Polycystic ovarian syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a hormonal disorder which is believed to affect around 1 in 10 women in the UK although this may be an underestimate. Symptoms typically begin in the late teens or early 20s and it is a condition where at least two (and often all three) of the following occur:
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Multiple tiny cysts (follicles) in the ovaries.
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An altered balance of body hormones so your ovaries make more male hormone testosterone than normal.
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A lack of ovulation each month causing irregular or absent periods
There may also be other symptoms such as acne, unwanted body hair, weight gain, depression or low mood and thinning of the hair on the scalp. In later life it can be linked with type 2 diabetes and high cholesterol levels in a collection of conditions making up metabolic syndrome.
The cause of PCOS is unknown but early diagnosis and treatment is needed to help manage the symptoms.
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How is PCOS diagnosed?
There are three main features of PCOS, and at least two must be present for a diagnosis.
The first is irregular periods. The second is excessive male-type hormones in your body called androgens, which can be measured on a blood test. They lead to symptoms such as coarse facial hair around the cheeks, upper lip and chin, chest hair, moderate to severe acne and weight gain. Androgens can be measured in a blood test.
The third is multiple follicles (or cysts) on the ovaries, seen on ultrasound scanning. This is only significant if other features are present - many women can have multiple cysts on the ovaries without having PCOS.
What causes PCOS?
People don’t clearly know why PCOS occurs, but it is known to run in families. PCOS sufferers are typically insulin-resistant, which leads to high levels of insulin in the body. Insulin normally controls the sugar levels in the blood.
A high level of insulin is also triggered by being overweight and can lead to increased levels of other hormones like testosterone. Complications of PCOS include infertility, type 2 diabetes, depression and anxiety, abnormal bleeding and endometrial cancer.
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What will the doctor do?
Your doctor will want to know all about your symptoms, your concerns and any conditions that run in the family. They will do a physical exam to check for excessive hair growth and acne and they will take a measurement of your weight and height.
Your doctor can organise for blood tests and also a pelvic ultrasound scan for confirmation. They will likely take your blood pressure and order blood tests for diabetes and high cholesterol, to flag up any cardiovascular risks.
How is PCOS treated?
There is no cure for PCOS so it is important to manage the symptoms. If you are overweight, it is vital to lose weight as this contributes to high levels of insulin in the body, affecting the production of other hormones.
Treating acne, excessive hair growth and fertility can be done with lifestyle or medications. If you are not trying to get pregnant, the contraceptive pill is an effective method to regulate your periods.
If you are trying to get pregnant, a specialist may suggest you trial a medication called clomifene to stimulate egg release.
Metformin is another medication initiated by specialists and used in treating PCOS to lower insulin levels in the body.
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