Dr. Monu Sarin
What causes PCOS?
The exact cause of PCOS is not clear. Many women with PCOS have insulin resistance. This means the body can’t use insulin well. Insulin levels build up in the body and may cause higher androgen levels. Obesity can also increase insulin levels and make PCOS symptoms worse.
PCOS may also run in families. It’s common for sisters or a mother and daughter to have PCOS.
What are the risks for PCOS?
You may be more likely to have PCOS if your mother or sister has it. You may also be more likely to have it if you have insulin resistance or are obese.
Clinical Presentation – PCOS
Recurrent pregnancy loss / infertility +
All PCOD patients may not be obese. Some are thin
How is PCOS diagnosed?
Your health care provider will ask about your medical history and your symptoms and your complete physical examination. This checks your reproductive organs.
Some of the symptoms of PCOS are like those caused by other health problems. Because of this, you may also have tests such as:
Ultrasound: This test uses sound waves and a computer to create images of blood vessels, tissues and organs. This test is used to look at the size of the ovaries and see if they have cysts. The test can also look at the thickness of the lining of the uterus (endometrium).
Current Morphological Criteria of Polycystic ovaries on USG:
>=25 follicles per ovary
Increased ovarian volume (>10 cc)
Corpus lutea, Cysts or Dominant follicles should not be present
Ref Image 1
- USG Image polcystic ovary
Hyperechoic central stroma
Peripherally placed follicles: giving ‘string of pearl appearance’
Follicles of similar size, measuring 2-9 mm
MRI: not a routinely done investigation in PCOS
Blood tests. These look for high levels of androgens and other hormones.
Luteinizing hormone (LH) is usually increased.
Follicle Stimulating Hormone (FSH) can be normal or decreased.
LH:FSH ratio may be >2:1 or >3:1.
Your health care provider may also check your blood glucose levels. And you may have your cholesterol and triglyceride levels checked.
How is PCOS treated?
Treatment for PCOS depends on a number of factors. These may include your age, how severe your symptoms are, and your overall health. The type of treatment may also depend on whether you want to become pregnant in the future.
If you do plan to become pregnant, your treatment may include:
A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms.
Medications to cause ovulation.
If you do not plan to become pregnant, your treatment may include:
Birth control pills. These help to control menstrual cycles, lower androgen levels, and reduce acne.
Diabetes medication. This is often used to lower insulin resistance in PCOS. It may also help reduce androgen levels, slow hair growth, and help you ovulate more regularly.
A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms. They can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.
Medications to treat other symptoms. Some medications can help reduce hair growth or acne.
What are the complications of PCOS?
Women with PCOS are more likely to develop certain serious health problems. These include type 2 diabetes, high blood pressure, problems with the heart and blood vessels, and uterine cancer. Women with PCOS often have problems with their ability to get pregnant (fertility).
In the end I would like to conclude that it takes a team effort involving Endocrinologists, Gynaecologist and Radiologist to confirm the diagnosis of this disorder whose management is epicentered at life style modification and appropriate medication.
In SGT Medical college and hospital, we have ultrasound facility at a very affordable rate ,comparable with government hospital rates not a burden on patients pocket. Our aim should be to diagnose this disorder as early as possible and treat it with our best possible team.
Key of success lies in early diagnosis and early treatment by right person which is the vision and mission of every doctor in SGT.
(The author is a Professor in Department of Radio-diagnosis, Faculty of Medicine and Health Sciences, SGT University, Gurugram)