Irregular Menses in PCOS

Irregular Menses in PCOS

Polycystic ovarian syndrome (PCOS) is the most common endocrine pathology in females of reproductive worldwide.

One of the most common endocrine diseases affecting females of reproductive age globally worldwide is polycystic ovarian syndrome (PCOS). A female can be diagnosed with PCOS if she has chronic anovulation (absence of periods despite having follicles and viable oocytes), hyperandrogenism (condition of excess of androgens (male sex hormones), and polycystic ovaries (condition of enlarged ovaries with fluid-filled follicles)

There are various diseases that resemble the symptoms of PCOS such as thyroid disease, hyperprolactinemia, non-classical congenital adrenal hyperplasia, etc. Only an accomplished endocrinologist can correctly differentiate PCOS from other diseases.

PCOS Types

  1. Insulin Resistant PCOS: This is the major type of PCOS (Around 70%). In insulin resistance the body muscles cannot utilise the insulin secreted by the pancreas thus causing diabetes. This condition is also called hyperinsulinemia since the blood stream contains excess insulin. Weight gain, especially around the abdominal area is commonly seen in this disease.
  2. Post-Pill PCOS: This type of PCOS is seen developing some 3-6 months after stopping contraceptive pills. Researchers postulate that a natural spike in male hormones after hormonal contraception could be the cause. Irregular periods or no periods at all, combined with acne, and excess hair growth are the common symptoms.
  3. Adrenal PCOS: The increased levels of DHEA-S despite normal levels of androstenedione and testosterone (male hormones) can cause this type of PCOS. DHEA-S is a type of male hormone produced by the adrenal glands. It is commonly known to occur as an abnormal stress response. Menstrual dysfunction, unwanted hair growth, etc can be the common disorders.
  4. Inflammatory PCOS: Chronic inflammation can cause the ovaries to promote excessive testosterone which results in ovulation problems and other symptoms such as fatigue, headaches, joint pain, etc.

PCOS Symptoms

Common symptoms of PCOS include:

  • Irregular menses: disturbances in the menstrual cycle is one of the most common symptoms. Apparently it is seen in 75-85% of women suffering from PCOS and they present long and/or irregular menstrual cycles. Longer menstrual cycle length concurs with higher androgen levels.
  • Excessive hair growth (hirsutism): Hirsutism in PCOS could range from 70-80% affected women and occurs mostly due to excess production of male hormones. The endocrinologists may prescribe combined oral contraceptives as an intervention to decrease hirsutism in PCOS by suppressing male hormones.
  • Acne: One of the most common skin disorders, acne occurs due to sebum accumulation and colonization by Propionibacterium acnes (P. acnes). The male hormones in PCOS worsen acne formation by increasing sebum production which also causes oily skin.
  • Weight gain: PCOS and obesity are closely linked, and obesity is seen in 38 and 88% of women with PCOS. Insulin resistance is one of the most common factors for PCOS.
  • Infertility: A woman is said to be infertile if she is unable to be pregnant even after 12 months of regular unprotected sex. Usually, non-pharmacologic treatment is favoured first for infertility in the first line.

PCOS Causes

The exact cause of PCOS is unknown, but several factors are believed to play a role:

  • Hyperandrogenemia (increased male hormones production): One of the hallmark causes of PCOS is hyperandrogenemia (increased production of male hormones) by the ovaries is presented through hirsutism, acne, etc. This also causes oligomenorrhea (irregular periods).
  • Hyperinsulinemia (increased levels of insulin): Insulin resistance causes hyperinsulinemia. Insulin apart from initiating glucose metabolism can also induce steroidogenesis (production of steroids) and indirectly raises GnRH, resulting in the excessive androgen (male hormone) production. Male hormones in turn can cause PCOS.
  • Genetics: The complex pathophysiology of PCOS has multiple signalling pathways and proteins. PCOS may be developed polygenically (involving multiple genes) which affect fertility either directly or indirectly. it can run in families.

When to See a Doctor?

You should see a doctor if you experience PCOS signs like irregular periods, excessive hair growth, acne, or difficulty conceiving. It's particularly important to seek medical advice if your menstrual cycle is consistently irregular, as untreated PCOS can lead to complications like infertility, type 2 diabetes, or heart disease. Book an appointment with Dr. Prudwiraj Sanamandra today for expert evaluation and Polycystic Ovary Syndrome (PCOS) Management.

Risk Factors of PCOS

Certain factors increase the likelihood of developing PCOS:

  • Family history: PCOS risks are higher if a close female relative has the same ailment.
  • Obesity: Being overweight can exacerbate insulin resistance, worsening symptoms.
  • Sedentary lifestyle: Lack of physical activity can contribute to insulin resistance and weight gain, making PCOS more likely.
  • Age: Although PCOS can develop at any age after puberty, the symptoms often become more noticeable during the reproductive years.

PCOS Complications

Untreated PCOS can lead to several complications, including:

  • Infertility: Lack of ovulation affects a woman's ability to conceive.
  • Type 2 diabetes: Insulin resistance in PCOS can develop into diabetes over time.
  • Endometrial cancer: Women with prolonged absence of menstruation may have a higher risk of developing this type of cancer.
  • Heart disease and hypertension: The metabolic imbalances in PCOS can increase the risk of cardiovascular disease.

PCOS Prevention

Prevention focuses on managing lifestyle factors such as maintaining a healthy weight, exercising regularly, and following a balanced diet. Regular check-ups can help monitor symptoms and prevent long-term complications.

PCOS Diagnosis & Tests

This ailment is diagnosed through a combination of medical history, physical examination, and PCOS tests, including:

  • Blood Tests: To measure levels of androgens, insulin, and other hormones.
  • Pelvic Ultrasound: Used to examine the ovaries for the presence of cysts and assess the endometrial lining.
  • Glucose Tolerance Test: To check for insulin resistance or prediabetes.

PCOS Treatments

Treatment options for polycystic ovary syndrome (PCOS) depend on the patient's symptoms and goals:

  • Medications: Birth control pills regulate menstruation and reduce androgen levels. Anti-androgens, such as spironolactone, can help reduce excessive hair growth.
  • Lifestyle changes: Weight loss through diet and exercise can improve insulin sensitivity and restore regular menstrual cycles.
  • Fertility treatments: Clomiphene or letrozole may be used to stimulate ovulation in women who are trying to conceive.
  • PCOS Surgery: In rare cases, PCOS procedures such as ovarian drilling may be performed to reduce androgen levels and stimulate ovulation.

Do's and Don'ts

Do's:

  • Do maintain a healthy diet and exercise regularly. Weight loss can significantly improve PCOS symptoms and reduce the risk of complications.
  • Do monitor your menstrual cycle. Keeping track of your periods can help you detect irregularities early and seek timely medical attention.
  • Do consider medical treatment options. Medications like birth control or metformin can help regulate hormones and improve insulin resistance. Also, PCOS management should be thoroughly followed.
  • Consult endocrinologist for PCOS treatment risks: PCOS treatment has hormonal implications which could bring various PCOS treatment side effects. Only a competent endocrinologist can diagnose and treat side effects.

Don'ts:

  • Don’t ignore symptoms like irregular periods or excessive hair growth. These could be signs of an underlying hormonal disorder like PCOS.
  • Don’t skip regular check-ups. Monitoring hormone levels and managing symptoms is essential in preventing long-term complications.
  • Don’t rely solely on natural remedies. While lifestyle changes are crucial, medications may also be necessary to manage PCOS effectively.

Care at Dr. Prudwiraj Sanamandra Endocrinology Clinic

At Dr. Prudwiraj Sanamandra Endocrinology Clinic, we offer comprehensive care for women with PCOS, focusing on personalized treatment plans that address both hormonal imbalances and lifestyle factors. From accurate diagnosis to effective management strategies, our team ensures that each patient receives the highest standard of care. Schedule a consultation with Dr. Prudwiraj Sanamandra for expert guidance in managing irregular menses and other PCOS symptoms.

Call Now for Appointment