Understanding polycystic ovarian syndrome

What you need to know:

  • Polycystic ovarian syndrome (PCOS) is a condition where you have few, unusual or very long periods. It often results in having too much of a male hormone called androgen

About six years ago, Annabelle Tarimo, noticed her period was late as her cycle kept getting longer and longer. Forty days had passed and she still had not had her period. But the signs were there; stomach cramps, nausea and loss of appetite.

“The thought that these signs meant I would soon be having my menstrual period changed into something else. I panicked because I thought I was pregnant,” recalls Annabelle, a 28-year-old woman who later found out she had polycystic ovary syndrome (PCOS).

PCOS is a hormonal disorder causing enlarged ovaries with small cysts on the outer edges. Most women are usually unaware they have PCOS until they notice some significant changes. With irregular menstrual cycles being the top symptom of PCOS, many women, just like Annabelle, usually think they are pregnant or get to know about it because they are having difficulty getting pregnant.

According to a report titled Burden of Polycystic Ovary Syndrome in the Middle East and North Africa Region’ by Motlagh Asghari and others, globally, 1.55 million women of reproductive age experience PCOS, resulting in 0.43 million disability-adjusted life-years (DALYs). In 2017, the age-standardised incidence rate of PCOS, among women of reproductive age, was 82.44 per 100,000 population, which was 1.45% higher than in 2007.

Dr Pronety David, a general practitioner at Kipasika Health Centre in Mbezi says the burden of PCOS keeps growing largely because women barely know about this hormonal imbalance.

“PCOS is usually defined and diagnosed by a combination of signs and symptoms of androgen excess, ovarian dysfunction, and polycystic ovarian morphology on ultrasound. The exact cause of PCOS is unknown, but it often runs in families. It’s related to abnormal hormone levels in the body, including high levels of insulin,” he adds.

Other symptoms according to Dr David are hirsutism (excess hair on face, chin, chest), hair loss, high testosterone levels, acne and being overweight.

After the pregnancy scare that Annabelle had, she opted to visit a gynaecologist for a check-up and that is when her doctor told her she had multiple cysts on her right ovary. This is what was causing her irregular periods.

“When the doctor told me this, I became more curious because I thought I needed surgery to remove the cysts but the doctor told me he was going to prescribe some hormonal medications,” Annabelle shares.

Annabelle says her worry was whether she would be able to conceive when she was ready because having children of her own was something she was looking forward to in the future.

Here Dr David highlights what PCOS means for women who are diagnosed with the condition, stressing that it is treatable and that it can be a cause of infertility if left untreated for a long period.

“Having PCOS does not mean you can’t get pregnant. PCOS is one of the most common but treatable causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries. If you don’t ovulate, you can’t get pregnant,” Dr David says.

Ovulation is one of the major processes that enable a woman to get pregnant. According to Mayo Clinic, Ovulation is the process in which a mature egg is released from the ovary. After it’s released, the egg moves down the fallopian tube and stays there for 12 to 24 hours, where it can be fertilised. Sperm can live inside the female reproductive tract as long as five days after sexual intercourse under the right conditions. Your chance of getting pregnant is highest when live sperms are present in the fallopian tubes during ovulation.

For a woman with a normal cycle, ovulation would happen somewhere around 14 days before the start of the next menstrual period and you are most likely to know if you are ovulating when you track your menstrual calendar, when you notice changes in vaginal secretions or changes in your basal body temperature.

Women with PCOS though tend to skip this process in some months, hence having a hard time getting pregnant. Although the process may be hard, it is not an impossible one.

Annabelle is a vivid example that PCOS doesn’t necessarily mean infertility. She is a loving mother of two children and enjoys her motherhood profoundly.

“After being treated with a series of medicines and lifestyle changes like losing some weight, my symptoms gradually started to improve. I was seeing signs of ovulation in more months and soon after, I got married. Although it took us eight months of trying, I finally got pregnant with my first child and two years later, our second child followed,” she says.

Despite the fact that PCOS affects your hormones and your menstrual periods, it can still be a catalyst of other much major complications such as total infertility and some non-communicable diseases like type 2 diabetes.

Dr David adds that, “PCOS increases the risk for cardiovascular complications, cerebrovascular diseases, type 2 diabetes, endometrial hyperplasia and carcinoma.”

You might be wondering, especially if you are a newly diagnosed, whether you will be able to manage this condition. Well, the good news is that PCOS is totally treatable and manageable.

One of the ways of managing it includes watching what you eat.

“When someone is diagnosed with PCOS, we advise them to do exercises along with changing their diet,” Dr David says.

He adds; “Sometimes we also prescribe drugs like Metformin hydrochloride or/and Clomiphene Citrate to help in controlling ovulation and blood sugar levels as the condition can cause insulin resistance. In severe cases though, a laparoscopic ovarian drilling procedure can be done, where the cysts are drained to increase one’s chances of getting pregnant,” he tells Your Health.

The new technological ways like having a laparoscopic ovarian drilling have really helped in increasing women’s chances of getting pregnant despite having PCOS. Although many women have no reason to get their ovaries checked from time to time, doctors advise seeking medical attention whenever one notices changes in their menstrual cycle that they think require a doctor’s attention.

Early diagnosis can help manage your symptoms much more better and also prevent very severe cases of untreated PCOS such as ovarian cancer, which ultimately can lead to a surgical removal of your ovaries in order to stop the process of incomplete ovulation.