Polycystic Ovarian Syndrome (PCOS)

What is PCOS?

Polycystic ovary syndrome (PCOS) is a common condition which affects around 20% of women. It is a chronic, long-term condition in which there is no cure. PCOS affects the way in which a woman’s ovaries function and is, therefore, the most common cause of infertility in women.Diagram of polycystic ovary syndrome PCOS

When a woman has PCOS, her ovaries will contain a large number of small harmless follicles (fluid-filled sacs) up to 8mm in size; twice the number of follicles that normally exist on the ovaries. These follicles are often unable to release an egg which means that normal ovulation cannot occur.

Polycystic ovary syndrome usually manifests during adolescence and results in a hormonal imbalance. In all women, testosterone is produced by the ovaries in small amounts, but this is higher than normal in women with PCOS, which can cause several problems, such as irregular periods, weight gain and excess bodily hair.

The exact causes of PCOS are unknown, though it is very usual for the condition to run in families, so if other women related to you have PCOS then your risk of developing it is higher.

What are the Symptoms of PCOS?

Around 1 in 5 women in the UK have PCOS, though it is estimated that more than half of these do not experience any symptoms.

For those that do have symptoms, these will differ from woman to woman, with some only experiencing very mild symptoms and others severely suffering from the full range.

However, there are several common symptoms, including:

  • Acne and oily skin
  • Excessive hair growth on the face and body (hirsutism)
  • Weight gain and difficulty losing weight
  • Irregular or no periods
  • Difficulty getting pregnant
  • Thinning hair or hair loss (alopecia)
  • Mood swings and depression

How are you diagnosed with PCOS?

Having polycystic ovaries does not necessarily mean you have PCOS. To be diagnosed with the condition you must exhibit at least two of the following three symptoms:

  • Irregular or no periods
  • High level of male hormones
  • Polycystic ovaries – i.e. where the ovaries are enlarged and contain follicles

Pregnant woman getting ultrasound from doctorTo properly diagnose the condition a pelvic ultrasound scan can be carried out, along with blood tests to check for hormonal imbalances. PCOS is diagnosed in only around 5% of women. Once a proper diagnosis has been made, your GP may decide to refer you to a specialist gynaecologist or an endocrinologist (a doctor who specialises in the hormonal system).

PCOS is a long-term condition which can have serious health implications, for example, the increased risk of type 2 diabetes and heart disease. As such, patients need to be diagnosed promptly and counselled appropriately, so that they can take steps to manage their condition and live healthy, happy lives.

Where diagnosed, regular follow-ups are recommended to monitor blood pressure and check for diabetes.

What Causes PCOS?

The cause of PCOS is unknown, but it can be hereditary, which means that if your mother, sister or aunt has PCOS, then you are more likely to also have the condition.

PCOS occurs due to abnormal hormone levels. All women produce a small amount of testosterone (the male hormone) in their ovaries, however, those with PCOS will have a higher level of these hormones, which is why many of the symptoms, such as hair growth, occur.

Insulin is the hormone in the body that controls glucose levels in the blood. People with PCOS may have insulin resistance, which means your body might not respond to insulin, making your glucose levels higher. The body then naturally produces more insulin to attempt to stop glucose levels becoming too high. Again, this can lead to several symptoms of PCOS, such as irregular periods and weight gain.

Is There a Cure for PCOS?

While there is currently no cure for PCOS, there are several treatment options aimed at managing and reducing the symptoms. The options available can be discussed with your doctor and are typically tailored to each individual woman. For every woman with PCOS though, it is highly recommended that a healthy, active lifestyle be followed.

Can I Lose Weight When I Have PCOS?

One of the most common symptoms of PCOS is weight gain and difficultly losing weight. However, losing weight is possible for people with PCOS, through making healthy lifestyle changes, including regular exercise and following a balanced, nutritious diet. When diagnosed with the condition it is usually a good idea to seek advice from a specialist dietitian. It is suggested that weight loss of even just 5% may lead to a significant improvement in PCOS symptoms. A low glycaemic diet can also help women who have insulin resistance and are therefore more prone to diabetes.

Does PCOS Cause Irregular Periods?

Hormonal preparations, such as the oral contraceptive pill are usually very helpful for symptoms associated with irregular periods. These will also help in reducing the long-term risk of endometrial cancer (cancer of the lining of the womb), which is associated with lack of a regular menstrual cycle.

Can I Get Pregnant if I have PCOS?

Although PCOS is the most common cause of infertility in women, many women with PCOS do manage to fall pregnant naturally, while some may need help with medication in order to begin ovulating or to regulate ovulation. Clomifene is a medication which works by encouraging the monthly release of an egg from the ovaries and is usually the first option offered to women with PCOS who are trying to conceive. Where this is unsuccessful, other medication, such as metformin may be recommended, which is typically used to treat type 2 diabetes. Careful monitoring is necessary when ovulation induction drugs are prescribed.

Another option is to undergo minor surgery for PCOS-related fertility issues. This is called laparoscopic ovarian drilling (LOD) and is carried out under general anaesthetic. It involves a small cut being made to the lower abdomen and then a microscope being passed through so that doctors can look inside the body. Heat or lasers are then used to destroy the tissue that is producing the male hormones, helping to correct any hormonal imbalance and restore normal ovarian functions.

Does PCOS Cause Hair Growth?

Due to the high level of male hormones in patients with PCOS, another common symptom of is the growth of excess hair, which can be embarrassing for many women.

Facial hair growth can be treated with special creams or through waxing or laser treatment. Eflornithine is a special cream often used by PCOS sufferers, which works by slowing down the growth of unwanted facial hair and typically a visible improvement is seen after around 6-8 weeks.

Where these treatments are ineffective or where hair growth or is excessive (hirsutism), medications, such as certain types of the combined oral contraceptive, can be prescribed to control the problem. Many of these will also help in treating hair loss caused by PCOS. Such medications work by preventing the effects of the male hormones (testosterone), while some will be able to stop these hormones from being produced in the ovaries.

Is PCOS Serious?

Many women with PCOS live healthy, normal lives. However, women with the condition are at greater risk of certain long-term health issues, such as diabetes, high blood pressure, depression and cancer.

PCOS is under-diagnosed and, therefore, under managed. This means that many people with the condition do not take steps to manage it and attempt to lead a healthier lifestyle. Unmanaged PCOS is often associated with type 2 diabetes, obesity, cardiovascular disease, infertility and depression. As such, early diagnosis and treatment is important and can help decrease the risks associated with the condition.

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