PCOS: An often-undetected condition on the rise

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When you think of diseases, the illnesses that first come to mind are likely common ones, such as diabetes, heart conditions, and, more recently, COVID-19. Although certain demographics may be at higher risk for developing these conditions, they can ultimately affect anyone, regardless of race or gender. However, certain gender-specific conditions exist, and among those that affect only women, one of the most prevalent is polycystic ovarian syndrome (PCOS).اضافة اعلان

Globally, it is estimated that 4–20 percent of women have PCOS, but establishing the exact rate of occurrence is difficult. This is largely due to underdiagnosis. A 2010 study took a random community sample of women and found that roughly 68 percent of those with PCOS only discovered the condition during the course of the study and were not previously diagnosed. That said, the literature advises against mass screening, recommending awareness campaigns about PCOS symptoms instead, to encourage individuals to seek treatment.

What is PCOS?
PCOS is a unique metabolic condition that affects women of reproductive age and is still not fully understood. It is a disorder that falls under the field of female reproductive health (gynecology) and hormones (endocrinology). PCOS is a syndrome, meaning that a certain set of symptoms characterize the condition. However, different organizations have established varying diagnostic criteria, making diagnosis difficult.

The most common diagnostic tool, the Rotterdam criteria, identify three different symptoms. The first is oligo-anovulation, or irregular menstruation and ovulation. The second is excess male hormones, known as androgens, and the third symptom is polycystic ovaries. If two of these symptoms are present, then an individual can be diagnosed with PCOS.

Hundreds of thousands of small sacs are present in a woman’s ovaries, known as ovarian follicles. Each ovarian follicle contains one immature egg, which has the potential to be fertilized during the menstrual cycle. When a follicle is selected to undergo maturation, it will develop depending on the natural hormones released during the menstrual cycle up to the point of ovulation (i.e., the release of an egg ready to be fertilized). However, since PCOS involves a hormone imbalance, the follicles cannot grow and mature properly. This ultimately results in the follicles being unable to release the egg, instead accumulating and growing in size within the ovaries. This can cause the entire ovary to expand.

According to the Rotterdam criteria, a diagnosis of polycystic ovaries requires the presence of 12 or more cysts (i.e., grown follicles with unreleased eggs) that are two to nine millimeters in size and/or an ovarian volume greater than 10mL for at least one ovary, where it occupies more than 10mL of space.

PCOS in Jordan
The exact global prevalence of PCOS is difficult to estimate, and Jordan is no exception. According to 2019 data from the Institute for Health Metrics and Evaluation, 4.06 percent of Jordanian women between the ages of 15 and 49 have PCOS.

Furthermore, Jordan has experienced roughly a 31 percent increase in PCOS since 1990. This increase has been noted internationally, and numerous studies attribute it, in part, to the more accurate diagnostics applied in the Kingdom. For example, after the UK began implementing the Rotterdam criteria, the prevalence of PCOS increased by 4 percent. Although some of the increase in Jordan can be attributed to better diagnostics, it is undeniable that other variables have contributed to the rise in cases.

Currently, no broad screening recommendations exist for diagnosing PCOS, and identifying the condition depends heavily on patient awareness. In Jordan, it has been found that women’s knowledge of PCOS is poor. A 2020 study administered a simple 20-question survey to a random sample of Jordanian women between 18 and 45. The survey contained basic questions on PCOS regarding causes, symptoms, and complications, and the average score was 10 out of 20. Since diagnosis is highly contingent on patient awareness, it is important that Jordan implement awareness campaigns about the condition.

Causes and risk factors for PCOS
PCOS is complex in nature, and our current understanding of the condition is quite poor. Currently, it is believed that genetics is the most decisive factor in causing the development of the illness. Since PCOS affects several aspects of metabolism, it has been difficult to identify any single gene responsible.

However, two other physical factors are associated with PCOS, although their exact role in the condition is unclear. The first factor is insulin, a hormone that helps regulate blood sugar. In the overwhelming majority of PCOS cases, women have insulin resistance, where the body no longer responds to insulin as it normally should. As a result, the body increases insulin production to compensate, and these high hormone levels can cause the ovaries to increase their production of androgens while also further contributing to impaired ovulation. However, it is unclear if insulin resistance contributes as a cause of PCOS or if it is simply a symptom.

The second factor is obesity. Similar to insulin resistance, this phenomenon is prevalent in most PCOS cases. While the syndrome has been shown to increase the risk of obesity, obesity is also known to impair hormone control in the body and could potentially worsen insulin resistance. Still, it is unclear if obesity directly causes PCOS, or if it is merely a symptom.

PCOS complications
As a result of impaired growth and maturation of the ovarian follicles, a host of symptoms and complications may arise. Some of the most common symptoms associated with PCOS are irregular or non-existent periods, as well as heavy bleeding during the time of menstruation. Additionally, since PCOS causes anovulation (the inability for an egg to be released) it can make conception difficult. It is, in fact, the most common cause of female infertility.

The presence of extra male hormones also results in many symptoms that may be easier to detect. Hirsutism is the abnormal growth of hair in a pattern more closely associated with males, such as facial and chest hair. Conversely, balding or thinning of head hair, known as alopecia, may occur, although it is an uncommon PCOS symptom. Finally, increased androgens can cause excessive acne.

Unfortunately, PCOS is also associated with many conditions that can be quite serious if not properly addressed. Especially in cases where obesity is observed, the syndrome increases the patient’s risk of high blood pressure, high blood sugar, raised LDL (bad cholesterol) levels, and low HDL (good cholesterol) levels. This set of symptoms is known as metabolic syndrome, which significantly increases the risk of heart disease, diabetes, and stroke. Additionally, the risk of type two diabetes is high among patients suffering from insulin resistance.

Similarly, sleep apnea, a condition in which breathing stops and starts during sleep, is common among those with PCOS, and is even more prevalent among people considered obese. Finally, due to the hormonal and physical changes caused by increased androgen production, depression is quite common among PCOS patients. One study found that 65 percent of Jordanians with PCOS have depression and 98 percent suffer from anxiety.

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