by: Dr. Nupur Sharma
Sr.Consultant- Obstetrics and Gynecology – Paras Bliss, Panchkula

Before we decide that PCOS causes diabetes or not it is important to understand the normal physiology. Usually, a single egg starts forming in one of the ovaries, grows to the size of 18-22 mm in a span of 14 days (beginning from D1 of periods). Usually, on D14 it comes out of its shell reaches the tube, waits there for its male counterpart ‘sperm’ for 24 hours. If it meets its male counterpart it results in pregnancy, if it doesn’t then after 14 days, the nest or the endometrium prepared by the womb for the baby sheds off which we see in form of monthly periods or menstruation. Usually the second half of cycle i.e. luteal phase is constant 14 days; there is variability in the egg formation and release time.

How PCOS causes diabetes?

In PCOD there is a multimolecular development where multiple eggs start the race but none reaches the deadline of 18-20 mm. Neither does the egg come out of the ovary. Since the first half of the cycle is variable. The cycle length becomes variable. Also since the egg pool is constant there is early exhaustion of the pool leading to premature ovarian failure. This endocrine disorder results from an imbalance between the hormones LH & FSH.
The cause is primarily genetic with environmental influences like improper diet, stress, lack of exercise unmasking these genes predisposing to syndrome ‘X’. Since the eggs do not rupture, ovary which is supposed to be a production house becomes a storage house and is unable to perform its functions. This collection of eggs is visible on USG as polycystic ovaries or multifollicular ovaries which people mistake for cysts in the ovary. Also because the endometrium or nest doesn’t shed off periodically it results in endometrial hyperplasia or very heavy and prolonged periods after an amenorrhoea (absent period of 2-3 months).
Also as we understand metabolic disruption doesn’t occur with LH/FSH hormones only. Insulin resistance or glucose intolerance is a distinctive part of this syndrome present in both lean and obese PCOS. This hyperinsulinemia has a direct stimulating effect on ovarian androgens causing the most agonizing symptom of PCO i.e. unwanted hair growth on body or HIRUTISM. Also, the glucose intolerance predisposes to diabetic mellitus, increased cholesterol or abnormal lipid profile.

To put it briefly the common symptoms of PCOS are:

• Absent or irregular periods
• Followed by very heavy or prolonged periods
• Hirsutism (unwanted hair growth)
• Weight gain (both causative and effect)

Signs associated with PCOS:

• PCO ovaries of USG
• Abnormal LH/FSH ratios
• Increase in serum androgens especially testosterone
• Impaired glucose tolerance
• Abnormal lipid profile

Comorbidities associated with PCOS:

• Infertility (inability or difficulty in conception)
• Pregnancy implications (gestational diabetes, preterm delivery, preeclampsia especially in obese)
• Obesity
• Type 2 Diabetes Mellitus
• Cardiovascular diseases (especially in the presence of additional risk factors like cigarette smoking, hypertension, dyslipidemia, family history)
• Depression

Treatment associated with PCOS:

Since it is a lifestyle disease enclosing far broader spectrum of diseases and not only irregular periods, impact of the diseases process continues far beyond menopause. As roots of all lifestyle disease set in adolescence so do PCO. There is a need for global change where we need to:
• Create awareness among adolescent girls regarding the epidemic of PCO.
• Lifestyle modification in the form of dietary regulation. Avoid junk food as far as possible; it makes your body junkyard.
• Regular exercise: household work tires whereas exercises energizes. So the two are not interchangeable 30 mins of vigorous physical exercise in form of yoga, aerobics, running, outdoor games minimum 5 times a week i.e. 150 mins/week (walking alone is not sufficient). Exercise plays an important role in both lean and obese PCOS. It is the best hormone balancer.
• Ayurvedic herbs like methi etc. may have a role.
• Last in the use is drug therapy, minimum 3-4 periods/menstruation in a year is a must to avoid complications like endometrial hyperplasia which further predisposes to endometrial cancer. (LNG IUS protects against endometrial hyperplasia such women desirous of contraception also)
• If glucose intolerance or abnormal lipid profile coexists it requires appropriate drug therapy for correction.
To put it in a nutshell, PCO is a disease which eats away the roots of the healthy body slowly and steadily but it is totally amenable to treatment provided, we recognize it and we are willing to fight it out by adopting a healthy lifestyle.

by: Dr. Nupur Sharma
Sr.Consultant- Obstetrics and Gynecology – Paras Bliss, Panchkula

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