Root causes of pcos
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Polycystic Ovarian Syndrome (PCOS) is one of the most common metabolic & reproductive disorders amongst women of reproductive age.
What are the symptoms
One may experience a range of symptoms :
- Irregular periods (more or less often than monthly)
- excess hair growth on the face, stomach, back
- loss of hair on the top of the scalp
- Severe acne
- Unexplained weight gain or weight loss (lean PCOS)
- difficulties getting pregnant
- emotional challenges (depression and/or anxiety)
- increased risk of diabetes with earlier onset
- sexual health challenges
- low self-esteem & poor body image issues
* The symptoms of PCOS vary between women & at different life stages.
Although there have been various PCOS criteria established i.e. (1) National Institutes of health criteria, (2) Rotterdam criteria, (3) Androgen Excess & PCOS Society but Rotterdam criteria are the most widely accepted.
Rotterdam criteria says one must have at least 2 of the below 3 findings to be diagnosed with PCOS:
1. Hyperandrogenism: excessive acne, androgenic alopecia, or hirsutism; or chemically, by elevated serum levels of total, bioavailable, or a free testosterone or DHEA-S
2. Ovulatory dysfunction: Either oligomenorrhea (cycles more than 35 days apart but less than six months apart or amenorrhea (absence of menstruation for six to 12 months after a cyclic pattern has been established).
3. Polycystic ovaries: ovary containing 12 or more follicles ‘ fluid-filled sacs’. (or 25 or more follicles using new ultrasound technology) measuring 2 to 9 mm in diameter. And/OR an ovary(s) that has a volume of greater than 10 mL on ultrasonography.
Who is responsible for producing Key Hormones?
The Pituitary gland in our brain makes the luteinizing hormone (LH) & follicle stimulating hormone (FSH). These hormones stimulate follicular growth and ovulation
Our Ovaries ; after getting the signal from these LH & FSH hormones, make female sex hormones - estrogen and progesterone. That help prepare the uterus for menstruation. Our ovaries also make a little bit of the androgen- testosterone, a male sex hormone.
The Pancreas are responsible to make insulin which inturn helps to regulate blood sugars in our body. High levels of insulin can also cause the ovaries to make more of the hormone testosterone.
Image credit: Pearl fertility
How Hormones affect Menstruation?
The menstrual cycle starts when the brain sends LH and FSH to the ovaries, a big surge of LH is the signal that causes the ovaries to ovulate, or release an egg. The egg travels down the fallopian tube and gradually in the uterus. Progesterone from the ovary causes the lining of the uterus to thicken. If the egg isn’t fertilized, the lining of the uterus is shed. This is a menstrual period.
Now, with PCOS, LH levels are already quite high when the menstrual cycle starts,hence there is no LH surge. Without this LH surge, ovulation is affected. Also high levels of insulin (from the pancreas), could also cause the ovaries to make extra amounts of
testosterone causing further hormonal imbalance. Therefore, Women with PCOS may ovulate occasionally or may not ovulate. This may cause their periods to be irregular or completely absent
What causes the Hormonal imbalance ?
Family inheritance, hormones that are increased during our development in the womb before birth, and a lifestyle that includes processed & inflammatory foods , high levels of oxidative stress , poor sleep hygiene and negative emotional health ; could trigger high Insulin resistance & high levels of androgens or "male hormones resulting imbalanced hormones leading to PCOS .
In fact, there is increasing evidence suggesting that PCOS affects the whole life of a woman, it can begin in utero, manifests at puberty, and continues during the reproductive years. It can also expose patients to increased risk of cardiovascular disease, hypertension, diabetes and other metabolic complications, especially after menopause.
Early diagnosis is therefore crucial to help reduce the risk of any complications.
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