Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is a condition which can affect a woman’s menstrual cycle, fertility, hormones and aspects of her appearance. It can also affect long-term health.
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.
A diagnosis is made when you have any two of the following:
- irregular, infrequent periods or no periods at all
- an increase in facial or body hair and/or blood tests that show higher testosterone levels than normal
- an ultrasound scan that shows polycystic ovaries.
Polycystic ovaries are slightly larger than normal ovaries and have twice the number of follicles (small cysts). Polycystic ovaries are very common affecting 20 in 100 (20%) of women. Having polycystic ovaries does not mean you have polycystic ovary syndrome. Women with PCOS have symptoms as well as polycystic ovaries.
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).
The symptoms vary from woman to woman. Some women have a few mild symptoms, while others are affected more severely by a wider range of symptoms. Polycystic ovaries do not cause pain.
You may still become pregnant even if you do not have periods.
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.
Women with PCOS often have symptoms that come and go, particularly if their weight goes up and down. This can make it a difficult condition to diagnose, which means it may take a while to get a diagnosis.
If your blood glucose does not stay normal, this can lead to diabetes. One or two in every ten women with PCOS go on to develop diabetes at some point. If the diabetes is untreated, this can cause damage to organs in the body.
If you have PCOS, your risk of developing diabetes is increased further if you:
- are over 40 years of age
- have relatives with diabetes
- developed diabetes during a pregnancy (known as gestational diabetes)
- are obese (a body mass index (BMI) of over 30).
Women with PCOS tend to have high blood pressure, which is likely to be related to insulin resistance and to being overweight rather than to the PCOS itself.
Women with PCOS are also at increased risk of high cholesterol.
If you have fewer than three periods a year, the lining of the womb (endometrium) can thicken and this may lead to endometrial cancer in a small number of women. There are various ways to protect the lining of the womb using the hormone progestogen.
This may include a five-day course of progestogen tablets used every three or four months, taking a contraceptive pill or using the intrauterine contraceptive system (Mirena®). The options will depend on whether or not you are trying for a baby.
PCOS does not increase your chance of breast or ovarian cancer.
The main ways to reduce your overall risk of long-term health problems are to:
- eat a healthy balanced diet. This should include fruit and vegetables and whole foods (such as wholemeal bread, whole-grain cereals, brown rice and whole-wheat pasta), lean meat, fish and
- cut down the amount of sugar, salt and caffeine that you eat and drink. You should
- not drink more alcohol than is recommended (14 units a week for women).
- eat meals regularly, especially breakfast
- take exercise regularly -30 minutes at least three times a week
- aim for a body mass index (BMI) of between 19 and 25
The benefits of losing weight include:
- a lower risk of insulin resistance and developing diabetes
- a lower risk of heart problems
- a lower risk of cancer of the womb
- more regular periods
- an increased chance of becoming pregnant
- a reduction in acne and a decrease in excess hair growth over time
You only have to lose a small amount of weight to make a difference to your symptoms and your health.
What to do if you're concerned you may have Polycistic Ovary Syndrome
If you are concerned that you may have polycystic ovary syndrome please book an appointment for a consultation with one of our doctors. Depending on your symptoms and menstrual cycle we may take blood tests at the consultation or schedule them for another day.
You may also be referred to an ultrasound department for a pelvic ultrasound scan.
Hormone blood tests can take two or three weeks to be reported. Ultrasound scan reports are available within two or three days.
Depending on the reports, the doctor will contact you by email, letter or telephone.
If the reports confirm that you have PCOS then the doctor will discuss your long term health plan. For example, how often to have blood pressure checks and blood tests for diabetes and cholesterol. Many women with PCOS successfully manage their symptoms and long-term health risks without medical treatment. However in some instances for example very infrequent periods, medication may be advised. Also, if you are trying for a pregnancy but have irregular cycles medication is available which usually regulates the cycle.