Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS) is common. It affects 8-13% of Australian women of reproductive age. Polycystic Ovarian Syndrome (PCOS), is diagnosed when at least two of the following occur and often all three:
- At least 12 tiny cysts (follicles) develop in your ovaries. (Polycystic means many cysts.)
- Your ovaries make more testosterone than normal.
- You do not ovulate each month. Some women do not ovulate at all. In PCOS, although the ovaries usually have many follicles, they do not develop fully and so ovulation may not occur.
What are the symptoms of PCOS?
- 70% of women have irregular or no periods.
- Difficulties getting pregnant -you need to ovulate to become pregnant. If you don’t ovulate very often or even at all it will affect your ability to become pregnant.
- Scalp hair thinning or loss (alopecia).
- 60% of women suffer with excess hair in places usually associated with male hair patterns-face, chest and abdomen.
- Acne and rough, dark, velvety patches of skin can also develop in women with PCOS. This is acanthosis nigricans and is also associated with metabolic syndrome.
- Weight gain.
- Emotional problems, such as anxiety and depression or poor self-esteem may develop as a result of the other symptoms
- Higher risk of type 2 diabetes. Women with PCOS have insulin resistance.
Each person can have different symptoms and symptoms can change over time.
What causes polycystic ovarian syndrome?
The exact cause is not totally clear. Genetics, hormones and lifestyle factors all play a role in PCOS. Women with PCOS are 50% more likely to have a mother, aunt or sister with PCOS and the condition is more common in women of Asian, Aboriginal and Torres Strait Islander and African backgrounds.
Several factors are believed to be involved:
Insulin resistance. Women with PCOS have insulin resistance. Cells do not respond to insulin properly and more is needed to keep the blood sugar levels normal. The insulin stimulates the ovaries to produce more testosterone and this can reduce ovulation. The extra testosterone leads to male pattern hair growth and extra insulin leads to weight gain.
Weight. Fat tissue increases insulin resistance leading to higher levels of insulin which leads to weight gain. Recognising the problem can help to tackling weight gain more effectively.
Luteinising hormone (LH). 40% of women also have higher than average levels of LH which is produced in the brain and part of the normal menstrual cycle. It promotes testosterone production and higher levels lead to more testosterone.
If you have PCOS, over time you have an increased risk of:
- Developing type 2 diabetes.
- Developing diabetes and high blood pressure in pregnancy.
- High cholesterol.
- High blood pressure.
- Being overweight, carrying fat around your middle.
Over time the risk of cardiovascular disease such as heart attacks and strokes increases because of the effects of long term insulin resistance.
Blood tests can measure insulin, testosterone and luteinising hormone (LH) which are often high in women with polycystic ovarian syndrome (PCOS).
An ultrasound scan of the ovaries will show evidence of follicles.
Treatments for PCOS
Irregular periods
- Hormonal contraception such as the pill, implant or IUS.
- A medication called metformin can reduce insulin resistance and promote ovulation.
- If you have fewer than four periods a year, your doctor might prescribe progesterone to bring on a period.
Excess hair
- Testosterone levels can be lowered using the contraceptive pill, alone or in combination with anti-androgen drugs,
- Waxing, laser hair removal, electrolysis, depilatory creams .
Acne
- Hormonal contraception
- Isotretinoin
- Anti-androgens
Fertility
- Lifestyle – weight management. Losing 5-10% of body weight, if overweight, can help to induce ovulation
- Medications – such as letrozole, clomiphene citrate and metformin
- Surgery – laparoscopic ovarian surgery, bariatric surgery
- Depression & Anxiety – If you experience thoughts of fear or sadness, or have lost interest in your usual activities, discuss your mood with your doctor. Effective treatments include a healthy lifestyle, psychological/counselling support and medications if required.
Preventing long-term problems
A healthy lifestyle is important to help prevent the conditions listed. You should:
- Eat a healthy diet.
- Exercise regularly.
- Lose weight if you are overweight or obese.
- Not smoke.
Maintaining a healthy lifestyle is particularly important for women with PCOS, as they may have extra risk factors for health problems in later life. These risks are reduced if you are not overweight and do not smoke.
See your Femma doctor if you need help with lifestyle changes.
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