PCOS - side effects

Such is made of the fact that polycystic ovary syndrome (PCOS) is one of the main causes of infertility in women.

What's not as well known is that it may also lead to other serious complications such as cardiovascular disease, high blood pressure and diabetes. These conditions may be fatal unless they're diagnosed in good time. In fact, PCOS sufferers are seven times more likely to develop cardiac problems than non-sufferers.

They also run the risk of developing high blood pressure, while 40 per cent of PCOS sufferers develop Type 2 diabetes by the age of 40. PCOS manifests in women during their fertile years, in other words before menopause. Four to 10 per cent of women suffer from the syndrome, yet the symptoms often remain undetected, so many women don 't even realise they have it.

This is because many PCOS symptoms are subtle or may be confused with other causes. For instance, if a woman suddenly starts gaining weight or she menstruates for longer than usual, it 's often attributed to stress or lifestyle changes. But these are also symptoms of PCOS. If the disease is diagnosed at an early stage the sufferer 's plight can be eased considerably.

The symptoms of PCOS are that the sufferer stops menstruating or menstruates for excessively long periods, there are often cysts on her ovaries, she's overweight,she has excessive facial and bodily hair, the hair on her head starts thinning, and she could be diabetic as well as infertile. Not all sufferers have all these symptoms.

The condition?
Although PCOS was identified 75 years ago doctors are still not sure why certain women develop it. There is an indication that it occurs in some families. There is no cure for PCOS, but the symptoms can be treated with medication, diet and exercise.

The syndrome probably develops when a fault occurs in the enzyme that controls the ovary sex hormones. This causes an increase in the production of male hormones called androgens (of which testosterone is one). Under normal circumstances numerous follicles grow in the ovaries during each menstrual cycle and they form eggs.

During ovulation (in the middle of the cycle) one of the eggs is released so that it can be fertilised while the others ripen and break off. When there is an excess of androgen present, the follicles don't grow properly, so the egg is not released and forms a cyst instead.

The higher androgen levels can also affect the feedback process between the pituitary gland and the ovaries, causing even more androgen to be produced. This results in excessive growth of facial hair, and acne. Researchers have also found a link between PCOS and insulin resistance (when the body doesn't utilise insulin properly).

In the case of insulin resistance the body is inclined to store more fat than it should, affecting cholesterol and lipid metabolism as well as blood pressure. Insulin resistance also causes an increase in the production of androgen in the ovaries. This hormonal imbalance will in turn result in additional fat accumulation on the stomach, which in turn exacerbates the insulin resistance.

How is it diagnosed?
Your doctor will send you for a transvaginal ultrasound scan. Cysts are often detected although there may be no other symptoms.Because the other symptoms may develop later if you gain weight and aren't very active, your doctor should check that your weight and body mass index (BMI) are normal. She should also measure your waistline because there is a strong association between an increase in waistline and insulin resistance. A waist measurement of more than 80cm is risky,and over 88cm is considered a high risk for insulin resistance, irrespective of BMI.

Your hormone levels will also be tested during the different stages of your menstrual cycle and a fasting glucose or glucose tolerance test can be done in conjunction with a fasting insulin test to check if you 're a diabetes risk. It's estimated that 30 to 60 per cent of sufferers are insulin resistant. A cholesterol profile will be taken and your blood pressure measured. Your doctor will also ask you questions about your menstrual cycle. If you have facial hair or acne these symptoms can be treated, depending on their severity.

What you should know
PCOS sufferers have a tendency to insulin resistance,which makes them susceptible to Type 2 diabetes by the age of 40. It also increases the risk of pregnancy diabetes.

Then there is the danger that insulin resistance, along with the other side effects of PCOS, such as abnormal cholesterol levels and overweight, makes the sufferer a definite candidate for cardiovascular disease. The risk of endometrial cancer is three times greater than usual because ovulation has ceased. The emotional pain of infertility and the embarrassment caused by excess facial hair and acne are all additional complications.

Eat healthily
Losing only two to five per cent of the weight around your waist will help to reduce the fat on your stomach. A leaner stomach in turn helps to improve insulin resistance and can even result in ovulation. Avoid crash diets and try to lose weight at a safe rate of 0,5kg a week. Do not starve yourself or eat only once a day because this can exacerbate insulin resistance.If you suffer from PCOS and have to contend with the threat of diabetes and heart disease, you should ask your doctor or a registered dietician to devise a diet plan to suit you.

Exercise regularly
Exercise not only helps you lose weight, it 's also good for your heart and plays an important role in dealing with insulin resistance. Thirty minutes of exercise a day is recommended, or an hour- long workout three to four times a week.

Stop smoking
Research has shown that there is a connection between smoking and infertility. Smoking is also associated with fat accumulation on the stomach. In addition, there are indications that smoking stimulates the production of adrenal androgens. Even if you 're not insulin resistant or overweight, lifestyle changes are still necessary to ensure you don't gain weight later on and develop insulin resistance.

Your doctor can prescribe insulin-sensitising medication for three to four months. This treatment goes hand-in-hand with exercise and diet management. A contraceptive pill can be prescribed for women who don 't want to fall pregnant to regulate hormone levels during the menstrual cycle. The Pill can also help to alleviate acne and problems with excess hair.

Fertility treatment
There are several treatments,depending on the patient 's personal circumstances. In some cases weight loss can help, while in others medication is necessary. Medication that stimulates the ovaries to grow the follicles and ensure the egg is released during ovulation is available. Alternatively the patient can be injected with synthetic hormones. A laparoscopic ovarian drill procedure is a surgical method used to encourage ovulation. But it may leave scars on your ovaries, reducing your chances of falling pregnant.

The good news: Some of the symptoms of PCOS can be overcome with lifestyle changes. Sufferers are encouraged to watch their weight, exercise regularly and stop smoking.

Image: Nadette Clare-Talbot/ True Love magazine

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