KUWAIT CITY, April 19: The New Mowasat Hospital, Salmiya, on Saturday, April 18, 2009, held a patient’s information evening on what is said what a person needs to know about polycystic ovarian syndrome (PCOS). The evening was held under the slogan ‘Caring for the Generations’. The presentation was given by Dr Nahed Hammadieh, Consultant in Gynecology and sub-specialist in Reproductive Medicine & Surgery MD, MRCOG, MD, Dip in Med Science, HEA and Head of Assisted Conception Unit at the New Mowasat Hospital. “The first question that anyone is likely to ask is ‘What is polycystic ovarian syndrome’ which is also goes by the name Stein-Leventhal syndrome. This is an imbalance affecting several hormone systems that causes women to have a variety of symptoms,” stated Dr Hammadieh.
He went on to say, “These symptoms include women having a high level of androgens (a male hormone), missed or irregular period and many small cysts in the ovaries (which are abnormal, closed sac-like structures within a tissue that contain a liquid, gaseous or semisolid substance, which can occur anywhere in the body and can vary in shape).
“Other signs include acne, obesity, excessive hair growth, abnormal hair growth and distribution and skin discolorations. If PCOS is not treated it can progress to metabolic syndrome: high blood cholesterol, high blood pressure and diabetes,” he added.
He disclosed, “Other important signs include endocrine disturbances such as increase in insulin level, increase in prolactin, increase in testosterone level, and increase in luteinizing hormone that stimulates the ovary.”
Any of the above symptoms and signs may be absent in PCOS, with the exception of irregular or no menstrual periods. All women with PCOS will have irregular or no menstrual periods. Women who have PCOS do not regularly ovulate, that is, they do not release an egg every month. This is why they do not have regular periods. It is a common cause for anovulation and female infertility, he said.
PCOS affects 20 percent of all women of reproductive age, and it is more common in the Middle East and Asian populations. However no one is quite sure what causes PCOS. Although women with PCOS often have a mother or sister with the condition, so there seems to be a hereditary factor. In a study, 93% of girls who had PCOS reported that their mothers also suffered from this syndrome. Stress may also be an important contributing factor, sometimes that stress is biological, such as going through puberty, he disclosed.
Dr Hammadieh emphasized this issue by pointing out how in the Arab world people deal with the issue of puberty as a taboo. “Arab girls who hit puberty tend to feel shy and mostly ashamed by the change that happens in their body, and most of the time try to hide any of their physical change, this issue increases their risk of stress and anxiety,” he said. Sometimes stress is the result of a ‘high energy personality.’
The symptoms of PCOS seem to occur more often when there is also a diagnosis of bipolar disorder, anxiety, and/or depression. It may be that PCOS is what happens when the body starts to have trouble keeping up with the demands of a stress response that never has the opportunity to turn off. The socio-environmental factor is also significant.
“Most people in the Middle East tend to have a very unhealthy lifestyle especially when it comes to sleeping, most people stay awake all night and then sleep in the afternoon, however what people don’t realize is that unhealthy sleep is one of the contributing factors to people who suffer from some of the PCOS symptoms,” Dr Hammadieh said.
“PCOS is also a health problem that can affect a women’s menstrual cycle hindering her ability to have children, plus it leads to the appearance of blood vessels and 60% of women suffering from this problem are obese, stressed Dr Hammadieh.
He continued by saying “Most women with PCOS have trouble in their menstrual cycle mainly because ovulation does not occur and the hormone progesterone is not made, and without progesterone the menstrual cycle is irregular or absent. The small cysts make male hormones which also prevent ovulation.
“However the syndrome has many different presentations and no women are alike. Two things do appear to be common in most cases and that is insulin resistance and some kind of stressor that pushes the body into “stress mode,” Hammadieh said.
It is also important here to speak on the polycystic ovarian syndrome diagnosis. The diagnosis of PCOS is generally made on the basis of clinical signs and symptoms. However the cysts in the ovaries can be identified with imaging technology such as ultrasound.
“There is no cure for PCOS, treatment goals are only based on the symptoms, stated Hammadieh. For younger women who desire birth control, especially those with low “androgenic” (male hormone-like) side effects, birth control pills like Jasmine, can cause regular periods and prevent the risk of uterine cancer. For acne or excess hair growth, a water pill (diuretic) called spironolactone may be prescribed to help reverse these problems. Other medications include Diane, anti-androgens, Finasteride, Vaniqa cream and laser hair removal.
“For women who desire pregnancy, a medication called clomiphene (Clomid) can be used to induce ovulation (cause egg production). In addition, weight loss can normalize menstrual cycles and often increases the possibility of pregnancy in women with PCOS. Therefore modifying one’s lifestyle can also help. “The best diet to follow for those suffering from PCOS is a low carbohydrate diet. Emerging research is also pointing to the importance of Omega-3 fatty acids, which maintains mood and hormone function among PCO patients, stated Dr Hammadieh.
“Women with PCOS are at a higher risk for a number of illnesses, including high blood pressure, diabetes, heart disease, and cancer of the uterus (endometrial cancer),” included Dr Hammadieh.
“Much of the risks can be reversed by getting your symptoms under control at an earlier age and to talk to your doctor about treating these symptoms. It is also important to eat right and exercise, and to avoid smoking cigarettes or ‘shisha”, a regular test for diabetes can also help,” he said. “Family support is also very important and everyone needs to know that PCO is a common illness but is not the most serious illness however treatment of the symptoms at an early stage is a great help to all sufferers of PCOS,” Dr Hammadieh emphasized. Today the management of polycystic ovary syndrome should include patient education and attention to diabetes and cardiovascular risk factors such as hyperlipidaemia, obesity, physical exercise, glucose intolerance, hypertension and cigarette smoking, he concluded.
By Rena Sadeghi
Arab Times Staff