Everything you need to know about polycystic ovary syndrome (PCOS)

The thought that Tracy Wahito would struggle to bear children was one of those things that she would never have imagined. But a year after getting married and trying for a baby, she had failed to conceive.

“I began to fear that something might be wrong. But I didn’t reach out to anyone at first. I kept hoping. Month after month, I would wait for delayed periods but my cycle was always on time,” she says.

There were days when she would have pregnancy symptoms, get mood swings, and even miss her period... only for it to make a violent comeback.

“I slowly began to feel crushed. I decided to see a gynecologist at Kikuyu Hospital. I remember procrastinating a lot. I was afraid of being told I had a problem,” she says. But the doctor was reassuring. He told her it could have been anything from nerves to anxiety, and advised that she gives it a bit more time.

She waited for some months then decided to get a second opinion. “I underwent ultrasound scans and a hysterosalpingogram (HSG tes, which tests for blocked Fallopian tubes), as well as a trans-vaginal ultrasound which tests the uterus, ovaries, tubes, cervix, and pelvic area,” she says.

“These tests were not only costly, but painful as well. I contracted fevers, vomited regularly, and suffered sharp pains in my lower stomach. The results came in with a diagnosis. I had polycystic ovarian syndrome (PCOS),” she says. 

What is polycystic ovary syndrome?

When your ovaries produce an abnormal amount of androgens, your doctor might diagnose you with PCOS. According to the Centre for Disease Control (CDC), this condition occurs when the woman’s ovaries produce more androgens than normal.

Androgens are the male sex hormones that are found in women in small amounts. Lancet Kenya cites that PCOS is the most common hormone disorder in women. It is also one of the leading causes of infertility, and affects roughly five to 10 per cent of women of childbearing age. This condition can affect girls as young as 11.

The CDC says one result of PCOS is that cysts (fluid-filled sacs) develop on the ovaries. “Women who are obese are more likely to have PCOS. Women with PCOS are at increased risk of developing Type 2 diabetes, high blood pressure, problems with the heart and blood vessels, and uterine cancer.

Symptoms

According to the CDC, symptoms of PCOS may vary, but will mostly include: 

• Infertility
• Enlarged ovaries with cysts
• Pelvic pain
• Excess hair growth on the face, chest, stomach, thumbs, back, buttocks, or toes
• Baldness or thinning hair
• Acne, oily skin, or dandruff
• Patches of thickened dark brown or black skin
• Urinal or fecal incontinence 

According to the Kenya Laparoscopic Surgery Services (KLASS) which offers treatment for PCOS, eating a balanced diet goes a long way towards alleviating some of the symptoms associated with it. For instance, a balanced meal will help you avoid constantly fluctuating levels of glucose and insulin in your bloodstream.

“If you continuously consume a high-carbohydrate diet, eventually, cells trying to protect themselves from glucose overload will not respond well to insulin,” KLASS cites in their PCOS guide.

“Excess sugar levels in the bloodstream cause the proteins in the body to malfunction, which may lead to a decrease in the effectiveness of the immune system, may damage blood vessels, and negatively affect connective tissues in the joints.”

Diagnoses

Polycystic ovary syndrome can be diagnosed through an ultrasound or through blood tests. According to Johns Hopkins Medicine, the ultrasound examines the size of the ovaries to determine if there are any cysts present.

This test also examines the thickness of the lining of the uterus. This lining is known as endometrium. On the other end, blood tests are taken to examine the presence of hormones such as high levels of androgens.

There are three main features that characterise PCOS. These include:

• Irregular periods: General physician Dr. Patrik Kihiu says this when the length of your menstrual cycle keeps changing. Your menstrual cycle refers to the gap between the start day of your periods. The average menstrual cycle lasts 28 days. It could however be shorter or longe,r but not by a lengthy period. 
• Excess androgen: When you have very high levels of male hormones. These hormones might result in changes in your body, including the presence of excess body hair. 
• Polycystic ovaries: When your ovaries become enlarged and contain many fluid-filled sacs or follicles that surround the eggs.

Causes

According to Johns Hopkins Medicine, the exact cause of PCOS is not known. However, there are various factors that appear to predispose women to having this condition.

For instance, the majority of women who are diagnosed with PCOS also tend to have high levels of insulin resistance. “Their bodies are unable to use insulin appropriately. This results in the build-up of insulin levels in the body, which trigger a rise in androgen levels,” cites Johns Hopkins Medicine.

Also, women with obesity are at an increased risk of aggravated symptoms of PCOS. This is largely due to the increased levels of insulin that come with obesity.

PCOS is also genetic. According to Johns Hopkins Medicine for instance, this syndrome is common among sisters or a in a mother and her daughter where the genetic factor is the main cause.

Treatment

According to Johns Hopkins Medicine, treatment for PCOS will depend on whether the patient is trying to get pregnant or not. If the patient is not trying, treatment might include birth control pills that will be prescribed to control her menstrual cycle, reduce the impact of acne, and lower her androgen levels.

“Diabetes medication might also be used to lower insulin resistance, and a healthy diet will also be recommended,” cites Johns Hopkins Medicine. If the patient is trying for a baby, she will be recommended to take a healthy diet that will enable their body to process insulin more properly, lower their blood glucose levels, and support ovulation.

According to KLASS, the patient may also be recommended for a minimal ovarian laparoscopic surgery as a last line of treatment.

Although treatment with medications that support ovulation is also part of the treatment regimen, Johns Hopkins Medicines says this could trigger abdominal bloating and pelvic pain, and ovarian hyperstimulation (where the patient’s ovaries release too many hormones).