Many patients with polycystic ovary syndrome (PCOS) also have features of the metabolic syndrome, including insulin resistance, obesity, and dyslipidaemia, suggesting an increased risk for cardiovascular disease. The risk factors for metabolic syndrome include central obesity, hypertension, atherogenic dyslipidaemia and insulin resistance. Thus, metabolic syndrome affects 33% of women with polycystic ovary syndrome (PCOS). The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.
Polycystic ovary syndrome (PCOS) is a hormonal disorder which is common among women of reproductive age and affects 10–18% of women. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. Hence, it is the need of the hour for women with PCOS to take good care of themselves, and keep these fatal conditions at bay.
Madhuri Burande Laha, Consultant, Obstetrics & Gynaecology, Motherhood Hospital, Kharadi, Pune, said, “Binge eating, can increase insulin secretion and insulin resistance. Thus, the safest and cheapest therapy that has shown benefit both in diabetes and PCOS is weight loss by lifestyle modifications. In obese women with PCOS, incorporating carbohydrates with a low glycaemic index (GI) has demonstrated considerable improvement in insulin sensitivity. Moreover, medical therapies for insulin resistance are available and can improve not only glucose control, but also the reproductive abnormalities associated with PCOS. Metformin increases ovulation rapidly (as early as 3 months), modestly and without weight loss. It has also improved spontaneous pregnancy rates.”
Patients with diabetes and a BMI> 35 kg/m2, bariatric surgery may also be an appropriate intervention. Weight loss after bariatric surgery also leads to improvements in insulin resistance, hypertension, and dyslipidaemia.
“Likewise, 150 minutes of exercise per week including 90 minutes of moderate intensity aerobic activity, resulting in a net loss of 7 % body weight and a 58 % reduction in the progression to diabetes. Reduced body weight is associated with a decrease in metabolically active visceral fat, which in turn leads to decreased insulin resistance and an optimised lipid profile and may have psychological benefits such as reduced anxiety and depression, ” stated Dr Madhuri.
Recommended screening for metabolic syndrome in women with PCOS
· Weight, BMI, Waist circumference to be measured at every visit.
· Check BP for women with BMI < 25 once in a year and for women with BMI >25 at every visit.
· Do a lipid profile for women with normal profile every 2 years.
· For women who have an abnormal profile or excess weight- do a lipid profile annually.
· 75 gm OGTT to be done in all women every 2 years, whereas in women with added risk factors to be done once every year.