Polycystic ovarian syndrome (PCOS) is a hormonal disorder with a wide range of symptoms and signs. It is a fairly common condition and occurs in up to 10 of every 100 women of child bearing age in Australia and New Zealand. PCOS can start around puberty.
As a gynaecologic disorder, PCOS is a leading cause of impaired ovulation, infertility and excessive production of male hormones (androgens). PCOS can have a major effect throughout life on the reproductive, metabolic and cardiovascular health of affected women.
PCOS may cause signs and symptoms such as:
- Disruptions of the menstrual cycle, including irregular, heavy or absent periods or spotting between periods.
- Slightly enlarged or “lumpy” ovaries with many small follicles in them, known as “polycystic” ovaries; these follicles are fluid-filled cavities.
- Difficulty in becoming pregnant due to irregular ovulation.
- Pregnancy problems such as gestational diabetes, pregnancy-related high blood pressure or premature labour.
- Excessive hair growth (hirsutism).
- Oily skin, acne and pimples.
- Obesity and difficulty losing weight.
- Sleep apnoea.
- High blood levels of cholesterol and fats.
- Fatty liver, which may be linked to liver disease.
- Mood disorders, which may need treatment in some patients.
- Insulin resistance, which occurs in seven to 10 women with PCOS. Insulin is a hormone made by the pancreas that helps the cells of the body to use sugar.
Long-term issues may include:
- Body image problems and depression.
- Type 2 (adult onset) diabetes.
- Cardiovascular disease and high blood pressure.
- Changes in the lining of the uterus (endometrium) that could increase the risk of endometrial disorders and very occasionally cancer of the uterus.
Diagnosis of PCOS
Diagnosis requires tests to measure the levels of hormones in the blood. Diagnosis depends on the detection of fluctuations in the hormones, not simply the presence of polycystic-appearing ovaries. In some women, the syndrome can be difficult to diagnose.
Diagnosis of PCOS typically requires confirmation of two of the following (in the absence of other conditions):
- Polycystic ovaries on ultrasound.
- Irregular periods.
- Increased hair growth or increased blood testosterone.
Treatment Options to Manage PCOS
Whatever the symptoms, lifestyle changes are the cornerstone of medical treatment for those overweight women with PCOS.
If a woman is overweight, losing as little as five to 10 percent of her body weight may improve PCOS symptoms and help restore spontaneous ovulation. If obese, she may need to lose more to reduce the severity of the symptoms including:
- Regulating blood sugars and insulin levels.
- Reducing the levels of male hormones.
- Improving symptoms such as hirsutism, acne and alopecia.
- Triggering ovulation.
- Regulating periods.
- Reducing the risk of PCOS complications such as heart disease and diabetes.
Medications to manage with your cycle or hair growth
- Contraceptive pill can regulate the menstrual cycle.
- Spironolactone: the diuretic spironolactone is used to control high blood pressure and may be prescribed for its anti-androgenic effects.
- Anti-diabetes drugs, also known as insulin-sensitising agents.
- Intrauterine hormones: in some women with persistent menstrual bleeding problems and PCOS, a special intrauterine contraceptive device (IUCD) that contains synthetic progesterone may help.
f pregnancy is desired, the doctor may refer you to a fertility specialist. Initial treatment includes finding out whether you are ovulating. If you are not ovulating, the specialist may suggest that you first try lifestyle changes such as regular exercise, healthy eating habits and weight loss.
If lifestyle changes fail to trigger ovulation, the specialist may recommend various medical tests. These tests help to determine whether PCOS is the only reason for your infertility. Fertility drugs such as clomiphene or gonadotrophins (FSH) may then be prescribed.