Understanding PCOS

Polycystic ovary syndrome (PCOS) is the most common disorder in women and a major cause of anovulatory infertility. PCOS is a complex heterogeneous disorder that has several aspects in terms of pathology such as metabolic, endocrine, reproductive, and psychological. It is the most common endocrine disease that affect 5 to 10% of women of adolescent and reproductive age.

It is defined and diagnosed by a combination of signs and symptoms of androgen excess, ovarian dysfunction, and polycystic ovarian morphology on ultrasound. There is increasing evidence to suggest that PCOS affects the whole life of women. The causes of PCOS are not fully understood. Several factors such as genetics, diet, lifestyle, underlying neuroendocrine disorders contributes to multiple pathological mechanisms that lead to hormonal imbalance resulting in PCOS.

PCOS happens when there is an increase in levels of androgen, insulin and an increased levels of Luteinizing hormone (LH) and decreased levels of Follicle Stimulating Hormone (FSH). This varying imbalance in the hormones causes the ovaries to produce more testosterone leading to hirsutism, acne, multiple ovarian follicles (cysts), and menstural irregularities because eggs don’t ovulate or ovulate only occasionally.

Key characteristics of PCOS are:

1. Excess production of androgen male hormones. (increase in male type hormones - hyperandrogenism)

2. Increase in insulin resistance. (increased insulin levels - hyperinsulinemia)

3. Increase in Lutenizing hormone (LH) & Follicle Stimulating Hormone (FSH) ratio.

Signs or symptoms of PCOS:

• Irregular periods (more or less often or no periods).

• Polycystic ovaries.

• Absence of ovulation (anovulation).

• Hair growing on the face, stomach, and back (hirsutism).

• Loss of scalp hair.

• Acne.

• Delay in getting pregnant or infertility

• Weight gain or trouble losing weight.

• Depression.

• Risk of developing type 2 diabetes.

Menstural cycle and PCOS:

The menstrual cycle is 24 to 35 days cycle and it refers to the maturing and release of an egg from an ovary and the preparation of the uterus to receive and nurture an embryo. The menstrual cycle is governed by fluctuations in hormone levels in the body, which rise and fall in a monthly pattern. When the cycle is running smoothly, the pituitary gland in the base of the brain produces a hormone called follicle-stimulating hormone (FSH) to prepare an egg for release. The menstrual cycle starts two weeks before your period when the egg is ready and this is when the brain sends signals to release LH and FSH hormones to the ovaries. A large surge of LH stimulates follicles in the ovaries to release an egg (ovulation). While this is happening, the ovaries are secreting other hormones such as estrogen and progesterone to thicken the lining (endometrium) of the uterus and prepare it for pregnancy. The ovaries also produce small amounts of androgens (male hormones), such as testosterone, which is converted into estrogen. If the egg meets the sperm in the fallopian tube, fertilization, and conception may occur. If fertilization does not occur, the endometrium lining sheds and results in menstrual bleeding.

With PCOS, LH levels are often high when the menstrual cycle starts and the levels of LH are also higher than FSH. Because the LH levels are already quite high, there is no LH surge, Without this surge, ovulation does not occur and periods are irregular Women with PCOS may ovulate occasionally or not at all, so periods may be too close together, or more commonly, too far apart. Some women may not get a period at all.

PCOS and Fertility:

Women with PCOS have normal uterus and contain follicles with eggs in them, but the follicles do not develop and mature properly - so there is no ovulation or release of eggs. This is called anovulation. If ovulation do not occur, getting pregnant become impossible. Hypersecretion of LH and high increase in ovarian androgen production also manifest into infertility.

Women with PCOS have a greater risk of anovulation and infertility. Many women do not find out they have PCOS until they try to conceive, particularly if they were using contraception that uses hormones, which masks irregular or no periods, because it allows for a monthly bleed.

PCOS is not a disease!

PCOS is not a disease that can be cured, it is a syndrome that required supplemental, dietary and lifestyle modification and support.

Unived’s PCOS Fertility is formulated in a ratio that is clinically studied and has shown to deliver a higher chance of conception while also addressing and helping to manage the all other symptoms of PCOS.

References:

1. De Leo, V., et al. "Genetic, hormonal and metabolic aspects of PCOS: an update." Reproductive Biology and Endocrinology 14.1 (2016): 1-17.

2. Günalan, Elif, Aylin Yaba, and Bayram Yılmaz. "The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: A critical review." Journal of the Turkish German Gynecological Association 19.4 (2018): 220.

3. Carmina, Enrico, and Rogerio A. Lobo. "Polycystic ovary syndrome (PCOS): arguably the most common endocrinopathy is associated with significant morbidity in women." The journal of clinical endocrinology & metabolism 84.6 (1999): 1897-1899.

4. Cianci, Antonio, et al. "d-chiro-Inositol and alpha lipoic acid treatment of metabolic and menses disorders in women with PCOS." Gynecological Endocrinology 31.6 (2015): 483-486.

5. Kalra, Bharti, Sanjay Kalra, and J. B. Sharma. "The inositols and polycystic ovary syndrome." Indian journal of endocrinology and metabolism 20.5 (2016): 720.

6. Mendoza, Nicolas, et al. "Comparison of the effect of two combinations of myo-inositol and D-chiro-inositol in women with polycystic ovary syndrome undergoing ICSI: a randomized controlled trial." Gynecological Endocrinology (2019).