Polycystic ovary syndrome is the most common gynecological endocrine disease in women of reproductive age. It affects between 4% and 20% of women worldwide and depends on genetic and environmental factors. Despite its prevalence, it remains a conundrum among clinicians and allied health professionals. Conversation Africa’s Nigerian editor Kofoworola Belo-Osagie asked health lecturer Ajike Saratu Amagbemi to explain the syndrome and the challenges surrounding how it is detected.
What is polycystic ovary syndrome?
The disease refers to the presence of small, benign and painless cysts in the ovaries, which leads to a number of symptoms and changes in hormonal levels.
It is characterized by an increased level of androgens. In turn, this leads to excessive growth of body and facial hair and menstrual irregularities (absence of periods or prolonged periods).
It’s called a syndrome because it’s a set of signs and symptoms that occur consistently together.
Polycystic ovary syndrome can easily or severely disrupt a woman’s reproductive, endocrine, and metabolic work.
How big a problem is this in Nigeria?
Polycystic ovary syndrome affects one in six infertile women in Nigeria. Local studies have shown rates from 13.8% to 18.1% among the test group of women of reproductive age.
Local research is mainly focused on determining its prevalence, treatment and management methods. Only a few studies have focused on condition knowledge; and their results were mixed. It is unclear how many people are aware of PCOS in Nigeria.
It is important to address the knowledge gap about the situation in Nigeria. The country suffers from a double burden of communicable and non-communicable diseases such as HIV/AIDS, tuberculosis, cardiovascular disease, diabetes and obesity. There is increasing evidence that they are associated with polycystic ovary syndrome.
What is the impact?
Polycystic ovary syndrome can have a profound impact on the health and well-being of girls and women in the short, medium and long term, leading to a reduced quality of life.
It can start as early as puberty. The girl may not understand what she is going through, and may not be aware of the risk of health deterioration. Older women may not seek or receive targeted care early enough. They may have years of unrecognized ill health before being diagnosed.
Symptoms are often associated with impaired self-esteem and self-concept and may therefore affect her psychosocial health.
Infertility, the classic symptom of polycystic ovary syndrome, remains a major problem in many African societies. There is a huge stigma in Nigeria when women cannot conceive. Psychosocial and other consequences can include deprivation and neglect, violence, marital problems and mental health problems.
Why is the syndrome difficult to recognize?
Polycystic ovary syndrome is most often diagnosed two to three years after the onset of puberty, as the menstrual cycle stabilizes around this time. At this stage of development there are various manifestations. Some teenagers are more likely to experience menstrual irregularities – a good marker of increased androgen levels. This in turn leads to unwanted events such as male pattern baldness on the chest, back and face, male pattern baldness and acne. It is believed that an increase in androgens leads to the development of polycystic ovary syndrome in adulthood.
The syndrome is not the only cause of the absence of ovulation in the menstrual cycle, but is strongly associated with menstrual disorders.
Other manifestations are a skin condition known as acanthosis nigricans, which causes darkening of the skin in the folds of the body, and precocious puberty, when the changes of puberty occur too early – often before the age of eight.
In teenagers, the condition is easy to miss. And at the transition between adolescence and adulthood, normal changes can mimic the characteristics of the syndrome.
Why do older women not seek treatment early?
Polycystic ovary syndrome manifests itself in different ways, so it is usually treated differently. Health professionals still find it difficult to understand this themselves, so they cannot always provide women with the necessary information. Sometimes women just try to treat their symptoms on their own.
Women using contraceptives may not realize that the hormonal changes they are experiencing are actually symptoms of PCOS. It is only when they stop using contraceptives and try to conceive without success that they seek help.
What social and lifestyle factors can cause the syndrome?
The exact cause is unknown. Factors such as genetics and lifestyle have been linked to the development of PCOS. Risk can be inherited. Research has revealed kinship ties.
Women with polycystic ovary syndrome have an imbalance of insulin and androgens. A higher level of insulin indicates a high-calorie diet and a sedentary lifestyle. Up to 85% of women with PCOS also experience insulin resistance – when their body’s cells stop responding normally to insulin and instead block the entry of glucose into the cell and therefore cannot maintain normal glucose levels. Insulin resistance is caused by certain lifestyle factors, such as poor diet and lack of physical activity. Physical activity plays a role in disorders such as diabetes and insulin resistance.
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What should be done?
The big challenge is to fill the gaps in knowledge about the condition. Then people will be able to better fight the disease, prevent complications and worry less about fertility.
Women and girls with this condition and those at risk need to be educated about the potential for metabolic complications so that they can make lifestyle changes.
Ajike Saratu Amagbemi, Lecturer, Babcock University
This article is republished from The Conversation under a Creative Commons license. Read the original article.