Polycystic Ovary Syndrome (PCOS)

What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women. Polycystic ovary means the ovaries contain more developing follicles than normal. These follicles contain eggs which do not mature and are hence not released, thereby leading to formation of cysts.

The polycystic ovary syndrome (PCOS) is a condition in which women with polycystic ovaries also have one or more additional symptoms like menstrual irregularity, acne or excessive hair growth.

What causes polycystic ovaries?

The cause of PCOS is not yet known. PCOS sometimes runs in families. If any of your relatives (mother, aunts, sisters) are affected with PCOS, your own risk of developing PCOS may be increased.

The symptoms of PCOS are related to abnormal hormone levels. Hormones are chemical messengers which control body functions. Testosterone, a hormone produced by the ovaries is found to be in higher levels in women with PCOS. This is associated with many of the symptoms of PCOS like acne and excessive body hair.

Insulin is a hormone, which regulates the level of glucose (a type of sugar) in the blood. If you have PCOS, your body may not respond to the hormone insulin (known as insulin resistance), so the level of glucose is higher. To prevent the glucose levels becoming higher, your body produces more insulin. High levels of insulin can lead to weight gain, irregular periods, infertility and higher levels of testosterone.

How common are polycystic ovaries and polycystic ovary syndrome?

Polycystic ovaries (PCO) are very common, affecting around 1 in 5 women. Polycystic ovary syndrome (PCOS) is also very common, affecting 1 in 10 women. It is usually diagnosed when women are in their 20’s and 30’s.

What are the common symptoms of PCOS?

Some women with PCOS have no symptoms and not all women with PCOS have the same symptoms.

The symptoms may be in the form of:

Infrequent menstrual periods, no menstrual periods, and irregular bleeding (occurs in 7 in 10 women with PCOS)

Difficulty in getting pregnant (infertility)

Have more bodily hair (face, chest and lower abdomen) than normal – called hirsutism

Acne, oily skin or dandruff

Hair loss appears as thinning of hair on the top of the head

Weight gain or obesity – 4 in 10 women with PCOS become overweight or obese

Anxiety or depression – due to poor self-esteem because of other symptoms such as infertility

How is PCOS diagnosed?

Diagnosis is made with the help of a detailed history, examination findings and investigations like ultrasound and blood tests.

Assessment includes history of menstrual pattern, weight gain, abnormal hair growth and physical examination. Physical examination entails measuring your body mass index (BMI) and checking for the areas of increased hair growth.

Ultrasound scan: Ultrasound scan of the pelvis (usually performed vaginally), will be recommended to check the ovaries for small ovarian follicles (cysts) and check out the endometrium (lining of the uterus) which may become thicker if your periods are not regular.

Blood tests: Blood will be taken to measure the level of testosterone and LH (luteinizing hormone) as they tend to be high in women with PCOS. You may be advised to have regular blood tests for sugar and cholesterol to detect early changes.

Will PCOS affect my fertility?

Some women with PCOS do not have problems conceiving. Lack of ovulation is the most common cause of fertility problems in women with PCOS.

How is PCOS treated?

There is no cure for PCOS but symptoms can be treated. If you have PCOS and you’re overweight, losing weight and eating a healthy, balanced diet can improve some symptoms.

Treatments are based on symptoms and some women will require a combination of treatments.

Treatment of menstrual irregularity and prevention of endometrial hyperplasia (thickening of lining of the womb): Irregular periods can usually be regulated with a contraceptive pill. Most contraceptive pills will regularise periods but Dianette is also beneficial for hirsutism, and is often prescribed in PCOS.

Some women with no periods or infrequent periods may not want any treatment but they run the risk of developing cancer of the uterus(womb). When a regular menstrual cycle is not required, oral progestogen taken at intervals of every three months will induce menstrual bleeding and protect the endometrium (womb lining).

If the pill is not suitable, some women will prefer progestogen intrauterine coil (Mirena) to provide both contraception and protection of the lining of the womb.

Treatment of subfertility: Once other causes of subfertility have been excluded, the first line medication to stimulate ovulation is clomiphene citrate. Those who fail to ovulate on clomiphene will be stimulated with gonadotrophins (FSH and LH). Both clomiphene and gonadotrophins are associated with the risk of multiple births although the risk is higher with gonadotrophins.

Treatment of hirsutism (excessive hair growth) and acne: The oral contraceptive pill may be effective in reducing excessive hair growth. Commonly used pill is Dianette which contains the progestogen cyproterone acetate. This progestogen has anti-androgenic effects that blocks the action of male hormones that contribute to acne and growth of unwanted facial and body hair.

Eflomethine (Vaniqa) is a cream which is applied to the face and acts directly on hair follicles to inhibit hair growth. Electrolysis or laser treatments are faster and more efficient alternatives than medical therapy.

What is the effect of PCOS on pregnancy? 

Patients with PCOS appear to have a higher rate of miscarriage, gestational diabetes and premature delivery.

What are the long-term risks of PCOS?

If you have PCOS symptoms, you may be at risk of developing long-term health problems such as:

Insulin resistance or type 2 diabetes

High blood pressure

Heart problems due to high cholesterol

Cancer of the lining of the womb (endometrial cancer)