Q. I am 35 years old and single. I have been diagnosed with PCOS recently because of irregular and heavy periods. My gynae asked me to take oral contraceptive pills to regulate the menses. I am not very keen. Is there any alternative? What will be the consequences if I am not treated?
A. PCOS or Polycystic ovarian syndrome is a common disorder caused by an imbalance of reproductive hormones. It affects about 10-15% of women of reproductive age.
There are 3 components in this disorder:
1. Irregular ovulation resulting in absent, irregular, infrequent or prolonged periods that may be scanty or heavy.
2. Excess male hormones resulting in excess body and/or facial hair, severe acne, thinning of hair and weight gain.
3. Enlarged polycystic ovaries on ultrasound examination. The ovaries contain numerous small fluid-filled sacs(follicles) which surround the eggs.
The exact cause of PCOS is unknown but the following factors may play a role:
Excess Insulin: Insulin is the hormone produced by the pancreas that allows cells to use sugar (glucose). In PCOS, there is increased insulin production. This causes the ovaries to produce more male hormones which then interfere with the growth and release of eggs from the ovaries (ovulation).
Low-grade inflammation. Research studies have shown that in PCOS, there is low-grade inflammation which causes the ovary to produce more male hormones.
Heredity: Certain genes are found to be linked to PCOS.
Women with PCOS require long-term care as there is no cure for this disorder. They have increased risk for the following conditions especially if obesity is also present.
· Infertility
· Abnormal uterine bleeding
· Cancer of the uterine lining (endometrial cancer)
· Gestational diabetes or pregnancy-induced high blood pressure
· Type 2 diabetes
· Metabolic syndrome with increased risk of cardiovascular diseases e.g. stroke and heart attack
· High blood pressure
· Cholesterol and lipid abnormalities
· Severe liver inflammation caused by fat accumulation of fats in the liver
Treatment of PCOS has to be individualised. Keeping your weight in check by dietary control and exercise will help restore ovulation.
Since your main concern is menstrual irregularities and you are not comfortable taking oral contraceptive pills to regulate your menstrual cycle, an alternative approach is to take progesterone for 10 to 14 days every month. This type of progesterone therapy regulates your periods and offers protection against endometrial cancer, but it doesn't reduce the male hormone levels.
You may also try taking metformin, an oral medication for diabetes that improves insulin resistance and lowers insulin levels. This drug may help with ovulation and lead to regular menstrual cycles. Metformin may also slow the progression to type 2 diabetes if you already have prediabetes and helps in weight management if your BMI is high.