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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 appear as fluid filed sacs (cysts) just beneath the surface of ovary. That’s how polycystic ovary syndrome gets its name.

These follicles contain eggs which do not mature and are hence not released leading to formation of cysts.

How is polcystic ovaries different from PCOS

The term polycystic ovariy means that the ovaries contain several cysts (egg containing follicles) which have not been able to develop properly due to hormonal imbalance.

The term 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 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.

PCOS affects the function of the ovaries, which produce eggs and the hormones oestrogen and progesterone. Other imbalances affect hormones produced by the brain and include elevated levels of luteinising hormone (LH) and a relative deficiency of follicle-stimulating hormone (FSH), both of which control the release of eggs from the ovaries. As the ovaries aren’t working properly, eggs may not be released in a regular monthly cycle.

How common is 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 one 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.

  • Infrequent menstrual periods, no menstrual periods, and or 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 as a result of other symptoms such as infertility

How is PCOS diagnosed?

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

Your doctor will take a medical history specifically for menstrual pattern, weight and abnormal hair growth.

During physical examination your doctor will measure your body mass index (BMI) and check 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 commonest cause of fertility problems in women with PCOS.

How is PCOS treated?

There is no cure for PCOS but symptoms can be treated.

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 clomifene citrate. Those who fail to ovulate on clomifene will be stimulated with gonadotrophins (FSH and LH). Both clomifene and gonadotrophins are associated with risk of multiple births although the risk is higher with gonadotrophins.

Women who have PCOS and insulin resistance will also benefit from using metformin.

Treatment by IVF is another treatment option available to these patients.

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.

Other anti-androgen drugs such a Spironolactone has been shown to reduce abnormal hair growth in women. In women with insulin resistance, diabetes or obesity, Metformin by reducing insulin resistance can minimise abnormal hair growth.

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.

Metformin

Metformin hydrochloride (Glucophage) used to treat type 2 diabetes, makes the body cells more sensitive to insulin and lowers testosterone production. In women with PCOS, abnormal hair growth will slow down, and ovulation may return after a few months of use. In addition to the positive effect on insulin resistance, metformin treatment has been shown to improve hirsutism, acne, and menstrual irregularities in thin PCOS women.

Dietary therapy

If you have PCOS and you are overweight, weight loss is the most effective method of restoring normal ovulation and menstruation. Weight loss reduces the high insulin levels that occur and the knock-on effect is reduction in testosterone levels. In addition to improving the chance of regular ovulatory cycles, it may help reduce hair growth and acne. The increased risk of longterm problems such as diabetes, high blood pressure and heart disease are also reduced.

What is effect of pcos on pregnancy? 

Patients with PCOS appear to have a higher rate of miscarriage, gestational diabetes, pregnancy induced high blood pressure (pre-eclampsia) and premature delivery. Metformin can be given to those who have insulin resistance and does not appear to cause any major birth defects or other problems during pregnancy.

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)