Sandeep Reddy Ganta is an Endocrinologist having experience of 6 years. He has completed his MBBS in 2010 from N.T.R. University, Vijayawada and his MD from Osmania Medical College in 2015 and DM Endocrinology from Sri Venkateshwara Institute Of Medical Science completed in 2020. He is a member of the Endocrine Society of India (ESI). He is currently practising in Kamineni Hospital, Hyderabad.
Diagnosis of PCOS
Dr Ganta begins, “PCOS is the most common metabolic and reproductive disorder. This is seen in women between the age of 18 to 45. PCOS can be diagnosed based on one’s symptoms and image sequencing. Some of its symptoms are irregular periods where the menstrual cycle can be lost for more than 45 days or 1 cycle lost for more than 3 months. Less than 9 cycles a year is considered as irregular periods.”
“Another thing would be Hyperandrogenism. Some of its features are extreme acne that cannot be solved with conventional treatment. Another element is the excessive growth of hair over the body. Some can even develop a deeper voice, male-like muscular body and breast atrophy.”
“We will clinically test by checking the androgen levels. We check this on day 2 and day 5 of the cycle. If it is more than 0.6 then we say it is hyperandrogenism. We can even check the LH/FSH ratio. We rule out the secondary PCOS symptoms like thyroid and cortisol excess problems. After ruling out these causes we label it as idiopathic PCOS.”
“In addition to this, we also do an ultrasound. With ultrasound, we can figure out the polycystic morphology. Here we will get the 2 to 9 mm of follicles, we also do a follicle count. Based on this we diagnose PCOD. It is a long-term metabolic disease like type 2 diabetes. With PCOS we also evaluate for diabetes and obesity. With ultrasound, we also check for Nonalcoholic fatty liver disease (NAFLD).”
Can PCOS women get prgnent with IVF and ICSI?
Dr Ganta explains, “The long-term problem with PCOS is infertility, especially in the reproductive age group. There is ovulatory dysfunction. There are many ways with which PCOS women can achieve fertility.”
“The first is lifestyle modification. This includes a regular diet and exercise to lose weight. With a weight loss of 7-10% of one’s body weight, they will experience a decrease in the symptoms. With weight loss, they can get pregnant without any medical treatment.”
“Some people will require ovary induction drugs. One of them is clomiphene, this drug will help stimulate the release of the ovum. This increases the chance of pregnancy. But the problem with clomiphene is that it can cause multiple pregnancies. This is a rare complication of hyperstimulation ovarian syndrome.”
“For ovulation induction, we have 3 medicines - clomiphene, letrozole and calotropis. If they are not conceiving with these medicines then the infertility specialist will advise for IVF with ICSI (Intracytoplasmic Sperm Injection). With this the chance of getting pregnant are high. There are some complications attached to this. The patient may develop OHSS or ovarian hyperstimulation syndrome. The chance of multiple pregnancies is also there. Then there is Laparoscopic ovarian drilling, where some parts of the ovary are removed. This brings down the androgens level. This was the treatments given before there was IVF and ICSI.”
“Some other medication like metformin tablet which is useful for diabetes and can also be used for PCOS. In PCOS, pregnancy outcomes will be different compared to regular pregnancy outcomes. Even if a PCOS patient conceives there are high chances of pregnancy-related complications. There is a high chance of gestational diabetes, preeclampsia (high blood pressure during pregnancy), low birth weight or high birth weight.”
Does Pregnancy cure PCOS?
Dr Ganta mentions, “Pregnancy cannot cure PCOS. Even if a person gets pregnant, their PCOS symptoms won’t come down. The pathogenic marker of PCOS is mainly due to weight gain. Weight gain leads to insulin resistance. There is an increase in insulin release and there will be a hormonal imbalance with excessive estrogen and low levels of progesterone. We will also witness an increase of androgens which are normally low in women. Once the PCOS woman gets pregnant, if after 6 or 2 months they gain weight then they will experience all the PCOS symptoms. There is no cure for PCOS. One can only control its symptoms.”
How to manage PCOS?
Dr Ganta advises, “There is no cure for PCOS but we can control its symptoms. The first is to modify one’s lifestyle. This includes a low-calorie and low-glycemic-index diet and regular exercise. One needs to lose weight 7 to 10% of the initial body weight. So for instance, if a person weighs around 70 kgs, then she must reduce 7 kgs to lessen the symptoms and reduce the ovulatory and bleeding problems. With weight loss, the androgens level and insulin resistance will also come down.”
“Other treatments are OC pills (oral contraceptive pills). OC pills mainly suppress the elevated LH and FSH levels. OC pills also decrease androgen levels and regularise bleeding periods. It decreases the risk of endometrial which is a long-term effect of PCOS.”
“The side effects of OC pills will be the risk of cardiovascular problems. So we should maintain caution after age 35 or 40 with OC pills. Other pills will be progesterone withdrawal bleeding which is used for diagnosis and for patients who cannot take OC pills. Those patients who have migraine, severe diabetes, established cardiovascular disease or those who have a history of CVA. Other treatments include anti-androgens like Spironolactone. This is the most common drug used to reduce androgens. Then there is metformin that can be used before the onset of diabetes and to regulate ovulation. We advise patients to go for laser therapy to further prevent the spread.”
“Once every year we have to evaluate the patient for complications like type 2 diabetes, obesity, dyslipidemia and fatty liver. Ultimately PCOS is a lifestyle disorder where the patient needs to keep checking her weight. It is mainly caused due to genetic or environmental reasons. Even after menopause, people can develop signs of cardiovascular disease and diabetes due to PCOS. With a history of PCOS, people can get complications even after their periods are over.”
(Edited by Priyal Shah)