Polycystic Ovarian Syndrome (PCOS)

PCOS is a common condition that can affect a woman’s menstrual cycle, fertility and appearance. The cause is unknown but the balance of hormones produced by the ovaries is affected, and in some women, the testosterone level is slightly higher than normal. Women with PCOS tend to have larger ovaries, filled with multiple, fluid filled follicles (cysts), but although one in every five women will have polycystic ovaries, only one in twenty of these will have the syndrome. It affects women of childbearing age and can run in families. PCOS also affects long-term health.

Symptoms Of PCOS

• Irregular periods, or no periods at all
• Difficulty becoming pregnant
• Excess hair on the face or body (hirsutism)
• Weight gain and difficulty losing weight
• Thinning of hair on your head
• Oily skin and acne
• Mood swings and irritability

What Causes PCOS?

The cause of PCOS is not fully understood but we know that it can run in families, and you are more likely to be affected if a close relative has it. The imbalance of hormones produced by the ovary results in some of the symptoms of PCOS, but insulin levels (a hormone which controls blood sugar levels) may also be raised, which in turn leads to weight gain, irregular periods, difficulty getting pregnant and will increase testosterone levels further.

How Is PCOS Diagnosed?

The symptoms and appearance of multiple cysts on the ovaries can come and go, so it can take a while to be diagnosed. Two of the following must be present for make a diagnosis of PCOS:

• Irregular (some cycles >6 weeks apart) or no periods
• Excess facial or body hair, or higher than normal testosterone levels on a blood test
• Ultrasound scan showing polycystic ovaries

Treatments For PCOS

There is no cure for PCOS, but various treatments can help improve symptoms. The treatment tried by your doctor will depend on the symptoms you have, and whether or not you are trying to become pregnant.

The first step is to make sure you have a healthy lifestyle, eat plenty of fruit and vegetables and take at least 30 minutes of sweat-inducing exercise per day. This helps to reduce the insulin hormone levels, helps weight loss and will also make you feel better about yourself. It is important to keep your weight within a healthy range, because your PCOS symptoms will be less severe. If you are trying to become pregnant, losing weight is often enough to achieve this, without having to undergo fertility treatments. Whilst weight loss may be more difficult with PCOS, it is by no means impossible.

Irregular periods can be helped by starting the hormone contraceptive pill to regulate your cycle. If the few periods you do get are extremely heavy and/or painful, the pill will help improve this too.

Using topical creams can treat excess hair growth on the body and face, and some hormonal contraceptive pills can also help. The treatments tend to work slowly over several weeks. Other strategies include waxing and shaving. Laser hair removal is helpful but not available on the NHS.

Some doctors may prescribe you a treatment usually used for people with diabetes. This drug is called metformin, and helps reduce insulin levels. It is most commonly used to help women ovulate more regularly in order to become pregnant. However, there is not good evidence that it works reliably and other options may be better for you.

If you are having difficulty becoming pregnant, your doctor may refer you to the hospital to see a fertility specialist. A fertility specialist will want to investigate both you and your partner’s fertility in order to offer the right treatment for you. Most of the time, the difficulty in getting pregnant comes from not ovulating (releasing eggs from the ovary) on a regular basis. However, it is important to check that your tubes and womb look healthy, and that your partner’s sperm is healthy, before offering you drugs to help you to release eggs. This drug is called clomiphene citrate, and can only be prescribed for a limited period of time, if your body mass index (a measure of weight) is in the normal or just above normal range.

Long-term Health Problems With PCOS

The risk of developing insulin resistance and diabetes is increased, and one in ten women will go on to develop diabetes. This risk is increased further in women over 40 years old, have relatives with diabetes, had diabetes in pregnancy (gestational diabetes) or have a body mass index (BMI) over 30.

Women with PCOS have an increased chance of developing high blood pressure. The risk is higher if you are overweight, and is a reason that keeping your weight within the healthy range is important.

PCOS increases the chance of developing cancer of the womb lining (endometrial cancer), because in having very few periods, the womb lining becomes thickened, and can over-grow. Taking the pill, or hormone tablets to induce a period every 3-4 months reduces this risk. The risk of breast, ovarian or cervical cancer is not increased from PCOS, but being overweight does increase the risk.

Links

• https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/gynaecology/polycystic-ovary-syndrome-pcos.pdf
• http://www.nhs.uk/conditions/polycystic-ovarian-syndrome/Pages/Introduction.aspx
• http://www.webmd.com/women/tc/polycystic-ovary-syndrome-pcos-topic-overview
• http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html