PCOS: What Happens Next?

Diagnosis and treatment Diagnosing PCOS is mainly done by the principle of exclusion or considering all signs and symptoms and ruling out other likely disorders. There's no specific test that can provide definite diagnosis of PCOS. Women must consult a doctor if they observe PCOS-like symptoms like irregular periods, excess hair growth on face and hands, inability to conceive, etc. Criteria for diagnosing PCOS PCOS can be clearly diagnosed if other rare causes of similar symptoms are ruled out and the affected woman meets at least two of the following criteria:

1. Irregular or infrequent periods
2. High levels of male hormones or androgens in blood test reports
3. Presence of polycystic ovaries in scans

To reach a confirmed diagnosis of PCOS, a doctor takes into account the following factors:

1. Medical history - Women are asked questions about their menstrual cycles, weight changes and other signs.
2. Physical examination - The doctor will assess the basic health parameters including weight, height and blood pressure.
3. Pelvic examination - A woman suspected of having PCOS is asked to undergo a pelvic examination for the doctor to manually and visually inspect reproductive organs for any abnormal growths or masses.
4. Blood test - Since PCOS is essentially a hormonal disorder, a blood test is employed to measure the levels of various hormones involved in maintaining a regular menstrual cycle, along with those that cause menstrual abnormalities. Further, the doctor may recommend testing for cholesterol levels along with blood glucose levels, both before and after fasting.
5. Pelvic ultrasound - An ultrasound shows the appearance of ovaries and the thickening or uterine wall. This is carried out using a transducer that is placed inside the vagina (transvaginal ultrasound); sound waves emitted from the device are converted into images that are seen on a computer screen.

Women diagnosed with PCOS are referred to a specialist if they had initially consulted a general practitioner, either a gynaecologist who treats conditions of the female reproductive system or an endocrinologist who treats hormone disorders. Treatment There are three options for treating PCOS, which a doctor may recommend depending on the woman's specific condition. These include medication, surgery and lifestyle changes. Medication - Medicines are prescribed to tackle the following conditions:

1. Irregular or absent periods - Contraceptive pills or progesterone tablets are prescribed to induce regular periods if a woman is not trying to become pregnant. These pills reduce the androgen levels in the body and give the body a break from the continuous flow of oestrogen. This also reduces a woman's risk to endometrial cancer.
2. Irregular or absent ovulation - Ovulation is necessary for women trying to conceive. Medicines like Clomifene induce the monthly release of egg from the ovaries. If these do not help a woman with PCOS to become pregnant, another set of medicines known as gonadotrophins are administered through injections; these contain follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
3. Excessive hair growth - The doctor prescribes birth control pills to reduce androgen production or spirolactone to block the effects of androgens on the skin. However, spirolactone is not prescribed to pregnant women or women trying to conceive as the drug can cause birth defects.

Surgery - An outpatient laparoscopic procedure is carried out to treat PCOS if medications do not work. The surgeon makes a small incision in the abdomen and inserts a tube with a tiny camera at its end (laparoscope) to obtain detailed images of ovaries and surrounding organs. Using surgical instruments, the surgeon proceeds to create holes in the follicles on the surface of the ovaries, using electrical or laser energy beams. This procedure creates access points to enable ovulation. Lifestyle changes - Daily life changes go a long way in keeping the effects of PCOS at bay. These include:

1. Weight management - Symptoms and risk to long-term health issues increases in overweight women. Obesity worsens insulin resistance. Weight loss to reach healthy weight can reduce both insulin and androgen levels. Healthy weight can be found out by calculating the body mass index (BMI), which measures weight in relation to height.
2. Diet regulation - A low-fat, high carbohydrate diet can increase insulin levels in the body. While carbohydrates must not be completely removed from the diet, women with PCOS can opt for more complex carbohydrates that are rich in fibre. Managing nutrition is also helpful in achieving weight loss goals, and help reduce symptoms of PCOS and further health risks.
3. Exercise - A regular physical activity plan helps manage weight and keep blood sugar levels in check.

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