar presentation. It is more important to eliminate other causes as the treatment of these is different from the management of PCOS. Hypothyroidism (under functioning of the thyroid gland), hyperprolactinemia (elevated prolactin hormone), and late onset congenital adrenal hyperplasia (LOCAH) are some of the causes that present with similar features of PCOS. A detailed family history, appearance and progression of the clinical features, and relevant blood tests help in the identification of the correct diagnosis.

My sister has been diagnosed with PCOS. How is it relevant to my family?

It is important to understand that all close relatives of the PCOS patients have the same genetic composition and may have some of the disturbances below the threshold for detection. The PCOS equivalent for males is the presence of early-onset androgenic alopecia (bald-head), excess hair growth, and the presence of metabolic disorders like diabetes and hypertension. Previous studies have shown that the immediate family members of a PCOS case have a higher risk of cardiovascular disorders than the general population. Hence, it is important to screen for metabolic and hormonal imbalances in all the family members of a patient with PCOS.

The complications of PCOS are many and include short-term and long-term effects. The short-term complications include subfertility, iron deficiency anemia, hyperpigmentation, and hirsutism. Long-term metabolic complications include diabetes, hypertension, obesity, fatty liver, cardiovascular events, endometrial cancer, and many other systemic disorders.

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