POLYCYSTIC OVARIAN SYNDROME – LITTLE KNOWN FACTS

Polycystic ovarian syndrome or “PCOS” is a loosely used term with a variety of interpretations. In this article, I will try to break it down and simplify the understanding of the signs, symptoms and management options of PCOS or the “metabolic syndrome”.

 

Q: What is Metabolic Syndrome and how do I know I have it?

The metabolic syndrome is a group of characteristics. You do not need to have all of the characteristics to have it. However, a person with one characteristic is more likely to have others. Most expert groups define metabolic syndrome as the presence of three or more of the following characteristics in a person:

• Obesity, especially in the abdominal area (defined by some groups as a waist size greater than 94 to 102 cm (38 to 41 in) in men or greater than 80 cm (32 in) in women)
• Impaired fasting glucose (fasting blood sugar of 100 to 125mg/dLor 5.6 to 7 mmol/L)
• Increased blood pressure(130/85or higher) or if you take medicine for high blood pressure
• Increased fasting levels of triglycerides (bad cholesterol).

 

Q: What increases my risk of developing Metabolic syndrome? Can I avoid it?

The following factors are thought to increase the risk of developing metabolic syndrome:

• Being overweight (body mass index of 25kg/m²or more)
• Menopause (in women)
• Increasing age
• Smoking
• Eating a high carbohydrate diet
• Lack of physical activity
• Family history of diabetes or metabolic syndrome.

 

Yes, by carefully monitoring your diet and having an active exercise regimen, you may be able to avoid the florid clinical manifestation of metabolic syndrome.

 

Q: What are the long-term health risks of metabolic syndrome?

Diabetes — Type 2 diabetes is much more likely to develop among people with the metabolic syndrome. Healthy lifestyle changes, such as weight loss and exercise, can help to reduce the risk of developing type 2 diabetes.

Heart disease— People with metabolic syndrome are at increased risk for developing cardiovascular disease. Cardiovascular disease includes coronary artery disease (collections of fatty plaques inside the heart’s blood vessels), cerebrovascular disease (collections of fatty plaques inside the blood vessels leading to the brain), and high blood pressure. Cardiovascular disease can lead to heart attack, stroke, or angina (chest pain).

 

Q: Can I get tested for PCOS or metabolic syndrome? How do I know I have it?

The metabolic syndrome is diagnosed based upon a physical exam and a blood test of your fasting (before breakfast) blood sugar, cholesterol, and triglyceride levels.

Your doctor will check your weight, blood pressure and perform a full physical exam

Your doctor will also run some blood tests to check your fasting cholesterol, blood glucose, liver function and HbA1c. Checking fasting Thyroid hormone levels is also helpful because sometimes-slow thyroid (hypothyroidism) can look clinically like metabolic syndrome. Slow thyroid can be easily fixed by thyroid hormone supplementation.

Q Is there any treatment available for PCOS or Metabolic syndrome?

The goals of treatment for the metabolic syndrome are to:

• Reduce or eliminate underlying problems (e.g., obesity, lack of activity) by losing weight and becoming more active.
• Treat cardiovascular risk factors, such as high blood pressure and cholesterol, if these problems persist despite losing weight and exercising.

Weight loss — Management of the metabolic syndrome usually includes losing weight and becoming more active. Your diet should be low in fat and cholesterol.

• The Mediterranean diet is high in fruits, vegetables, nuts, whole grains, and olive oil. This diet can help to lower weight, blood pressure, lipids, and improve insulin resistance.
• The DASH (Dietary Approaches to Stop Hypertension) diet can reduce blood pressure, weight, lipids and fasting blood glucose levels. The DASH diet requires you to eat no more than 2400 mg of sodium per day, four to five servings of fruit, four to five servings of vegetables, two to three servings of low-fat dairy products, and all foods must contain less than 25 percent total fat per serving.

Exercise — Exercise can help with weight loss and can also help to reduce the size of the abdomen, especially in women. Experts recommend at least 30 minutes of moderate physical activity, such as brisk walking, most days of the week.

Reduce the risk of type 2 diabetes — Losing weight (if you are overweight or obese) and staying active can reduce the risk of developing type 2 diabetes.

Reduce cholesterol — High levels of low-density lipoprotein (LDL) (bad) cholesterol increase the risk of coronary artery disease. In people with metabolic syndrome, an LDL level of less than 80 to 100 mg/dL is recommended.

If diet and weight loss do not adequately reduce your LDL levels, a medicine may be recommended.

Lifestyle modification — Aggressive lifestyle modification focused on weight reduction and increased physical activity is the primary therapy for the management of metabolic syndrome. The importance of weight management in preventing progression of metabolic syndrome components is illustrated by The Coronary Artery Risk Development in Young Adults (CARDIA) study. In this observational study of 5115 young adults (ages 18 to 30 years), increasing body mass index (BMI) over 15 years was associated with adverse progression of metabolic syndrome components compared with young adults who maintained stable BMI over the study period, regardless of baseline BMI.

Weight reduction is optimally achieved with a multimodality approach including diet, exercise, and possible pharmacologic therapy.

 

Q: Is one exercise regimen better than another?

 

Endurance exercise is an effective strategy to prevent muscular insulin resistance. A new study published in the Journal of physiology demonstrates that exercising in the fasting state is more effective than exercise after eating a meal.

 

Q: I have a very busy schedule and I don’t have time to exercise, can I just get liposuction?

Removal of abdominal adipose tissue with liposuction does not improve insulin sensitivity or risk factors for coronary heart disease, suggesting that the negative energy balance induced by diet and exercise are necessary for achieving the metabolic benefits of weight loss.

Q: How can I control the symptoms of PCOS if I do not want to be pregnant just yet?

Lifestyle changes such as diet, exercise and weight loss will help regulate periods even without medical therapy. Studies have shown that even 10-15 lbs. of weight loss can help regulate the periods.

Q Are there any medicines I can take for PCOS?

If just weight loss doesn’t help, oral contraceptive pills (birth control pills) can help balance out the hormone imbalance and regulate the periods. Your gynecologist may recommend adding a drug called Metformin to help in regulating the insulin resistance in PCOS, which may help regulate periods and help you ovulate on your own if you desire pregnancy.

 

Dr. Adeeti Gupta