What Is Polycystic Ovary Syndrome (PCOS)?
Polycystic ovary syndrome (PCOS) , a common condition which affects about 10% of women, is caused by an imbalance of female sex hormones. It mainly affects women’s skin, hair, weight, menstrual cycles and fertility. It can also impact insulin function and the health of the liver, heart and blood vessels.
This blog post is going to explain what PCOS is, what the symptoms of it are and how the condition can be treated.
PCOS has many symptoms, which can be hard to manage without support and treatment.
Symptoms of PCOS can include:
- Irregular or infrequent periods
- Heavy and painful periods
- Excessive spots and oily skin
- Unwanted, excessive hair growth, typically on the chin and body
- Hair thinning on the scalp
- Weight gain
- Fertility issues
The changes in appearance can also cause issues with confidence and self-esteem..
Diagnosis for PCOS is based on a physical examination, blood tests and an ultrasound scan of the pelvic area. PCOS is diagnosed based on three criteria and if two out of three are present — it confirms PCOS.
The three criteria are:
- Infrequent or absent periods (periods that usually happen more than 35 days apart).
- Excessive acne or unwanted body hair or raised levels of male pattern hormones such as testosterone in the blood.
- PCO appearance of ovaries on ultrasound scan (ovaries appear to have more than 20 small fluid-filled sacs).
No one exactly knows the cause of hormone imbalance in PCOS — however, evidence suggests there is a genetic link to this disorder.
Certain factors also appear to play a role in this syndrome. These can include:
- Higher levels of LH (luteinising hormone) as compared to FSH (follicle stimulating hormone) produced by the pituitary gland in the brain.
- Excess male pattern hormones such as testosterone in the blood.
- Insulin resistance – this happens when the insulin cannot function properly in the body.
The effect of these factors is that the monthly period which usually follows ovulation does not happen, and the higher levels of male pattern hormones drive the growth of excess body hair and acne. And when insulin function slows down, it causes weight gain too.
There are some complications related to PCOS, including:
- Subfertility – lack of regular ovulations can cause difficulties with conception and fertility treatment may be necessary.
- Womb lining cancer – lack of regular shedding of the womb with periods can cause the inner lining to become thicker, increasing the risk of developing endometrial cancer. It is recommended that a woman should experience at least four periods every year to reduce the risk of womb lining thickening.
- Illnesses related to excessive weight gain and insulin resistance – being overweight or obese can increase the risk of illnesses such as high blood pressure, diabetes, liver problems and heart disease.
Early diagnosis and intervention are key to preventing long-term problems associated with the condition.
The term ‘polycystic ovaries’ (PCO) describes the appearance of the ovaries seen on an ultrasound scan, but there are no symptoms or hormone problems being experienced.
Polycystic ovaries are very common — around 1 in 5 women in the general population have ovaries with this appearance.
When symptoms or hormone imbalances develop in addition, PCOS is diagnosed.
Because there is no cure for PCOS, it needs to be managed to prevent further health problems. Treatments are based on the symptoms and whether there is a need for contraception or pregnancy.
A healthy, balanced diet (small portions of food which are not rich in sugars or calories) alongside regular exercise can help to your improve insulin function and restore both ovulation and regular periods. Even a 5—10% weight loss can significantly improve PCOS symptoms for many women.
The combined contraceptive pill (often just called ‘the pill’) contains the hormones oestrogen and progesterone, which can regulate the menstrual cycle to help restore regular periods. The pills protect from any abnormal womb lining thickening and decrease the appearance of hair growth and acne. Periods usually become abnormal again when you stop taking the pill.
Another type of contraceptive pill which contains only one hormone is the progesterone-only pill, also known as POP or the ‘mini pill’. This prevents womb lining thickening but will not help to reduce acne and hair problems..
The Mirena coil is another type of hormonal contraception that can stop heavy and irregular periods. The coil (or IUS — intrauterine system) is a small, T-shaped device which can be fitted inside your womb to release the hormone progestogen, stopping you from getting pregnant and alleviating some PCOS symptoms like heavy periods .
Metformin is a type of medication that affects the way insulin is used in the body. It also helps to decrease the male pattern hormone levels.
Metformin can help to restore ovulation, regularise periods and lessen excess hair growth. In some women, it can also assist weight loss efforts such as diet and exercise.
If you aren’t trying to get pregnant, medical treatments such as cyproterone acetate, spironolactone, finasteride, flutamide, roaccutane, topical antibiotics and eflornithine facial cream have been shown to reduce the effects of raised male hormone levels on your skin and hair.
Some treatments must be continued for 6–12 months before any results are seen. is due to the slow rate of hair growth.
Other non-medical treatments such as electrolysis or laser hair removal can be effective if you want to rid of unwanted hair.
Fertility medications such as clomiphene citrate oral tablets, letrozole oral tablets or injections of gonadotropins (hormone injections) can help restore ovulation and increase your chances of getting pregnant.
This treatment is called ovulation induction and is the first-line recommended fertility treatment for PCOS.
A keyhole surgery known as laparoscopic ovarian drilling is often an effective procedure that can restore fertility in some women. However, the benefits of the procedure need to be balanced against the associated risks . Women with additional medical or fertility problems, or those unsuccessful with ovulation induction, can pursue in vitro fertilisation (IVF) as the next fertility treatment option.
Psychological support and an individualised approach to management are key so that healthcare professionals can work with the woman to achieve the best health outcomes for her.
On average, PCOS appears to delay menopause by a couple of years. Research is being carried out on how hormone levels change as women with PCOS grow older.
It has been suggested that as women reach menopause, ovarian function changes and the menstrual cycle may become more normal. But, even with falling sex hormone levels, excessive hair growth on the body and scalp hair thinning can continue.
At London Medical, our experts can provide you with all the latest treatment options for symptoms or complications of PCOS.
If you’re struggling with symptoms that you think might be related to PCOS, don’t hesitate to get in contact with our experts in women’s health at London Medical.