Polycystic Ovarian Syndrome

If you find yourself consistently having irregular or absent menstrual periods, from once in 2 months up to half a year, while carrying excessive body weight, hear growth, blood androgens, also called ‘male hormones, as well as disorders in blood sugar and lipid, you are at risk of Polycystic Ovarian Syndrome (PCOS).

PCOS has been characterized as one of the most prevalent endocrine and metabolic disorders amongst female. Locally,, 1 to 2 in every  10-20 females will develop PCOS during their reproductive age and it does not usually come to light till they encounter issues in fertility. Females diagnosed with PCOS usually share at least 2 of the following sings:

1. Irregularity or absence of menstrual cycle
2. High androgen levels, leading to

• Hirsutism, excessive hair growth throughout different body parts such as chin, chest and abdominal area
• High testosterone level in blood

3. Existence of multiple immature follicle cysts, less than 8mm in diameter each, within ovaries under Ultrasound examination

What exactly causes the disease? Well, there is no consensus yet, but mounting evidence evidence has shown that PCOS is associated with hormonal disorders and its heredity nature. It could also be weight-related, given that 40-60% of female with PCOS are overweight or obese.

Despite the lack of well-established cause, insulin resistance plays a crucial role during the course of PCOS. Insulin is a regulatory hormone, produced and secreted by pancreas, performing various via acting on our body cells, such as coordinating carbohydrates and fat metabolism. When cells become insulin resistant, they cannot respond and react as adequately to insulin as normal cells do to carry out functions like taking up sugar from the blood. Pancreas then needs to work harder to secret more insulin against the resistance of the cells in response to the high blood sugar level. As a result, it is surprising for PCOS sufferers with insulin resistant to be hyperinsulinemic (excess insulin present in the blood). Both insulin resistance and compensatory hyperinsulinemia can occur in healthy weight females with PCOS, but are particularly evident amongst overweight sufferers.

How does too much insulin relate to PCOS? Excessive insulin overstimulates the production of androgens in ovaries. Normally, the actions of and organs produced by ovaries are well-regulated by estrogen, but such androgen overproduction forms the culprit of PCOS symptoms. Including erratic menstrual cycle via interfering the maturation of ovum in ovaries, and hirsutism via overstimulation of androgens-sensitive hair follicles especially around the face body parts like chest.

Does PCOS matter?

Thanks to insulin resistance, numerous research studies have indicated that females with PCOS, no matter how old and heavy they are, are 3-5 times more prone to several major chronic diseases including metabolic syndrome, Type 2 Diabetes and cardiovascular diseases. Being overweight or obese, of course, is part of the blame. Whine greater BMI for PCOS sufferers was associated with menstrual irregularity, abdominal fat deposit is found to exacerbate body cells insulin resistance and subsequent physiological and metabolic issues. That leaves the overweight PCOS sufferers more likely to develop hypertension, non-alcohol fatty liver disease, sleep apnea other than those conditions mentioned. Moreover , too much luteinizing hormone, one of the hormones normally produced as part of menstrual cycle, in PCOS sufferers will further stimulate estrogen and androgens production leading to extensive thickening of the endometrial lining , the innermost layer of uterus, which heightens the risk of endometrial cancer.

How do healthy diet and active lifestyle kick in?

Menstrual irregularity or absence

For quick-fix combination of oral contraceptives is usually prescribed for those 15-20% PCOS sufferers experiencing erratic menstrual cycle. Metformin is also clinically proven to be effective in restoring in restoring the hormonal balance and regularity of the cycle. In the long run, enjoying a healthy diet and active lifestyle is the key as they help maintain your healthy weight which keeps irregular menses at bay.

Overweight or obesity

Convincing evidence suggests 5% of overall weight reduction is beneficial for irregular menses and insulin resistance as well as fertility rate. Where to start? Making small achievable dietary changes aiming at lowering fat, sugar and salt intake, moderate portions, limited  dine out occasions or alcohol abstinence together with regular physical activities world give you a great start in managing your weight to improve PCOS management.

Insulin resistance

Insulin resistance is common to  40-70% of healthy weight PCOS sufferers and characterized by:

• High fasting blood sugar and insulin levels
• High glycated hemoglobin level(HbA1c)
• High blood sugar level after meal
• Impaired glucose tolerance
• High blood lipids levels

Enjoying moderate portions of carbohydrates and fat, swapping refined or simple carbohydrates such as sugary food and beverage, white bread for complex carbohydrates with lower glycemic index such as brown rice, whole wheat bread and soba will help modulate blood sugar level. The reduction of and organ levels over long term can help restore regular menstrual cycle and better manage hirsutism. For further enquiry or advice. Feel free to consult dietitian/nutritionist.

Reference:

Barr S, Reeves S, Sharp K & Jeans Y. (2010) Efficacy of a low-glycemic index diet in women with polycystic ovary syndrome. Proceedings of the Nutrition Society 69: E404

Barr S, Hart K, Reeves S, Sharp K & Jeans Y. (2011) Habitual dietary intake., eating pattern and physical activity of women with polycystic ovary syndrome. European Journal of Clinical Nutrition 65: 1126-1132

Diamanti-Kandarakis E. Christakou CD, Kandaraki E & Economou FN, (2010) Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome. Eur J Endocrinol 162(2): 193-212

Lam PM. Ma RCM. Cheung LP, Chow CC, Chan JCN & Haines CJ. (2005) Polycystic ovarian syndrome in Hong Kong Chinese women: patient characteristics and diagnostic and diagnostic criteria. Hong Kong Med J 11:336-41

The British Dietetic Association The food fact sheet: Polycystic Ovary Syndrome , http://www.bda.uk.com/foodfacts/pocs Retrieved from 12th Dec, 2014

330 Tips provided by:  Ms Grace Lam  (Senior Dietitian - Centre for Nutritional Studies, School of Public Health and Primary Care, Faculty of Medicine, CUHK)

Date: 2014-12-01