Polycystic Ovary Syndrome is an endocrine disorder characterized by hyperandrogenism, polycystic ovaries and irregular menstruation. Certain metabolic derangements observed in PCOS include insulin resistance and compensatory hyperinsulinemia, which can further increase the risk of diabetes and cardiovascular diseases, amenorrhea, oligomenorrhea, hirsutism, acne and prolonged erratic menstrual bleeding are commonly observed in women with PCOS. A woman with history of PCOS is at higher risk of developing PCOS. PCOS is a chronic disorder and therefore it is essential to consider other suitable fist line interventions such as coucenlling, exercise and weight management. Physical and psychological interventions can be helpful in management of PCOS.
Physical exercise
Physical exercises are known to regulate cardiovascular function, the reproductive system (reproductive hormones and menstruation) and metabolic functions including insulin resistance and glucose metabolism. Physical exercises that target slower weight loss are usually more effective for improving insulin sensitivity and restoring ovulation in infertile obese women with PCOS. Slow weight loss of 2% – 5% of total body weight can be helpful in restoring ovulation and insulin sensitivity as well as decreasing visceral adiposity in obese women having PCOS. Obesity is a crucial factor in pathogenesis of PCOS, weight loss is very essential for managing PCOS.
Homocysteine, a risk factor for heart disease increases the risk of atherosclerosis in women with PCOS by inducing endothelial dysfunction through limited bioavailability of nitric oxide and altered blood vessel elasticity.
Adherence to physical exercises which are as simple as walking help increase the body’s aerobic capacity and production of nitric oxide, which further reduces vascular shear stress. Physical exercises also help to reduce total plasma, homocysteinse concentration in obese women with PCOS.
Psychological treatment
It has been observed that patients with PCOS carry a psychological burden through their lives. Most women with PCOS fear infertility and loss of femininity and sexuality and lower self-worth which could lead to mental health problems.
Cognitive behavioral training (CBT) including individual sessions focused on comorbidity between physical illness and depression, positive thinking and cognitive restructuring can give effective results in adolescents with PCOS. Physiological comorbidities such as menstrual irregularity higher percent of fat mass, hypertension and mid region adiposity associated with PCOS can also be reduced with the help of cognitive behavioral therapy.
At times women with PCOS have reduced sexual libido due to higher level of androgenic hormones in the ovaries or adrenal glands as PCOS is a physical, psychological and social syndrome. A patient requires care beyond treating the physical symptoms.
(Author is Professor Dept of IBT, Kashmir Tibia College Hospital and Research Centre. Email: [email protected])
