Polycystic ovaries syndrome(PCOS)

Polycystic Ovary Syndrome (PCOS) is a common hormone problem. The term ‘polycystic ovaries’ describes the appearance of the ovaries on an ultrasound scan. The symptoms that many women describe include irregular periods; increased hair growth; acne; obesity; and problems getting pregnant.

Polycystic ovaries contain many small follicles. On an ultrasound scan there may be 12 or more, ranging in size from 2-8mm. In PCOS the dominant follicle does not develop as readily, and many of the small follicles produce differing amounts of hormones. The level of the sex hormones tend to be imbalanced with a higher level of LH compared to FSH.

Symptoms

Irregular periods

The changes in the hormones may result in irregular periods (called oligomenorrhoea) or even no periods at all (amenorrhoea). This imbalance in hormone production means that ovulation may only occur irregularly or not at all (anovulation). Some women may experience very heavy, although infrequent periods, which may also be associated with pain, bloating and breast tenderness.

Hair growth, acne and obesity

Testosterone is the dominant sex hormone in males, but is still produced by normal females, just at much lower levels. PCOS can result in a mild increase in testosterone levels in females. This may cause hair growth in a similar pattern to males. Troublesome acne may also appear on the face and back.

Obesity worsens PCOS but is not a characteristic of PCOS. Insulin regulates sugar metabolism in the body. Women with PCOs tend to be resistant to the effects of insulin and thus also have higher levels of this as well as testosterone and LH.

Infertility

Where ovulation is not occurring or is only occurring infrequently, then the chance of getting pregnant is low. We also know that the eggs produced are less likely to fertilise normally. Added to this is a well documented increase in miscarriages. These women often require medical assistance to have a family.

Treatment options

Irregular periods can be treated successfully with the contraceptive pill. This treatment is obviously only useful for those women who do not wish to become pregnant. The Pill will produce a regular cycle.

Hair growth and acne problem mainly relate to the high levels of testosterone. The treatment of these is generally to use an anti-androgen such as spironolactone or cyproterone acetate. Other non-contraceptive cosmetic measures are also available. It is important to continue any cosmetics and beauty treatments as it may take up to six months for improvements in hair and acne to become evident.

Those women who wish to achieve a pregnancy have a number of options. Weight loss,  admittedly a little more difficult for these women as it has a very beneficial effect on balancing hormones and restoring regular periods in many obese women. Also, most of these women have ‘insulin resistance’ there is usually a good response to insulin sensitizers such as metformin, a drug often used in diabetes.

Other ovulation inducing drugs are also often used. Clomiphene is the most common. For  those unresponsive to Clomiphene, injectable drugs (FSH) can be used but these require specialist facilities and close monitoring pregnancies.

Long term problems with PCOS

Women with PCOS are at higher risk of metabolic syndromes such as diabetes and hypertension. In women with little or infrequent menses, there is a higher risk of endometrial cancer (womb cancer).