PCOS Prevention

Introduction

What is PCOS?

Polycystic ovary syndrome (PCOS) is a common cause of infertility among people assigned female at birth, who are of reproductive age. About 4%–20% of people AFAB are affected by this condition.¹ 

The main cause of PCOS is an imbalance of sex hormones, which leads to the formation of cysts in the ovary. 

According to Dr Seema Patel, a molecular biologist, a cyst is ‘a water-filled sac containing the egg that should have been normally discharged for possible fertilisation.’ In the case of PCOS, a hormonal imbalance causes the formation of multiple cysts in the ovary, which prevents ovulation. As ovulation is disrupted or becomes absent in people suffering from PCOS, it becomes difficult for them to become pregnant.²

Symptoms

People with PCOS commonly present with the following symptoms:²

• No periods or irregular periods - this is mainly due to the absence of ovulation or irregular ovulation.
• The development of a range of physical symptoms due to the release of excess male sex hormones. These symptoms include
  • Excess facial and body hair 
  • Weight gain
  • Male-pattern hair loss
  • Acne 
• Skin pigmentation

Pelvic pain is a less common symptom that affects a portion of people with PCOS. This could be due to large cysts in the ovaries.

There is no known way to prevent PCOS

PCOS is a condition associated with various causative factors, which means its actual cause is still unclear. It was suggested that multiple genetic and environmental risk factors may contribute to the development of PCOS. Because of this, it is difficult for researchers and healthcare professionals to recommend prevention methods for PCOS. 

Currently, the best way to prevent PCOS is to minimise its risk factors and manage symptoms

Most common risk factors

Family History & Lifestyle

If you have family members who have PCOS, there is a likelihood that you might develop it too. This may be due to risk genes that are inherited from parents and potentially the lifestyle that is practised by the family.³ 

Some of the common lifestyle risk factors include having a diet that is high in saturated fats, a sedentary lifestyle, and smoking and drinking excessively.³ If you have a known family history of PCOS and are at higher risk, it is advised to adopt a healthier lifestyle to help lower the risks for PCOS.  

Health Conditions

Women with obesity and diabetes were found to be associated with having a higher risk for PCOS.⁴ A study found that women who were overweight or obese had an 8.61 times higher risk for PCOS compared to women with a healthy BMI (18.5—24.9 kg/m2).⁵ 

Both diabetes and obesity are metabolic disorders that are associated with insulin resistance. Insulin resistance occurs when your body does not respond to the insulin made. As a result, our bodies may produce more insulin to compensate, which causes excess insulin to circulate in the body. Excess insulin can stimulate the theca cells in the ovary and adrenal glands to produce more androgen than usual, which contributes to the development of PCOS.⁶ 

PCOS itself may also increase the risks for metabolic and cardiovascular disorders, including diabetes and visceral obesity (excess fat surrounding internal organs).

Exposure to Chemicals

A lot of consumer products and industrial pollutants actually contain chemicals that disrupt our hormonal balance. These chemicals are known as endocrine disruptors. Exposure to endocrine disruptors can affect metabolic and reproductive functions, which may lead to the development of PCOS. This is particularly true if people are exposed to these chemicals for a long period of time during important developmental phases, such as the foetal stage, infancy, and childhood.³

Some examples of endocrine disruptors are phthalates, found in cosmetic products, and bisphenol A, found in the coatings of plastic food containers.⁷

Managing symptoms of PCOS

As there is currently no cure for PCOS, the main aims of PCOS treatment are to alleviate the symptoms and prevent the development of complications. The first line of intervention for many women with PCOS is to modify their lifestyle, which may help in improving PCOS symptoms. There are certain medications that can be used for treating period irregularity and ovulation problems, but you should get advice from your GP before undertaking these treatments. 

Lowering androgen levels

As mentioned above, some of the most common symptoms of PCOS are the physical traits that develop with excess androgen produced. Besides that, excess androgen also disrupts ovulation and therefore the menstrual cycle. By lowering the androgen levels and bringing them back to balance, many PCOS symptoms can be improved.

Getting sufficient exercise and adopting a healthy diet are very important factors in improving insulin resistance and excess androgen production. Some studies also observed that weight loss helps regularise the ovulation and menstrual cycle of PCOS patients.⁸

Some oral contraceptive pills can also help reduce androgen levels and therefore the physical symptoms. However, do note that oral contraceptive pills can cause side effects and may not be suitable for everyone.

Pain relief

For people with PCOS who experience pain as a symptom, there are some over-the-counter medicines that you can try to relieve the pain. Examples include non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen, which are common pain relievers. If you decide to use these medicines, it is advised to talk to your GP regarding the dose to be taken. Alternatively, you might want to try stretching exercises or placing a warm towel on the painful site.  

Reducing systemic inflammation

PCOS is also associated with inflammation across the body, called systemic inflammation. Obesity and insulin resistance are two common health conditions which contribute to systemic inflammation. However, lifestyle modifications such as exercising regularly and eating healthy are often effective in improving systemic inflammation. 

In terms of diet, it is advised to reduce red meat, processed meat, sugar, and saturated fat intake. Higher fibre and the inclusion of anti-inflammatory herbs and spices are also encouraged. Examples of anti-inflammatory herbs and spices include ginger, black pepper, rosemary, thyme, and turmeric.⁹ 

Conclusion

Polycystic ovary syndrome (PCOS) is associated with excess androgen and irregularity or absence in ovulation. PCOS causes symptoms such as excess body hair, irregularity or absence of periods, and even infertility. Although the actual cause of PCOS and its prevention methods are not yet clear, people affected by PCOS can manage their symptoms to improve their condition and prevent complications. This includes lowering androgen levels, relieving pelvic pain, and reducing the systemic inflammation associated with PCOS. Lifestyle modification remains the first-line treatment for most patients, and in the case where medication is required, make sure to get advice from your healthcare provider.