The Silent Dangers of PCOS

The Silent Dangers of PCOS

Beware of the silent danger faced by women with excessive weight and irregular menstrual cycles.

This issue has been addressed by Lieutenant Professor Dr. Teerasak Thamrongthirakul and the medical team at the Fertility and Gynecologic Laparoscopic Surgery Center.

What is PCOS?

PCOS stands for Polycystic Ovarian Syndrome (sometimes referred to as PCOD, which stands for Polycystic Ovarian Disease). It is a commonly encountered group of symptoms or diseases in women.

The symptoms include:

-               Irregular menstrual cycles or prolonged absence of menstruation (caused by irregular or absent ovulation).

-               Excessive weight gain or obesity.

-               Abnormal hair growth on the face, chest, and abdomen.

It is estimated that PCOS affects 5-10% of women in their reproductive years. This condition is considered a silent danger because it can lead to chronic and severe diseases (which will be discussed later).

This disease was first identified in 1930 by two German gynecologists, Dr. Stein and Dr. Leventhal. They described female patients with irregular menstrual cycles, obesity, and hirsutism (excessive hair growth), along with the discovery of specific abnormalities in the ovaries and failure of ovulation.

Women usually seek medical advice for two main problems:

1.             Menstrual cycles that have been irregular or absent for a long time after adolescence.

2.             Difficulty conceiving despite being married, with or without symptoms mentioned in the first point.

How does PCOS occur?

In the normal menstrual cycle of a fertile woman (age 18-40), there should be regular ovulation of the ovarian follicles every month (every 28 + 7 days). In the first half of the menstrual cycle, the ovarian follicles stimulate the endometrial lining by producing estrogen hormones (after shedding during menstruation), promoting its thickening and growth.

During the later phase of ovulation, the ovarian follicles produce progesterone hormones, which further prepare the previously developed endometrial lining to receive and support the implantation and growth of the embryo if pregnancy occurs. The ovarian follicles continue functioning for about 7-10 weeks if conception takes place, after which they cease their activity, allowing the placenta to take over.

If ovulation occurs without conception, the ovarian follicles continue their activity for approximately 10-12 days and then cease hormone production. Subsequently, within 2-3 days, the previously developed endometrial lining sheds, resulting in menstrual bleeding.

In the absence of ovulation, the ovarian follicles do not produce progesterone but only estrogen. The endometrial lining continues to thicken. When the ovarian follicle degenerates, causing estrogen levels to decline, the endometrial lining also sheds. However, if the ovarian follicle remains undeveloped or grows slowly, with a prolonged presence, estrogen hormone production decreases gradually. Consequently, the endometrial lining does not shed, leading to the absence of menstruation.

If there is intermittent production and decline of estrogen hormones during this process, intermittent shedding of the endometrial lining may occur, causing irregular and uncertain bleeding. Alternatively, if the endometrial lining is excessively stimulated, it may shed spontaneously, resembling heavy and prolonged bleeding. It is evident that regular ovulation leads to regular menstruation, while the absence of ovulation can result in various patterns of menstrual flow.

Back to the symptoms of PCOS, we can see that instead of having just one ovarian follicle, multiple small follicles continue to grow but none mature enough to release an egg each month on alternating sides of the ovaries. This is why the term "polycystic" (poly = many, cyst = sac) is used to describe this condition.

We also find that in women with PCOS, the ovaries and adrenal glands produce higher levels of male hormones than normal, leading to excess hair growth on the face, chest, and lower abdomen, as well as a thicker waistline. Furthermore, these women have higher levels of insulin in their blood due to their cells being less responsive to insulin, which is responsible for regulating blood sugar levels in the body. As a result, the body produces more insulin to compensate, but when blood sugar in the cells remains low, it is converted into fat, leading to weight gain that is difficult to lose without proper insulin function.

In summary, the general characteristics of PCOS or PCOD include irregular menstrual periods, weight gain, and excess hair growth, although not everyone with this condition may have all three symptoms. However, the underlying issue in PCOS is the malfunction of the ovaries.

How is PCOS diagnosed by a medical professional?

Since each of the three symptoms can be caused by other conditions, such as nerve and brain abnormalities, thyroid dysfunction, or adrenal gland disorders, a doctor will usually diagnose PCOS based on a combination of the patient's symptoms, blood tests to check hormone levels, and ultrasound imaging to observe the ovaries.

What dangers does PCOS pose?

From observing individuals with PCOS, it has been found that there are risks for the following conditions:

Fertility issues: PCOS can cause difficulties in conceiving due to abnormal ovarian function.

Menstrual problems: Excessive and prolonged menstrual bleeding can lead to anemia. Irregular menstrual cycles increase the risk of future cancer, such as uterine or breast cancer, as the uterine and breast tissues are stimulated by high levels of estrogen for prolonged periods.

Increased risk of certain cancers: PCOS is associated with a higher risk of developing uterine and breast cancer, as the excessive estrogen stimulation affects the uterine and breast tissues.

Diabetes and its complications: PCOS is linked to insulin resistance, which can lead to the development of diabetes. Diabetes, in turn, can result in complications such as high blood pressure, brain-related disorders, kidney problems, and heart disease.

Treatment approaches for PCOS

Since the exact cause of this condition is still unknown, treatment focuses on addressing the patient's problems. Current scientific knowledge has identified three main abnormalities associated with PCOS: abnormal ovarian function, excessive hair growth, and high insulin levels due to poor cellular response. To mitigate the risks associated with these abnormalities, patients are divided into two categories:

1. Patients who do not wish to conceive:

Regardless of the present or future desire for children, the primary treatment goal is to regulate menstrual cycles to prevent excessive thickening of the uterine lining and reduce the risk of excessive bleeding and future cancer. The most convenient method for achieving regular menstrual cycles and contraception simultaneously is through the use of birth control pills, which help regulate hormones. Occasionally, some patients with PCOS may experience sporadic ovulation.

If birth control pills are not preferred, progesterone hormone therapy can be used cyclically. In cases of excessive hair growth, contraceptive pills that contain hormones with anti-androgenic effects are prescribed. If there are weight-related issues, medications that improve insulin response can be used to enhance glucose utilization in cells.

2. Patients desiring fertility:

To stimulate ovulation, medications can be used to induce egg release or enhance the body's response to insulin, depending on the specific case. If these methods prove ineffective or as an alternative option, minimally invasive surgery can be performed, using laparoscopy with electric current to destroy the excess tissue responsible for increased androgen production in the ovaries. This procedure helps promote spontaneous ovulation and increases the chance of pregnancy by 50-60%.

In conclusion, PCOS is a group of disorders with an uncertain cause, but its treatment depends on addressing the specific problems and needs of each patient. It is hoped that advancements in medical knowledge will lead to a better understanding of the causes and more effective treatments over time.

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