What is Metabolic Syndrome? In simple words, presence of conditions like high Blood pressure, Obesity, Diabetes, raised cholesterol levels that can lead to an increase in the possibility of developing heart disease and stroke. With reference to gynaecology, these conditions can have adverse effects on the women during her reproductive years and later. Unfortunately, more than 30% of women suffer from metabolic syndrome.
Metabolic syndrome can be a part of the following conditions:
Polycystic Ovarian Syndrome
Commonly known by the acronym PCOS, it’s also called Metabolic Reproductive Syndrome. Women with PCOS usually have insulin resistance (Adequate Insulin levels are present, but they cannot act properly). Symptoms include irregular menstrual cycles with or without excessive hair growth on the face, body and a tendency to form acne. Treatment focuses on diet modification with exercise and sometimes progesterone therapy to bring about periods. Women with this condition have a tendency to develop gestational diabetes during pregnancy and possibly type 2 diabetes later. These women are also at risk of endometrial cancer but the cancer is curable with early detection and treatment. It’s better to have at least 6 periods in a year with or without medications.
Abnormal Uterine Bleeding
Women who are overweight/obese are at risk of suffering from prolonged, heavy menstrual cycles. This not only affects their quality of life, but also results in low hemoglobin levels and consequent Anemia. Weight loss can lead to correction of the hormonal imbalance.
Both men and women can experience sexual dysfunction as a result of obesity and Diabetes.
Subfertility is the inability of a couple to conceive after regularly trying for one year. Obesity plays a major role in subfertility and when BMI is brought under control, many women find becoming pregnant easier. Diabetes can affect the sperm parameters and can affect fertility.
Corpus Cancer Syndrome: In this condition, endometrial cancer is present with comorbid conditions of diabetes, obesity and high blood pressure. It is important to make women aware that this type of cancer can be prevented by controlling the aforementioned conditions.
Breast Cancer: Being obese greatly increases the possibility of developing breast cancer. Preventive screenings also become difficult in women who are obese. They might need to go in for a mammogram once a year.
Cervical Cancer: While this cancer is caused by the human papilloma virus, recurrent and persistent HPV infection can lead to cervical cancer in women with uncontrolled DM. Pap smear done once every 3 years is a must to detect this cancer at an early stage. Alternatively, pap smear with HPV DNA is recommended once in 5 years (Dual testing).
Before women with metabolic syndrome undergo surgery, it is important to make sure all the risk factors are well within control. If this is not done, a number of serious conditions including stroke and myocardial infarction might result. Most of the gynaecological surgeries are done laparoscopically these days and it’s a great boon for women with obesity and other metabolic syndrome.
Enhanced Recovery After Surgery
A set of protocols are followed before, during and after surgery to ensure patients’ quick recovery and return to routine. This starts with making sure the patient is aware about the procedure she is to undergo and what it involves, opting for procedures that are least invasive (hysteroscopy, laparoscopy) which will in turn translate to reduced pain and getting the patient back on her feet as soon as possible . It involves early mobilization, chest and leg physiotherapy, medications to prevent clotting in the legs and lungs. The success of any procedure depends on the patient’s involvement and co-operation with thorough understanding.
Tertiary Centre and Manual Patient Handling Equipment
Small centres may not have adequate infrastructure equipped to handle women with metabolic syndrome. This is because requirements range from appropriately sized gowns, operating tables, suitable stretchers and more medical staff just to name a few. As a result, the patient will have to be shifted to a higher centre where an entire team (medical and paramedical) is available at all times.
Support to Handle Metabolic Syndrome
It is to be noted that metabolic syndrome affects a woman’s psychological well-being and women might need counseling to deal with it. Depression and a sense of low self-worth are also commonly seen. Professional medical help as well as moral support from friends and family goes a long way towards helping women suffering from these issues. While diet and exercise play crucial roles, reassurance from patients who have managed the condition successfully and interacting with support groups can help these women and make a huge difference in their lives.