What is polycystic ovary syndrome?
PCOS is a condition that can affect your periods, fertility, hormones and aspects of your appearance. It can also affect your long-term health. Estimates of how many women it affects vary widely from 2 to 26 in every 100 women. This information is about the effects on your long-term health and does not cover specific treatment options for PCOS.
What are polycystic ovaries?
Polycystic ovaries are slightly larger than normal ovaries and have twice the number of follicles (fluid-filled spaces within the ovary that release the eggs when you ovulate).
Having polycystic ovaries does not necessarily mean that you have PCOS. Women with PCOS have symptoms as well as polycystic ovaries.
What are the symptoms of PCOS?
The symptoms of PCOS include:
- irregular periods or no periods at all
- an increase in facial or body hair (hirsutism)
- loss of hair on your head
- being overweight, experiencing a rapid increase in weight or having difficulty losing weight
- oily skin, acne
- difficulty becoming pregnant (reduced fertility).
- Depression and psychological problems can also result from having PCOS.
The symptoms vary from woman to woman. Some women have very few mild symptoms, while others are affected more severely by a wider range of symptoms.
What causes PCOS?
The cause of PCOS is not yet known but it often runs in families. If any of your relatives (mother, aunts, sisters) are affected with PCOS, your risk of developing PCOS may be increased. The symptoms are related to abnormal hormone levels:
- Testosterone is a hormone that is produced in small amounts by the ovaries in all women. Women with PCOS have slightly higher than normal levels of testosterone and this is associated with many of the symptoms of the condition.
- Insulin is a hormone that controls the level of glucose (a type of sugar) in the blood. If you have PCOS, your body may not respond to insulin (this is known as insulin resistance), so the level of glucose is higher. To try to prevent the glucose levels becoming higher, your body produces even more insulin. High levels of insulin can lead to weight gain, irregular periods, fertility problems and higher levels of testosterone.
Diagnosis of PCOS
The diagnosis of polycystic ovaries with the transvaginal ultrasound does not mean you have PCOS. Women with PCOS often have symptoms that come and go, particularly if their weight goes up and down., which can make it a difficult condition to diagnose.
A diagnosis is made when you have any two of the three following criteria:
- Irregular, infrequent periods (oligomenorrhoea) or no periods at all (amenorrhoea)
- an increase in facial or body hair and/or blood tests that show higher testosterone levels than normal (hirsutism)
- an ultrasound scan that shows polycystic ovaries.
Blood tests usually recommended for pregnancy (β-hCG), prolactin, thyroid hormone (TSH) and follicle-stimulating hormone (FSH). Insulin levels are not used to diagnose COPD. They are high in overweight people and in addition there is no insulin level that is “diagnostic” for PCOS.
Is PCOS curable?
There is no cure for PCOS, thus the aim of the medical treatments is to manage and reduce the symptoms or consequences of having PCOS. Medication alone has not been shown to be any better than healthy lifestyle changes (weight loss and exercise).
Many women with PCOS successfully manage their symptoms and long-term health risks without medical intervention. They can achieve this by eating a healthy diet, exercising regularly and maintaining a healthy lifestyle.
Treatment options for PCOS
1. Contraceptive pills.Combined contraceptive pills (estrogen and progesterone pills)- COCPs- are the most commonly used treatment to regulate menstrual cycles in women with PCOS. COCPs protect women from hyperplasia or endometrial cancer by causing menstruation every month and are also effective in treating hair loss and acne, as they reduce the production of androgens in the body. Irregular periods may recur when discontinuing the contraceptive pills.
2. Progesterone Pills.Another method of treating irregular menstrual cycles is the hormone progesterone for 10 -14 days every one to three months. This causes withdrawal bleeding in almost all women with PCOS and reduces the risk of endometrial cancer. Progesterone pills are not effective for the treatment of hirsutism and acne.Before taking progesterone, a pregnancy test should be done to rule out pregnancy.
3. Dealing with excessive hair growth.It can be done by shaving, electrolysis, or laser treatment. As mentioned above, contraceptive pills may help in some cases to reduce hirsutism and treat acne; it may take up to 6 months to be effective.
4. Weight loss, diet and exercise programIt is one of the most effective approaches to reduce insulin resistance, irregular periods, and other symptoms of PCOS. Many overweight women with PCOS who lose about 5-10% of their initial weight, could gain regular menstrual cycles.
5. Metformin (Glucophage)Although it is a treatment for type 2 diabetes, it improves the action and increases the effectiveness of insulin produced by the body, so in selected cases it can be given to women with PCOS. Metformin can help women to lose more weight in combination with good diet, as some studies have shown.
Dr Efterpi Tingi
Consultant Obstetrician and Gynaecologist
