PCOS and Dyslipidemia – How, What and Why

If you are a working woman in any industry, you have most likely heard of the term “polycystic ovarian syndrome”, more commonly known as PCOS. It is a condition that affects women across age groups. 

Depending on the criteria used to diagnose the condition, the prevalence of PCOS can be as high as 15 – 20%.^[1] Many metabolic irregularities are also pretty common in this condition. Dyslipidemia is one such metabolic problem that may also be seen in women suffering from PCOS.^2,1 

So, what exactly happens in the ovaries in PCOS? And what connection does this syndrome have with abnormal lipid levels?

Blame it on the hormones

Polycystic ovarian syndrome leads to an imbalance in hormones of women in their reproductive age, between their 20s and late 30s. Irregular periods are the most common symptom seen in women with PCOS. These are usually accompanied by acne and unwanted growth of hair on the face, across the chin, jawline, and side-locks. Usually, the major difficulties women with this syndrome face are losing weight and conceiving a baby.³ It’s often at such a juncture that this syndrome is identified in the woman.

Is insulin the reason you can’t lose weight?

Doctors use the term ‘insulin resistance’, which is seen in 50%-80% of PCOS  cases, as the reason for the difficulty in losing weight. Insulin is the hormone that helps to convert the food you eat into energy. When you are insulin resistant, it means your body is constantly producing insulin, but your cells are not able to use it. This excess insulin that circulates in your blood can cause problems with the breakdown of fat in the body.⁴

Oh! That’s why it’s dys-‘lipid’-aemia!

When the fat breakdown mechanism in your body goes faulty, it can progress into problems like high cholesterol. High cholesterol, or more specifically a combination of a high amount of triglycerides, low-density lipoprotein (LDL), and low amounts of high-density lipoprotein (HDL), results in an improper fat balance in the blood. This is what defines the condition of dyslipidemia. And that’s how lipids and PCOS are connected.      

Contrary to popular belief, you don’t have to be overweight or obese to have these problems when you are suffering from PCOS. The Endocrine Society lists PCOS as one of the major causes of dyslipidemia.⁵

Why is the PCOS-dyslipidaemia connection of concern?

Dyslipidemia is of concern to every person as it increases your risk of cardiovascular diseases like heart attack and stroke. A high amount of fat in the blood can form waxy deposits called plaques, which stick to the walls of the blood vessels, thus narrowing the path of blood flow. This is called atherosclerosis. The narrowing of the blood vessels causes less blood to flow to the heart muscles too, increasing your risk of a stroke.⁵

Is PCOS a problem only for overweight women?

A recent study conducted in Maharashtra surveyed 80 women affected with PCOS and compared them with 40 healthy women with no characteristics of PCOS. The group of 80 women comprised both lean and overweight individuals. It was found that the women who were affected with PCOS had higher LDL and triglycerides in their blood as compared to the healthier women. The values of HDL (the ‘good’ cholesterol) were also lower in the women with PCOS as compared to those without.

The fact that the study group contained women of all body weights shows that PCOS is not a problem associated only with obesity. The study divided the 80 women into groups based on their weight and demonstrated that lean women were as much affected by dyslipidemia as the women who were overweight. This puts all women, independent of weight, at a higher risk of heart diseases.⁴

So, is there a way to lower the risk?

We may not have been able to find the exact triggers for PCOS, but treatment is available. Most treatment options can help you achieve a healthy lifestyle, as well as lowering your blood triglycerides. 

• Being physically active is one of the best ways to avoid heart-related disorders. This holds true for PCOS-related dyslipidemia as well. So go ahead and join that salsa class or gym that you have been thinking of. 
• Having a high-fibre diet helps too. You can switch from canned or packaged fruit juice to fresh juices and coconut water, and eat vegetables like carrots, tomatoes, and spinach instead of potatoes and peas.
• Instead of snacking on cookies, you can include a bowl of sugar-free yoghurt in your food.
• Aim for a balanced diet instead of a high-protein diet. You need the best of all worlds.⁶
• There are many medications available that may help solve problems related to PCOS. But remember to always consult your doctor before you start any new medication. ⁷

Disorders like PCOS and dyslipidemia may sound discouraging, but you can overcome them by making simple lifestyle changes and incorporating some fun activities into your routine.  Don’t let the risk of heart disease pull you down the motivation ladder. Instead, push yourself a little harder and climb two more steps each day.

References:

1. .Sirmans, S.M. and Pate, K.A., 2014. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical epidemiology, 6, p.1
2. Kim, J.J. and Choi, Y.M., 2013. Dyslipidemia in women with polycystic ovary syndrome. Obstetrics & gynecology science, 56(3), pp.137-142.
3. Girlshealth.gov. What is PCOS? [Internet]. [updated 2018 Aug 24; cited 2019 Jun 26]. Available from: https://www.girlshealth.gov/body/reproductive/pcos.html.
4. Lath R, Shendye R, Jibhkate A. Insulin resistance and lipid profile in polycystic ovary syndrome. Asian Journal of Biomedical and Pharmaceutical Sciences. 2015;5(48):30-35. doi: 10.15272/ajbps.v5i47.726.
5. Corsino L, Williams G, Young W. Dyslipidaemia [Internet]. [updated 2018 May; cited 2019 Jun 26]. Available from: https://www.hormone.org/diseases-and-conditions/dyslipidemia.
6. Girlshealth.gov. Living well with polycystic ovary syndrome [Internet]. [updated 2014 May; cited 2019 Sep 09]. Available from: https://www.girlshealth.gov/body/images/pcos_2014_508.pdf. 
7. Hosseinkhani A, Asadi N, Pasalara M, Zarshenas MM. Traditional Persian Medicine and management of metabolic dysfunction in polycystic ovary syndrome. Journal of Traditional and Complementary Medicine. 2018 Jan;8(1):17-23. doi: 10.1016/j.jtcme.2017.04.006.

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