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Facts about polycystic ovary syndrome
What is polycystic ovary syndrome?
Polycystic ovary syndrome (PCOS) is an endocrine (hormonal) condition in which the ovaries are enlarged and contain many small, fluid filled cysts. It occurs when your ovaries produce too much of the male hormones (androgens) that they normally make in only small amounts.
PCOS is a relatively common condition. Doctors estimate that it affects 5%-10% of all women who haven’t gone through menopause. It is one of the leading causes of infertility, yet many women do not know that they have it. PCOS is estimated to affect about 400,000 women in Australia.
What is the cause?
Doctors are still not certain of the cause. However, they know the condition is associated with being resistant to insulin (the substance in your body which helps regulate sugar levels). Because of this, doctors think PCOS might share some similarities with diabetes. The insulin resistance (or prediabetes) stage is more common than clinical diabetes (Type 2 diabetes).
New research suggests that the ovaries of women with PCOS produce more male hormones than normal because the women can’t process insulin properly. Doctors know that if insulin levels in the blood are too high, the ovaries react by producing male hormones. Relatively high levels of androgens cause acne and hair growth.
What are the symptoms?
Symptoms can begin at any age. Each woman’s symptoms may be different, but usually they will include some or all of the following:
- Excessive hair growth on the face, chest or abdomen
- Irregular or absent periods
- Abnormal bleeding from the uterus
- High blood pressure
- Acne
- Obesity, particularly around the middle
- Thinning hair or hair loss in a classic “male baldness” pattern
- Problems getting pregnant or infertility
- Symptoms of diabetes, such as thirst or excessive urination, vaginal thrush (candidiasis) or chronic skin infections
- Polycystic ovaries shown on ultrasound, although this sign may not always be present. About 20% of women (who have not gone through menopause) are shown to have polycystic ovaries on ultrasound yet may have no symptoms of PCOS itself.
How is it diagnosed?
There is no easy test for PCOS, so your doctor will need to assess your symptoms from your medical history and physical appearance. If your doctor suspects you have PCOS, they will probably order investigations to confirm it and rule out other more serious medical conditions.
These tests may include:
- Ultrasound to give a view or your ovaries
- Blood tests to check your hormone levels (such as free testosterone, sex hormone – binding globulin or DHEAS)
- Insulin measurements as part of a GTT (Glucose Tolerance Test)
How your doctor can help you?
Although PCOS cannot be cured, some of the symptoms can be controlled. Treatment will depend on your symptoms and how severe they are.
Excessive hair growth can be controlled very effectively by laser hair removal however in PCOS the treatment will very likely be long term and require regular maintenance treatments.
For more information see Laser Hair Removal.
Acne can be treated in a variety of ways depending on the severity ranging from topical products to laser treatment and in many instances prescription medication.
Medications
You may be prescribed a progestogen (a synthetic version of the female hormone progesterone) or a low-dose combined oestrogen-progestogen contraceptive pill to induce regular periods. Low androgenic combined oral contraceptive pills normally have beneficial skin effects in women with PCOS and acne. These can include a reduction in the oiliness of skin and pore size (starting after one cycle), fewer pimples less often (this may take three cycles to start but improvements continue for up to 6-9 cycles). These beneficial effects are often lost or greatly reduced when taken by women who are overweight. High doses of levonorgestrel may worsen acne as they breakdown into androgens that stimulate oil glands.
Cyproterone acetate is also available by itself (e.g. Androcur) and your doctor may try this, or another anti-androgen, spironolactone (Aldactone), that works in a similar way.
Sometimes excessive hair growth is best managed with both medical treatment and laser.
Isotretinoin (Roaccutane) is used for severe acne that hasn’t been helped by other treatments. It works by reducing the amount of oil the skin produces and shrinking the glands in the skin that do this. This medication can have side-effects and should not be used during pregnancy (or if you might be pregnant), as there is a risk of damaging the unborn baby.
Drugs such as metformin (e.g. Glucophage), which help your body make better use of the insulin it produces, may also be prescribed. Typically you are started on the lowest dose (e.g. 500 mg slow release) and the dose is built up over a month. Metformin not only reduces androgen levels and improves acne but also normalises insulin levels and helps with weight loss and the prevention of diabetes. For rapid acne control, metformin is best used in combination with other acne treatments such as topical creams and lotions during the first 3-6 months.
These medicines help people with PCOS lose weight and reduce blood pressure, and will often restore the menstrual cycle, as well as helping control excess body hair caused by high testosterone.
You should be aware that all these medicines may take some time to work.
Are there any complications from PCOS?
PCOS can increase your chances of developing health problems later in life. These may include:
- Type 2 diabetes: The difficulty in processing insulin that most women with PCOS have tends to worsen with age. By the time they reach menopause, about 50% of women who have PCOS will be diagnosed with type 2 diabetes. Because of this, it is important to start following a healthy diet and exercise program long before this time.
- Increased cholesterol levels: High levels of testosterone can cause the levels of LDL cholesterol (the so-called ‘bad’ form of cholesterol) in your blood to rise, resulting in an increased risk of heart disease and heart attack.
- Endometrial cancer: Because women with PCOS do not ovulate often, they have infrequent periods, which results in a build-up of the lining of the uterus (endometrium). This may increase the risk of the uterine lining producing abnormal cells that can turn into cancer, although this is not certain.
How can I help myself?
Your doctor may suggest you follow a special diet to try to normalise your insulin levels and keep your cholesterol levels normal. Exercise and losing weight are very important. Eating more frequent small meals with a low GI diet should be advised and a dietician may help with this. An exercise program should be developed and implemented. A personal trainer is usually beneficial but cost is a consideration.
