Gynaecology: Raising awareness of Polycystic Ovary Syndrome |20 September 2021

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Polycystic Ovary Syndrome is a serious health condition that affects some women and girls. According to the National Polycystic Ovary Syndrome Association, it is the leading cause of female infertility and a precursor for other serious conditions including obesity, type 2 diabetes, cardiovascular disease and endometrial cancer.

The month of September, in some countries, is Polycystic Ovary Syndrome (PCOS) Awareness Month, and in helping to raise awareness about this condition amongst our local population, Seychelles NATION spoke to Dr Serge Velazquez, gynecologist at PANAFRICARE CLINIC.

In the following interview, Dr Velazquez explains the causes, signs and symptoms of PCOS, as well as treatment options.

Seychelles NATION: What is PCOS? 

Dr Serge Velazquez: PCOS is the most common endocrine disorder in women of reproductive age. Women with this hormonal disorder may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels, which can stop eggs from being released (ovulation) and cause irregular periods, acne, thinning scalp hair, and excess hair growth on the face and body. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

Women with PCOS are often insulin resistant; their bodies can make insulin but can’t use it effectively, increasing their risk for type 2 diabetes.

The primary characteristics of this syndrome include: hyperandrogenism, anovulation, insulin resistance, and neuroendocrine disruption.

Seychelles NATION: From your own experience, is PCOS a common condition amongst women in Seychelles? What age group of women is most commonly affected by it?

Dr Serge Velazquez: In our experience, the incidence of PCOS is about 30% ‒ this represents a very common condition causing significant health problems to the Seychellois women. The age more often is between 15 - 35 years.

A review of the international evidence found that the prevalence of PCOS could be as high as 26% among some populations; however this figure has been reported as being between 4% and 18% despite its high prevalence.

Seychelles NATION: What causes PCOS?

Dr Serge Velazquez: The exact causes aren’t known at this time and there is no known cure, but androgen levels that are higher than normal play an important part. Excess weight and family history which are in turn related to insulin resistance can also contribute.

PCOS is caused by a combination of genetic and environmental factors. Risk factors include obesity, a lack of physical exercise, and a family history of someone with the condition.

Diagnosis is based on two of the following three findings: anovulation, high androgen levels and ovarian cysts. Cysts may be detectable by ultrasound. Other conditions that produce similar symptoms include adrenal hyperplasia, hypothyroidism and high blood levels of prolactin.

Seychelles NATION: What are the signs and symptoms of PCOS? What effects can it have on health?

Dr Serge Velazquez:

• Menstrual disorders: PCOS mostly produces oligomenorrhea (fewer than nine menstrual periods in a year) or amenorrhea (no menstrual periods for three or more consecutive months), but other types of menstrual disorders may also occur.
• Infertility: This generally results directly from chronic anovulation (lack of ovulation).
• High levels of masculinising hormones: Known as hyperandrogenism, the most common signs are acne and hirsutism (male pattern of hair growth, such as on the chin or chest), but it may produce hypermenorrhea (heavy and prolonged menstrual periods), androgenic alopecia (increased hair thinning or diffuse hair loss), or other symptoms.

• Metabolic syndrome: This appears as a tendency towards central obesity and other symptoms associated with insulin resistance, including low energy levels and food cravings. Serum insulin, insulin resistance, and homocysteine levels are higher in women with PCOS.
• Polycystic Ovaries: Ovaries might get enlarged and comprise follicles surrounding the eggs. As a result, the ovaries might fail to function regularly.
• Women that suffer from PCOS have a higher risk of adverse outcomes such as, hypertension, insulin resistance, metabolic syndrome and endometrial hyperplasia.

Seychelles NATION: How is PCOS managed / treated?

Dr Serge Velazquez: Treatment for PCOS depends on a number of factors like age, how severe your symptoms are, and your overall health.

If you plan to become pregnant:

• A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms. They can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.
• Medications to cause ovulation. Medications can help the ovaries to release eggs normally. These medications also have certain risks. They can increase the chance for a multiple birth (twins or more). And they can cause ovarian hyperstimulation which is when the ovaries release too many hormones. It can cause symptoms such as abdominal bloating and pelvic pain.

If you do not plan to become pregnant:

• Birth control pills. These help to control menstrual cycles, lower androgen levels and reduce acne.
• Diabetes medication. This is often used to lower insulin resistance in PCOS. It may also help reduce androgen levels, slow hair growth, and help you ovulate more regularly.
• A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms. They can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.
• Medications to treat other symptoms. Some medications can help reduce hair growth or acne.

Seychelles NATION: You mentioned that a change in diet and activity can play a role in the management of PCOS. Tell us a bit more about this.

Dr Serge Velazquez: Many of the patients who attend our consultations refer to symptoms related to the aforementioned, fundamentally concerned about menstrual disorders and the inability to get pregnant. As we have been able to observe that 80% of the patients with PCOS are overweight or obese patients, this aggravates the condition of the disease at the same time that it hinders the effectiveness of the usual therapies.

A change in lifestyle is the goal to guarantee the ostensible improvement of the patient's condition and therefore the sensitivity of current treatments. Hence, a rigorous diet with reduction of carbohydrates and fats; an increase in the consumption of vegetables and the performance of exercises with the reduction of at least 20% of the body weight, will contribute significantly to the success of the therapy and the reduction of the appearance of complications inherent to this condition.

Seychelles NATION: Is there anything else you would like to mention to our readers?

Dr Serge Velazquez: Summarising, PCOS has no cure as of 2020. Treatment may involve significant lifestyle changes such as weight loss and exercise. Birth control pills may help with improving the regularity of periods, excess hair growth, and acne. Metformin and anti-androgens may also help.

Efforts to improve fertility include weight loss, clomiphene, or metformin. In vitro fertilisation is used by some in whom other measures are not effective. Inositol (in any form) should currently be considered an experimental therapy in PCOS, with emerging evidence on efficacy highlighting the need for further research.

For more information and details:

-           Telephone PANAFRICARE CLINIC: 4321 310

-           Visit PANAFRICARE CLINIC at Le Chantier Mall, Victoria

F.P.