What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder occurring in approximately 10% of women of reproductive age.

Polycystic ovary syndrome is a condition that can cause women to have irregular periods, develop acne (oily skin and pimples), grow extra facial and body hair, or lose hair from their head. The condition can also make it harder to conceive.

A diagnosis of PCOS is made when you experience at least two of the following:

• irregular periods or lack of ovulation
• polycystic ovaries on ultrasound and/ or
• raised male hormones (androgens) either detected by a blood test result or by symptoms such as excess facial and body hair (hirsutism), acne or hair thinning.

 

 

 

 

What causes PCOS?

Doctors are still not entirely clear why some women have polycystic ovaries. Factors that might play a role include:

Heredity. There is often a hereditary link and a link with type 2 diabetes in the family. Research suggests that certain genes might be linked to PCOS. 

Excess androgens. The ovaries often produce abnormally high levels of androgens (‘male’ hormones), which can cause excess hair growth and acne and disrupt the menstrual cycle.

Excess insulin. In recent years it has become clear that PCOS is closely related to a problem with insulin. Insulin is a hormone released from the pancreas after a meal and it allows the organs of the body to take up energy in the form of glucose. In PCOS there is a ‘resistance’ of cells in the body to insulin, so the pancreas makes more insulin to try and compensate. The high levels of insulin have an effect on the ovary, causing a rise in androgen (testosterone) levels and preventing ovulation.

Low-grade inflammation. This term is used to describe white blood cells’ production of substances to fight infection. Research has suggested that some women with PCOS have low-grade inflammation which stimulates excess insulin and androgen production.

 

What are the symptoms of PCOS?

Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty.  Sometimes PCOS develops later, for example, in response to substantial weight gain.

The symptoms vary from woman to woman. Some women have mild symptoms, while others are affected more severely by a wider range of symptoms.

Signs and symptoms of PCOS vary and can include:

• Irregular periods: Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. The period disturbance is a sign that there may be a problem with regular monthly ovulation.
• Infertility: For some women who wish to start a family, getting pregnant may be difficult due to irregular or absent ovulation. It is not usually 100% absolute, and some women with PCOS will ovulate normally, some will ovulate less frequently (leading to a delay to pregnancy) and some will not ovulate at all. 
• Hirsutism (excess hair) and Acne: Raised androgens (male hormones) can cause spots (acne) and excessive  hair growth. These symptoms vary considerably and may not be a problem for some women with PCOS but for others the symptoms are highly distressing.
• Obesity or weight gain: Some women with PCOS are a healthy weight but many struggle to maintain this and often find that they can’t lose weight easily. This is a double-edged sword for women with PCOS. Weight gain often worsens the other symptoms of PCOS and the hormone changes associated with PCOS make weight loss more difficult.

What are the longer-term risks of PCOS?

PCOS is associated with an increased risk of developing type 2 diabetes mellitus. Women with PCOS also have a higher risk of high blood pressure, high cholesterol levels and possibly heart disease later in life. The best ways to reduce the risks are through careful food choices, exercise and weight loss in women with excess weight. 

Infrequent periods over a long period of time can lead to a slightly increased risk of cancer of the lining of the uterus. The key to reducing risk is to make sure you have a period in which the lining of the uterus is shed at least every three months. This can be achieved by taking birth control pills or progesterone/progestins.

Depression and anxiety are more common in women with PCOS as the symptoms associated with Polycystic Ovary Syndrome can affect your self-esteem and your self-confidence.

 

When should I see a doctor?

See your doctor if you have concerns about your menstrual periods, if you are struggling to conceive or if you have signs of excess androgen such as worsening hirsutism, acne or hair thinning.

 

Are there tests I should have?

Your doctor will decide which tests you should have based on your symptoms and individual situation. Possible tests include:

• Blood tests to measure levels of hormones, blood sugar and cholesterol
• A pregnancy test if you have missed any periods
• Pelvic ultrasound to look at your ovaries and womb. In PCOS the ovaries are found to have multiple, small cysts around the edge of the ovary. These cysts are only a few millimetres in size, and do not in themselves cause any problems

 

How is PCOS treated?

• Birth control (oral contraceptive) pills – The pills don’t cure the condition but they can improve many of its symptoms such as irregular periods, acne, and facial hair. Birth control pills also protect women from cancer of the uterus.
• Anti-androgens such as spironolactone (Aldactone) – These medicines block the hormones that cause some PCOS symptoms like acne and facial hair growth.
• Progestin – This hormone can make your periods regular, but only if you take it every month. It also lowers the risk of cancer of the uterus.
• Metformin – Helps to reduce insulin levels, which may in turn help to regulate your periods.  Metformin may also reduce the risk of developing type 2 diabetes. It can aid weight loss if you also follow a diet and an exercise programme.
• Clomiphene or Letrozole are both fertility drugs to help women who are looking to conceive ovulate.
• Medicated skin lotion or antibiotics to treat acne.
• Laser therapy or electrolysis to remove extra hair.

 

Is there anything I can do on my own to treat the condition?

Yes. If you suffer from overweight or obesity, losing weight can improve many of your symptoms. As little as 5% weight loss can regulate periods, improve fertility and excess hair growth. Try to eat a healthy, balanced diet. Choosee a diet that is high in fruit and vegetables, healthy protein, fat and low glycaemic index (GI) carbohydrates. Try to minimise your intake of processed food  and refined carbohydrates to improve health and weight loss. Regular exercise will help you maintain the weight you lose and is also important for health and wellbeing.

 

What if I want to conceive?

Regular periods usually indicate that you are ovulating normally and therefore should be able to conceive naturally.  However, if your periods are irregular then you may not be ovulating regularly and may need some help to conceive.  If you are overweight, losing weight can help improve your ovulation and your chances of becoming pregnant. If your periods remain irregular, your doctor can give you medicines to help you ovulate. With treatment most women with PCOS are able to conceive.

 

Summary

Women with Polycystic Ovary Syndrome are able to live normal lives. Early diagnosis and treatment will help your symptoms and protect you from other diseases

Lifestyle interventions to include a healthy diet and regular exercise are the first treatments for PCOS. Weight loss can treat the symptoms and improve the chances of becoming pregnant.

Medicines are an option if lifestyle changes don’t work. Birth control pills and metformin can both restore more normal menstrual cycles and relieve PCOS symptoms.