Complication of PCOS

Though PCOS in itself is not something you need to panic about, just like any other health derangement, early recognition and prompt treatment of PCOS is very important so as to avoid complication of pcos which may arise in future. PCOS has certain effects on your body which in due course of time may make you prone to these complications of pcos.

What are the possible complication of PCOS and why does it arise?

Though PCOS in itself is not something you need to panic about, just like any other health derangement, early recognition and prompt treatment is very important so as to avoid complication of pcos which may arise in future. PCOS has certain effects on your body which in due course of time may make you prone to these complications of pcos.

What are the possible complication of PCOS and why does it arise?

  • Diabetes
    One of the problems in women with pcos is decreased sensitivity to insulin which is termed as insulin resistance.
    Insulin resistance means failure of the body tissues to utilized the glucose consumed in diet. Thus blood glucose levels rise drastically following a meal which is termed as impaired glucose tolerance. The insulin resistance and impaired glucose tolerance seen in women with pcos are contributory to the development of diabetes. About 10 percent of women with pcos are prone develop diabetes in the long run. Some women with pcos may also develop diabetes during pregnancy as pregnancy worsens the already existent insulin resistance.
  • Heart Attack and Brain Stoke
    The hormonal imbalances present in pcos alters the lipid profile in women.It increases the levels of LDL which is commonly known as the bad cholesterol and decreases the levels of HDL which is the good cholesterol. There is also increase in the levels of triglycerides or fats in the blood. All these changes make the women more prone to heart disease and stroke etc. The increased levels of fat tend to deposit in the walls of blood vessels which lead to their narrowing. The fats deposited in the blood vessel wall cause oxidative damage to their lining and promote formation of blood clots, thereby further blocking the blood vessels. The blockage of arteries supplying the heart lead to heart attack and blockage of those supplying to the brain lead to stroke.
  • Hypertension
    The changes in lipid levels in women with PCOS is also known to be the reason for development of hypertension.Stress associated with symptoms of PCOS such as infertility, obesity etc. may also contribute to raised blood pressure levels.
  • Morbid Obesity and Obstructive Sleep Apnoea
    Obesity in women with PCOS is known to add to the problem of high lipid levels and insulin resistance, thereby increasing the risk for complications such as diabetes, hypertension, heart attack and stroke. Obesity is believed to be both the cause and effect of PCOS.So, in most women it tends to run a vicious cycle of obesity leading to pcos which further results in difficulty to loose weight. Women with pcos produce high levels of insulin so as to overcome the decreased sensitivity to insulin known as insulin resistance which is a prominent component of PCOS. Increased insulin levels stimulate excessive androgen production which are male sex hormones which in turn lead to male pattern of fat distribution. Therefore women with pcos accumulate fat in the upper body and abdomen. Obesity aggravates the problem of insulin resistance thereby keeping the vicious cycle going on.Long standing obesity associated with pcos leads to obstructive sleep apnoea due to increased neck circumference and fall back of the comparatively large tongue. It further leads to sleep problems and chronic lung problems due to inadequate ventilation of the lungs and exchange of gases.
  • Cancer of Endometrium
    Some studies show that untreated or neglected PCOS symptoms risk factors for developing cancer of the lining of the uterus termed as carcinoma endometrium.During a normal menstrual cycle the endometrium which is the uterine lining grows in thickness until the time of ovulation under the influence of hormone estrogen. The endometrial growth is in preparation for carrying a baby in case of conception. After ovulation, if the ovum is not fertilized by a sperm the level of the hormone progesterone gradually declines. In the absence of progesterone which is responsible for maintaining pregnancy, the uterine lining sheds of causing menstrual bleeding.In PCOS, there is absence of ovulation which is termed as anovulatory cycle. Due to anovulation progesterone levels are also very low. The action of estrogen thus goes unopposed and the uterine lining continues to grow thicker without being shed. Thus there may be absent menstruation termed as amenorrhoea.The above factors may lead to cancer of the endometrium. The unopposed action of estrogen on endometrial growth is considered to be the reason.
  • Deep Vein Thrombosis
    In women who are obese and have an unfavourable lipid profile, there are high chances of developing deep vein thrombosis if they are confined to bed or immobilized following surgery or prolonged incapacitation. Deep vein thrombosis is the development of blood clots within the deep lying veins of the leg. They present as painful swelling of the leg. There is risk of dislodging the blood clot into the veins of the lungs which may also prove fatal. But if recognized early it can be treated. The hormonal imbalance in women with pcos make them more prone to deep vein thrombosis. Obesity also adds to the risk of developing deep vein thrombosis.

After the long list of complication of PCOS you may be very eager to know whether the complication of pcos can be prevented. If so, how can the complication of pcos be prevented?
As in the case of any chronic medical condition, early recognition of the problem and proper treatment will prevent complication. Besides treatment few lifestyle modifications also may be necessary.

Prevention of Complication of  PCOS

  • Weight Loss
    Weight loss by eating healthy and exercising regularly will help prevent most of the complication of pcos to a large extent. As obesity worsens insulin resistance, losing weight may lead to improved insulin sensitivity, thereby decreasing the insulin levels in the body. Decreased insulin levels will then reduce many of the problems of pcos which are caused by insulin excess. Apart from insulin resistance and impaired glucose tolerance weight loss also successfully reduces lipid levels in the blood of women with pcos thereby reducing the risk for complications such as hypertension, heart attack and stroke.

    • Healthy Diet
      The diet should include plenty of green leafy vegetables, fruits, coloured vegetables, fish rich in omega3 fatty acids and lean meat such as skinless chicken and turkey. Snacking on whole nuts will provide your body with essential unsaturated fats. The foods to avoid in PCOS are sugary foods, saturated fats and dairy products. Sugary foods will lead to increased insulin production. Dairy products contain IGF-1 which mimicks actions of insulin in the body leading to worsening of pcos problem. Avoid refined carbohydrates such as refined flour which has high glycemic index, which means that after a meal containing foods with high glycemic index, your blood sugars rise rapidly.Salt intake may be around 5 grams per day.
    • Exercise
      In pcos exercise may be in any form such as walking, jogging, yoga, aerobics etc. But getting a moderate level of exercise on a day to day basis is important. If you are a beginner to exercising you may start by walking briskly for about 30-45 minutes daily.Yoga if done with adequate training is also a good form of exercise. It will help in weight reduction and improving fertility. Though claims of curing pcos through yoga may not be true, it surely is a very good form of exercise. If you are a beginner you may start with simples yoga poses under the guidance of a trained person.Exercise is also known to reduce stress levels and boost metabolism.
  • Metformin Therapy to Improve Insulin Sensitivity
    If insulin resistance and impaired glucose tolerance persists despite weight loss and diet control medical therapy with metformin will prove helpful. Metformin is also known to improve fertility in women with pcos. Metformin is a insulin sensitizing drug.Once insulin sensitivity improves weight loss and favourable lipid profile can be achieved.
  • Regulation of Menstruation
    If there is persistently irregular menstrual cycle or prolonged absence of menstruation you may need medicines to regulate your cycle or bring about menstrual bleeding. Prolonged absence of menstrual bleeding and increasing thickness of endometrium may put a women at risk for cancer of the uterine lining. Menstruation can be regulated using oral contraceptive pills which are hormonal preparations, so as to bring about balance in the hormone levels. Progesterone containing pills will produce withdrawal bleeding and prevent unopposed growth of endometrium.
  • Post operative Deep Vein Thrombosis Prophylaxis
    Adequate measures to avoid developing deep vein thrombosis during postoperative period should be taken. Overweight women are prone to develop deep vein thrombosis post operatively.Pneumatic stockings should applied during the post operative recovery period. Early mobilization will be helpful in avoiding deep vein thrombosis. In women with high risk of developing deep vein thrombosis or with previous history of deep vein thrombosis, prophylaxis with anticoagulants should be given during post operative recovery period. Anticoagulant drugs prevent formation of blood clots anywhere within the body.
  • Infertility
    Some consider infertility as a complication of pcos. But with the current advancements in medical science it need not be considered a complication for the following reasons:

    • It is usually not an irreversible problem in every woman with pcos and one need not think that there is no come back from infertility issues. PCOS is known to be associated with anovulatory cycles, where an ovum is not released during the course of menstrual cycle but there could be ovulatory cycles too during which the woman may conceive. Most women with pcos conceive naturally with simple things like just losing a few pounds of body weight,if they have no other factors contributing to infertility.
    • Availability of Medical Therapy to improve insulin sensitivity, induce ovulation and conceive naturally. If insulin resistance is profound and manifests as impaired glucose tolerance, metformin is given. The drug metformin improves insulin sensitivity. It is also known to improve fertility. Sometimes metformin therapy alone results in relief of hormonal imbalance seen in pcos and helps in women getting pregnant provided causes of infertility other than pcos are ruled out.If women with pcos fail to conceive despite metformin therapy, they may need medicines to assist with ovulation. The medicines modify hormone levels in the woman so as to get them to ovulate successfully.
    • Surgical Therapy for PCOS. If multiple cycles of therapy with ovulation stimulation drugs have failed and all other causes of infertility have been ruled out, laparoscopic surgery for drilling or puncturing of the cysts in the polycystic ovary may be attempted. About 3-4 cysts in each ovary are punctured. The cystic fluid released brings about improvement in hormone levels. Women mostly get pregnant within one year of the treatment and it is much more cost effective when compared to in-vitro fertilization (IVF) treatment.
    • Artificial Reproductive Techniques are very advanced. In case all the above treatment options have been exhausted, In-vitro fertilization commonly known as IVF is an option. In IVF an ovum is directly retrieved from the womans ovary after giving her hormones to ovulate and it is fertilised in the laboratory with sperms collected from her spouse. The embryo is then transferred into the womans uterus. Pregnancy tests are done to confirm successful implantation of the embryo in the uterus.

Can routine health check ups prove beneficial ?If so what are the recommended tests to take?
Yes, yearly, health check ups can help detect derangements in your blood parameters early. It will help you initiate preventive and therapeutic strategies at the earliest. The following tests are recommended:

Hormonal tests

  • Thyroid function tests

Other blood tests:

  • Blood sugar levels- fasting and post prandial (2 hours post meal)
  • Lipid profile
  • Oral glucose tolerance test

Cardiac evaluation:

  • ECG

Imaging

  • Ultrasound scan of abdomen and pelvis

You are also advised to maintain a menstrual diary so as to seek help in case of prolonged absence of menstruation other than when there is possibility of pregnancy.

So do you have to be worried if your suffering from polycystic ovarian syndrome (PCOS )? No, PCOS is no reason to worry if you get prompt treatment and advice from experts in the field. PCOS symptoms can be brought under perfect control so as to lead a very normal life with pcos.

Through this article I tried creating awareness regarding the possible complications of PCOS. It is also evident that by being cautious women with PCOS can prevent dreaded complications such as heart disease,stroke and cancer.

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