The menstrual cycle is essential to a woman’s reproductive health but can be challenging. Having an irregular menstrual cycle was a relief for Ella Brian (pseudo name) rather than a bother until she found out there was more to it.
Ms Brian, who had observed early in secondary school that she was not having a regular menstrual cycle like other girls, didn’t think much of it until years later when she was diagnosed with Polycystic Ovary Syndrome (PCOS).
“I started noticing my PCOS symptoms in JSS 3 to SS1. I started menstruation early at age 10. In secondary school, I noticed that everybody was menstruating, but I wasn’t. I wasn’t bothered because I felt like, oh, I’m not going to wear a pad, so I was free. In a year, I will just menstruate like two or three times,” she narrated.
This experience was different for Ann Ngele (pseudo name), who was more concerned by the inconsistent flow.
“It first started with me not seeing my period, but I didn’t think anything of it. I just wasn’t finding it easy menstruating anymore. I could go six months without seeing my period, so it started to bother me,” she explained.
According to the World Health Organisation (WHO), up to 70% of affected women remain undiagnosed worldwide, meaning many may suffer from this condition and not even realise it.
In celebration of World PCOS Day, marked every September 1, this article looks at this condition, its symptoms and treatment options.
What is PCOS?
Polycystic ovary syndrome (PCOS) is when you have few, unusual or very long periods, often due to too much androgen.
John Hopkins Medicine explains that it is a condition where the ovaries produce an abnormal amount of androgens (male sex hormones that are usually present in women in small amounts).
Polycystic ovary syndrome describes the numerous small cysts (fluid-filled sacs) that form in the ovaries. Although some women with this disorder do not have cysts, others without it can develop it.
When many small sacs of fluid develop on the ovaries, they may fail to release eggs (ovulate). Ovulation occurs when a mature egg is released from an ovary to be fertilised by a male sperm. If the egg is not fertilised, it is sent out of the body during menstruation.
PCOS, a “syndrome” or group of symptoms that affect the ovaries and ovulation, has three main features: cysts in the ovaries, high levels of male hormones and irregular or skipped periods.
What causes PCOS?
- Hormonal Imbalance
The exact cause of PCOS is unclear, but an article by Healthline noted that an imbalance of androgens causes it.
2. Insulin Resistance
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 run in families as it’s common for sisters or a mother and daughter to have PCOS. This means 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.
Women with PCOS often have increased levels of inflammation in their bodies, and being overweight can also contribute to inflammation. This study has linked excess inflammation to higher androgen levels.
What are the symptoms of PCOS?
Sometimes, a woman doesn’t make enough of the hormones needed to ovulate. When ovulation doesn’t happen, the ovaries can develop many small cysts, making hormones called androgens. The high levels of androgens can cause more problems with a woman’s menstrual cycle and many of the symptoms of PCOS.
The symptoms of PCOS may include missed periods, irregular periods, very light periods, and ovaries that are large or have many cysts. It can also include weight gain, especially around the belly (abdomen), acne or oily skin. Most of these symptoms were similar to those of Ms Brian and Ngele.
How is PCOS diagnosed?
There is no single test to diagnose PCOS, but your doctor will start by asking about the patient’s menstrual history.
Subsequently, your doctor can request several tests or procedures to help determine your condition. Some of these tests include a pelvic exam (to check your reproductive organs for masses, growths or other changes), blood tests (to measure hormone levels) and an ultrasound (to check the appearance of your ovaries and the thickness of the lining of your uterus).
When diagnosed with PCOS, your doctor might recommend more tests to check for complications. These tests can include regular checks of blood pressure, glucose tolerance, cholesterol and triglyceride levels, screening for depression and anxiety and screening for obstructive sleep apnea.
What is the treatment for PCOS?
Treatment for PCOS starts with lifestyle changes like weight loss, diet, and exercise. Losing five to ten per cent of your body weight can help regulate your menstrual cycle and improve PCOS symptoms. Weight loss can also improve cholesterol levels, lower insulin and reduce heart disease and diabetes risks.
Below are some of the common medical treatments for PCOS or its symptoms:
- Birth control pills
According to Healthline, birth control pills and diabetes drugs that combat insulin resistance can help fix the hormone imbalance and improve symptoms.
The American College of Obstetricians and Gynaecologists states that combined hormonal birth control pills can be used for long-term treatment in women with PCOS who do not wish to get pregnant.
These combined hormonal pills contain oestrogen and progestin that can regulate the menstrual cycle and reduce hirsutism and acne. They can also reduce the risk of endometrial cancer.
This explains why both Ms Brian and Ngele were given birth control pills to manage their PCOS, although they stopped taking it due to the body changes they noticed.
- Fertility Drugs
A fertility drug like Clomiphene (Clomid) helps women with PCOS get pregnant. It’s important to note that, as you’re discussing family planning, remember that clomiphene increases the chances of twins and other multiple births.
Letrozole (Femara), a breast cancer treatment, can work to stimulate the ovaries, while Gonadotropin, a hormone medication, is given by injection.
- Diabetes drugs
Metformin (Glucophage, Fortamet), a drug used to treat type 2 diabetes, also treats PCOS by improving insulin levels.
- Hair removal medications
Eflornithine (Vaniqa) cream is a prescription drug that slows hair growth. Laser hair removal and electrolysis are options to eliminate unwanted hair on your face and body.
Surgery is an option to improve fertility if other treatments don’t work. Ovarian drilling is a procedure that makes tiny holes in the ovary with a laser or thin heated needle to restore normal ovulation.
NOTE: If you have PCOS, plan regular visits with your primary care doctor who is trained in female reproductive medicine (gynaecologists), hormone disorders (endocrinologists) and infertility (reproductive endocrinologists). You will need regular tests to check for diabetes, high blood pressure, and other possible complications.
PCOS can disrupt a woman’s menstrual cycle and make it harder to get pregnant. However, as medical professionals recommend, lifestyle changes are a good point to start treatment. For medications, please consult a doctor.