Polycystic Ovary Syndrome (PCOS)
PCOS is a condition that causes irregular menstrual periods. This is due to the fact that monthly ovulation is not occurring and levels of androgens (male hormones) in women are elevated. The condition occurs in approximately 5 to 10 percent of women. The elevated androgen levels can sometimes cause excessive facial hair growth, acne, and/or male-pattern scalp hair thinning. These symptoms are collectively referred to as hyperandrogenism. Most, but not all, women with PCOS are overweight and they are at higher-than-average risk of developing diabetes and obstructive sleep apnoea. For women with PCOS who want to become pregnant, fertility pills or injections may be needed to help women ovulate.
Although PCOS is not completely reversible, there are a number of treatments that can reduce or minimise bothersome symptoms. Most women with PCOS are able to lead a normal life without significant complications.
Symptoms
To diagnose polycystic ovaries 2 out of 3 of the above criteria are required. Clinically one or more of the following symptoms may also be present:
- Irregular ovulation or no ovulation
- Infertility; difficulty in becoming pregnant
- Recurrent miscarriages
- Unwanted facial and/or body hair (hirsutism)
- Oily skin, acne
- Being overweight, rapid weight gain especially around the waist and abdomen (central obesity); or difficulty in losing weight
Causes
- In PCOS there is an imbalance between the pituitary gonadotropin luteinizing hormone (LH) and the follicle-stimulating hormone (FSH), resulting in a lack of ovulation and an increased testosterone production.
- Nobody knows exactly what causes this imbalance but it is felt that it is probably a combination of genetic and environmental factors.
- Many women with PCOS have a weight problem and there appears to be a relationship between PCOS and the body’s ability to make insulin.
Insulin is a hormone that regulates the change of sugar, starches and other food into energy for the body’s use or for storage. Many women with PCOS have insulin resistance, in which the body cannot use insulin efficiently. Since some women with PCOS make too much insulin, this leads to high circulating blood levels of insulin, called hyperinsulinemia.
It is believed that hyperinsulinemia is related to increased androgen levels and it is possible that the ovaries react by making too many male hormones (androgens). This can lead to acne, excessive hair growth, weight gain (obesity), and ovulation problems as well as type 2 diabetes. In turn, obesity can increase insulin levels, causing PCOS to get worse.
Investigation
- Transvaginal Ultrasound (specific reporting on numbers of follicles is essential)
- FSH/LH ratio (on day 3-5 of menses) or after progesterone challenge (avoid mid-cycle day 18-20 in women with cycles less than 35 days)
- Male hormone (androgen) profile
- Blood sugar testing (oral glucose tolerance ) if BMI >27
- Thyroid function tests
- Lipid profile (cholesterol, LDL and triglycerides)
Treatment
Lifestyle change and change in diet are absolutely paramount. Prescription medication is also an option that can be explored. We recommend contacting us for treatment options as each persons case may require different varieties of treatment.
Summary
- In polycystic ovarian syndrome presenting symptoms are highly variable
- Not all women with polycystic ovarian syndrome are infertile
- Treatment of polycystic ovarian syndrome is highly individualised
- Lifestyle changes and exercise are mandatory as part of the management of the condition
Conclusion
Polycystic ovaries is a very common problem in women of reproductive age that has both short-term effects upon reproductive function and longer term effects upon the risk of diabetes and cardiovascular disease.The treatment of polycystic ovaries is highly individualised and very much dependent on the presenting symptoms and needs of the woman in terms of fertility, cycle control, weight issues, and hyperandrogenic symptoms.