Polycystic Ovarian Syndrome (PCOS)  is a major health problem for women of all ages through its effect on fertility during the reproductive years and its gynecological and metabolic effects in both the reproductive years and thereafter.But it is a syndrome that also encompasses the metabolic, cardiovascular, dermatological and psychological conditions.PCOS is the most common endocrine syndrome affecting women of reproductive age with a prevalence of between 4% and 18%. Generally, it can affect up to 50% of South Asian Women. PCOS is more prevalent in obese women than those who are lean. It substantially contributes to infertility.

SYMPTOMS POLYCYSTIC OVARIAN SYNDROME:

The principal presenting symptoms of the woman suffering from PCOS are oligo or anovulation and or infertility as well as excess androgen production. Symptoms tend to be present at the time of menarche with less frequent or complete lack of menses. Other symptoms of excess androgen production are acne, hirsutism, alopecia, overweight or obesity, acanthosis nigricans.However, 20% cases of PCOS may be asymptomatic.

HORMONAL CHANGES:

The effects of PCOS are manifested via deranged hormonal profiles, primarily an excess of circulating testosterone, androstenedione, luteinizing hormone (LH) and insulin as well as a relative deficiency of Follicle Stimulating Hormone (FSH).Insulin Resistance and hyperinsulinemia are central to the pathophysiology of PCOS.

EFFECT OF PCOS:

Irregular menstrual cycle and infertifity.
Oligomenorrhea — menses occurring at intervals of 35 days to 6 months.
Secondary ammendhoerea — absence of periods for greater than 6 months. Often women require assisted fertility to conceive.
Lifestyle modification, weight reduction, increasing physical activity are important as the first line of management prior to medications.

PREGNANCY COMPLICATIONS:

Even if these women conceive with the treatment, they are at the increased risk of gestational diabetes, pre-eclampsia, preterm birth, prenatal mortality, and morbidity during pregnancy.

OBESITY:

A woman diagnosed with PCOS are more likely to be overweight or obese and obesity. Obesity has wide-ranging effects of developing metabolic syndrome, diabetes mellitus, cardiovascular disease, musculoskeletal problems, depression, cancer, pregnancy-related complications, miscarriage, and infertility. Even a modest loss of weight in the order of 5-10% can result in a 30% reduction in central adiposity and a marked improvement in symptoms.

CARCINOGENIC:

Women with PCOS are at increased risk of endometrial hyperplasia and endometrial Cancer. Other effects are

• Metabolic
• Androgenic
• Dermatological and Psychologic

KEY POINT:

Losing weight is probably the single most important factor that can confer beneficial effects across the spectrum of abnormalities that constitutes PCOS and therefore improve symptoms and reduce the metabolic and other consequences of this syndrome. Lifestyle advice, encouraging hypocaloric and low glycemic index diets with increased physical activity, hyperinsulinemia prior to starting medicines or along with medications if needed.