Polycystic ovarian syndrome (PCOS) is the most common hormonal disorder in females of reproductive age. It is characterized by two or more of the following:
- Irregular menstrual periods
- Hyperandrogenism
- Polycystic ovaries
Unfortunately, PCOS is underdiagnosed, frequently taking a long time to be identified, often over a year.
Multiple morbidities are associated with PCOS, including infertility, metabolic syndrome, obesity, insulin resistance, type 2 diabetes mellitus, cardiovascular risk, depression, obstructive sleep apnea, endometrial cancer, and non-alcoholic fatty liver disease .
PathoPhysiology:
Polycystic Ovarian Syndrome PCOS is believed to be a genetically inherited metabolic and gynaecological disorder. A repetitive vicious cycle occurs with hormones resulting in the progression of PCOS. To begin with, failure of an ovary to release oocyte results in increased levels of androgen production released from the ovaries as well as the adrenal cortex. The excess androgen hormones in the system have a twofold effect. First, androgens are stored in adipose tissue where they are then converted into estrogen. Excess androgens then result in an increased production of Sex Hormone Binding Globulin (SHGB). This increased SHGB then has the consequence of an even greater fabrication of androgens and estrogens. Thus, the cycle begins. The cause of the excess androgen production has been correlated to surplus Luteinizing hormone (LH) stimulation resulting in the presence of cystic changes in the ovaries.
What are the symptoms?
| Symptom |
Description |
| Enlarged polycystic ovaries |
Enlargement of ovaries with multiple small cysts. |
| Obesity and central fat distribution |
Increased body weight with a tendency to accumulate fat in the central region of the body. |
| Hirsutism |
Male pattern of hair growth primarily on the face, back, chest, lower abdomen, and inner thighs. |
| Virilization |
Development of male features including balding of the frontal portion of the scalp, voice deepening, atrophy of breast tissue, increased muscle mass, and clitoromegaly. |
| Anovulation |
Failure of the ovaries to release an oocyte. |
| Amenorrhea |
The absence of a menstrual period in women of childbearing age. |
| Oligomenorrhea |
The presence of menstrual cycles greater than 35 days apart. |
| Dysfunctional uterine bleeding |
Abnormal bleeding from the uterus not associated with tumors, inflammation, or pregnancy. |
| Acne related to hyperandrogenism |
Acne outbreaks due to elevated androgen levels. |
| Infertility; recurrent first trimester miscarriages |
PCOS can make it harder to get pregnant and increase the risk for pregnancy complications and miscarriage. Weight loss and other treatments can improve the chances of having a healthy pregnancy. |
| Pronounced psychological and psychosocial problems |
Significant mental and social challenges that affect health-related quality of life (HRQL). |
| Obstructive Sleep Apnea |
A sleep disorder where breathing repeatedly stops and starts during sleep due to blocked upper airways. |
A physiotherapist and dietician are highly recommended as these are considered first-line treatments.
Weight reduction is an important component of the physical therapy program since weight reduction improves glucose intolerance which in turn could resolve the reproductive and metabolic derangements often associated with PCOS. Weight loss may also reduce the pulse amplitude of luteinizing hormone thus reducing androgen production.
Other alternative interventions
| Intervention |
Description |
| Physical Therapy Interventions |
These interventions aim to decrease the main symptoms of PCOS by addressing hormonal imbalances, obesity, and improving the quality of life. Modalities such as High Intensity Interval Training, Cardiovascular training, and Resistance Training help increase heart rate, positively impacting cardiovascular health and hormone regulation. |
| Resistance Training (RT) |
RT is defined as the “increase in muscle strength by making muscles work against a weight or force”. It has been shown to reduce testosterone levels, waist circumference, and increase functional capacity, thus helping to improve and decrease PCOS symptoms. |
| Aerobic Training |
Involves activities like running, walking, and bike riding. Though there's no superior method, each type can alleviate PCOS symptoms. Engaging in aerobic activity that raises heart rate to sixty to seventy percent can improve autonomic and inflammatory functions. |
| Modalities (TENS, Hot/Cold packs) |
Using these modalities in physical therapy can help by relieving pain in specific areas. The "Core Four" muscles of the pelvic floor often painfully contract in PCOS patients. Given their experience with low back pain and pelvic discomfort, PCOS patients frequently suffer from primary dysmenorrhea. |
| Acupuncture |
Acupuncture therapy improvements are associated with regular menstrual cycles, slower hair growth, improved moods, and reduced acne. Some women also experience more tangible outcomes like more regular ovulation and pregnancy. |
