Ovarian condition that can cause missed menstrual periods and infertility goes undetected in Nigeria

Polycystic ovary syndrome is the most common gynecological endocrine disorder in women of childbearing age. It affects between 4% and 20% of women worldwide and is influenced by genetic and environmental factors. Despite its prevalence, it remains an enigma among clinicians and allied health professionals. Kofoworola Belo-Osagie, Conversation Africa’s Nigeria-based editor, asked public health lecturer Ajike Saratu Omagbemi to explain the syndrome and the challenges of detecting it.

What is polycystic ovary syndrome?

The condition refers to the presence of small, benign, painless cysts in the ovaries, which cause a range of symptoms and changes in hormonal levels.

It is characterized by high levels of androgens. This in turn leads to excessive body and facial hair and menstrual irregularities (missed or long periods).

It’s called a syndrome because it’s a collection of signs and symptoms that constantly occur together.

Polycystic ovary syndrome can cause mild or severe disruption to a woman’s reproductive, endocrine, and metabolic functioning.

How big is a problem in Nigeria?

Polycystic ovary syndrome affects one in six infertile women in Nigeria. Local studies have reported rates between 13.8% and 18.1%, among studied populations of women of childbearing age.

Local studies have mainly focused on determining its prevalence, treatment and management techniques. Only a few studies have focused on knowledge about the condition; and their conclusions were mixed. It is unclear exactly what people know about polycystic ovary syndrome in Nigeria.

It is important to bridge the knowledge gap on the situation in Nigeria. The country suffers from a double burden of infectious and non-infectious diseases such as HIV/AIDS, tuberculosis, cardiovascular diseases, diabetes and obesity. There is growing evidence that these are linked to polycystic ovary syndrome.

What is the impact ?

Polycystic ovary syndrome can greatly affect the health and well-being of girls and women in the short, medium and long term, leading to a deterioration in the quality of life.

It can start at the onset of puberty. A girl may not understand what she is going through or be aware of her risk of poor health. Older women may not seek or receive targeted care early enough. They may have years of unrecognized poor health before getting a diagnosis.

Symptoms are often linked to a deterioration in a woman’s self-esteem and self-image and can therefore affect her psychosocial health.

Infertility, a classic symptom of polycystic ovary syndrome, remains a major concern in many African societies. There is a lot of stigma attached to women in Nigeria if they cannot get pregnant. Psychosocial and other consequences can include deprivation and neglect, violence, marital problems and mental health problems.

It is often difficult for teenage girls to recognize the symptoms of polycystic ovary syndrome during puberty.
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Why is the syndrome difficult to recognize?

Polycystic ovary syndrome is most often diagnosed two or three years after the onset of puberty because the menstrual pattern stabilizes around this time. There are different manifestations at this stage of development. Some teenage girls experience menstrual irregularities more frequently – a good marker of high androgen levels. This in turn leads to unwanted developments such as male hair growth 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 missed ovulation in the menstrual cycle, but it is strongly associated with menstrual irregularities.

Other manifestations are a skin condition known as acanthosis nigricans, which causes darker skin in the folds of the body, and premature pubarche, where puberty changes occur too early – often before the age of eight. year.

It’s easy to miss the condition in teenagers. And in the transition from adolescence to adulthood, normal changes can mimic features of the syndrome.

Why are older women not likely to seek treatment early?

Polycystic ovary syndrome manifests in multiple ways and is therefore usually treated as different things. Health professionals still struggle to figure it out themselves, so they can’t always give women the information they need. Sometimes women just try to treat their symptoms on their own.

Women who use birth control may not realize that the hormonal changes they are experiencing are actually symptoms of polycystic ovary syndrome. It is only when they are out of contraceptives and trying to conceive without success that they seek help.

What social and lifestyle factors can cause the syndrome?

The exact cause is not known. Factors such as genetics and lifestyle have been linked to the development of polycystic ovary syndrome. You can inherit the risk. Studies have found family connections.

Women with polycystic ovary syndrome have an imbalance of insulin and androgens. Higher insulin levels suggest a high calorie diet and a sedentary lifestyle. Up to 85% of women with polycystic ovary syndrome also experience insulin resistance – when cells in their body stop responding normally to insulin and instead block glucose from entering the cell and therefore cannot maintain normal blood sugar levels. Insulin resistance is caused by certain lifestyle factors, such as poor diet and physical inactivity. Physical activity plays a role in insulin resistance disorders such as diabetes.

What needs to be done?

The big challenge is to fill the gaps in knowledge about the disease. People can then manage the disease better, prevent complications and be less anxious about fertility.

Women and girls with the disease and those at risk should be made aware of the possibility of metabolic complications so that they can make lifestyle changes.

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