Dr Sanjay Shah, senior gynecologist and IVF specialist says, "When comparable diagnostic criteria are applied, both the prevalence and severity of obesity are lower in women with PCOS outside the US. This observation suggests that environmental factors, such as lifestyle, contribute to development of obesity in PCOS. The consistent association between PCOS and obesity suggests a biologic basis for this observation. Moreover, obesity exacerbates many of the reproductive and metabolic abnormalities associated with PCOS.
In Mumbai, approximately 70-75 % of women diagnosed with PCOS are obese. The rest are Lean PCOS who have PCOS with normal BMI."
Obesity and PCOS
Does being overweight cause PCOS or does the disease result in obesity? Dr Ramen Goel, senior metabolic and bariatric surgeon says, "PCOS is associated with insulin resistance in most of the patients. Insulin resistance is an effect of accumulation of fat cells in body. Some studies show that insulin resistance itself increases weight further. Thus, though no cause effect relationship can be established between obesity and PCOS, most believe that PCOS is secondary to weight gain."Dr Rajendra Nagarkatti, senior gynaecologist and IVF specialist, says both are possible — being overweight can cause PCOS and also PCOS can result in obesity. He adds, "Signs and symptoms of polycystic ovarian syndrome begin for some soon after they start having periods. Women with PCOS produce too much insulin, or the insulin they produce does not work as it should. The inability of insulin to function normally is one reason why women with PCOS tend to gain weight or have a hard time losing it." For others, PCOS develops later on, following substantial weight gain. He adds, "What is clear is that women affected by obesity have a greater risk for PCOS and women with PCOS have a greater risk for obesity. Insulin resistance is a common finding in PCOS that is independent of obesity. Insulin-mediated glucose disposal is decreased by 35-40% in women with PCOS, compared to weight in reproductively normal women. This defect is independent of but substantially worsened by obesity."
Early diagnosis is important
There are immediate and late sequelae to PCOS and therefore diagnosing it early helps prevent these says Dr Shah. And to prevent these effects in later life it is important to make lifestyle changes and take supportive treatments. Dr Goel says, "PCOS results in hormonal imbalance in women which can be quite traumatizing mentally and may result in physical health issue in long run, so early diagnosis is important."
Immediate effects
Weight gain, acne, irregular periods, increased facial, abdominal, chest hair growth (due to excess androgen hormones) and infertility.
Late effects
Type 2 diabetes, high cholesterol, high blood pressure, sleep apnea and heart diseases.
Treatments
PCOS can't be cured, but the symptoms can be managed, states Dr Shah, adding, "Treatment options can vary as someone with PCOS may experience a range of symptoms, or just one."
Lifestyle changes: In overweight women, the symptoms and overall risk of developing long-term health problems due to PCOS can be greatly improved by losing excess weight. Weight loss of just 5% can lead to a significant improvement in PCOS. You can find out if you are a healthy weight by calculating your Body Mass Index (BMI), which is a measurement of your weight in relation to your height. A normal BMI is 19-25. Use the BMI calculator to workout if your BMI is in the healthy range. You can lose weight by exercising regularly and having a healthy balanced diet.
Pills for irregular or absent periods: The contraceptive pill may be recommended to induce regular periods or periods may be induced by progesterone tablets (which can be given regularly or intermittently).
Medication for fertility problems: With treatment, most women with PCOS are able to get pregnant. These medications encourage the monthly release of an egg from the ovaries (ovulation).
Bariatric surgery: Though lifestyle modifications are ideal, most of the patients are not able to sustain them resulting in worsening of symptoms. Dr Goel says, "Patients are extremely apprehensive about medicines which have temporary impact on menstrual cycles, but no substantial effect on their weight." He says that increasing number of them are preferring to have bariatric surgery which results in normalisation of hormones within 2-4 months, weight loss, reversal of hair growth and improved fertility.
Medication for unwanted hair growth and hair loss: These medications work by blocking the effects of male hormones, such as testosterone and some also suppress production of these hormones by the ovaries.
Ovarian surgery: A minor surgical procedure called laparoscopic ovarian drilling (LOD) may be a treatment option for fertility problems associated with PCOS.
'Most of the time weight gain starts initially and then PCOS presents. It is true that weight gain happens after PCOS manifests but this could be due to continuation of weight gain process or after effect of medicines taken for PCOS'
— Dr Ramen Goel, Metabolic and bariatric surgeon
From: http://timesofindia.indiatimes.com/life-style/health-fitness/health/The-obesity-PCOS-connect/articleshow/40270186.cms