PCOS, a hormonal condition affecting the ovaries can cause obesity and lead to the problem of infertility. PCOS and obesity are linked to fertility difficulties as they both cause irregular ovulation and contribute to infertility. Hence, it becomes important to learn the symptoms of PCOS to manage your health and avoid complications, such as obesity and infertility. We spoke to our expert Dr Pruthviraj MO, Consultant - Obstetrics And Gynaecology, Manipal Hospital, Varthur and Whitefield, who explained the link between PCOS, obesity, and infertility and how to manage it.
“Polycystic Ovarian Syndrome commonly known as PCOS, is a most common endocrine disorder among reproductive age group women. It consists of a group of symptoms coming together, such as an increase in androgen (male hormones), ovarian dysfunction, and polycystic appearance of ovaries on ultrasound scan”, said Dr Pruthviraj.
An increase in male hormones can cause:
- Male pattern hair growth over face, chest, abdomen, or back
- Recurrent episodes of acne
- Irregularity in periods (delayed or absent periods or rarely frequent periods followed by a few months of missed periods)
Ovarian Dysfunction:
- No ovulation or infrequent ovulation
- Inability to conceive naturally
Polycystic appearance of ovaries:
- The polycystic appearance of ovaries refers to the presence of multiple fluid-filled sacs
- “Patients often become concerned upon hearing the term "cyst." Typically, cysts in the ovary are defined when fluid-filled sacs exceed 3cms in size and periods remain regular. In PCOS, cyst sizes range from 2-9mm”, added Dr Pruthviraj.
How To Know Who Has PCOS
As per Rotterdam criteria, any two of the following three features should be present:
- Clinical or biochemical increased androgen levels.
- Absence of periods or infrequent periods (more than 35 days cycle )
- Ultrasound criteria: Polycystic appearance of ovaries: more than 12 in each ovary of size 2-9mm or increased ovarian volume >10cc
Risk Factors Associated With PCOS
- Inability to conceive naturally with irregular periods
- Risk of diabetes in pregnancy
- Endometrial hyperplasia, endometrial cancer
- Diabetes with advanced age
- Cardiovascular disease
- Hypertension
- Increased cholesterol levels
Link Between PCOS, Obesity, Infertility
According to the World Health Organization (WHO), being overweight is defined as having a BMI above 25, while obesity is characterised by a BMI above 30. While many obese women may experience normal periods, a small percentage may encounter irregular patterns of bleeding.
Obesity can lead to difficulty achieving pregnancy naturally, diabetes, hypertension, increased risk of malignancy, and metabolic syndrome.
Obesity And PCOS Causing Infertility
“Obesity is present in nearly 50% of PCOS cases. Excess body fat accumulated in the central region raises the waist-to-hip ratio, leading to the peripheral conversion of androgen to oestrogen. This process alters the production of hormones necessary for generating high-quality oocytes essential for pregnancy”, highlighted Pruthviraj.
“The impairment in the hypothalamic-pituitary-ovarian axis further exacerbates the situation, compromising egg quality and reducing the receptiveness of the uterine lining to pregnancy, he added. Consequently, irregular periods, often devoid of ovulation, become commonplace, making it challenging to pinpoint ovulation timing and ultimately leading to infertility.”
According to the Journal of Clinical Endocrinology and Metabolism, several studies have found a connection between PCOS and metabolic syndrome, indicating a prevalence of metabolic syndrome among women with PCOS ranging from 33-46%.
How To Overcome PCOS
- Obesity is one of the risk factors for developing PCOS, hence keep yourself active with moderate exercise 20-30 mins 3-4 days a week. If not exercising, do whatever suits you, including cycling, jogging, walking, swimming, sports, Zumba, aerobics etc
- Follow a low carbohydrate diet with high-fibre foods, such as whole grain, fruits, vegetables
- Avoid high-sugar carbs like soda, white rice
- Consume fruits and vegetables with low glycemic index, such as asparagus, broccoli, carrots, cauliflower, apple, berries, grapes
- Have small, healthy meals and snacks throughout the day
When To Consult A Doctor
- You should consult with your doctor in the following cases:
- If you have less than eight menstrual cycles in a year
- Failing to conceive despite trying for a year
Treatment Options
- Regularise periods if unmarried or married but do not want pregnancy
- Treatment for fertility by ovulation induction
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your expert if you have any symptoms of PCOS to rule out the complications.]