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Polycystic ovary syndrome

What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS), also known as Stein-Leventhal syndrome, polycystic ovarian syndrome or polycystic ovary disease, 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.

Normally, during each menstrual cycle, many small ‘follicles’ (sacs) grow in your ovaries and form eggs. At mid-cycle, or ovulation, one egg is released from one of the ovaries and all the other follicles over-ripen and break down. However, in PCOS, ovulation does not occur and an egg is not released. The follicles do not break down, but fill with fluid and turn into cysts. The ovaries can then swell in size, sometimes becoming 2 to 5 times larger than normal.

Women with PCOS sometimes develop masculine characteristics such as excess face and body hair, acne, hair loss in the same pattern as male baldness and fat deposits around the abdomen.

PCOS is a relatively common condition. Doctors estimate it affects 5-10 per cent of all women who haven’t yet gone through the menopause. It is one of the leading causes of infertility, yet many women do not know they have it.

What causes polycystic ovary syndrome?

Doctors are still not certain. 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. 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 more male hormones.

What are the symptoms of polycystic ovary syndrome?

Symptoms can begin at any age. They may develop during puberty and the start of menstrual periods may be delayed or not happen at all. Girls may be overweight and have body hair growing in a male pattern, such as on the chest and face. Or they may have irregular and heavy vaginal bleeding.

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 centred 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 per cent of women (who have not gone through the menopause) are shown to have polycystic ovaries on ultrasound yet may have no symptoms of PCOS itself.

How is polycystic ovary syndrome 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, he or she will probably order investigations to confirm it and rule out other more serious medical conditions. These may include:

• ultrasound to give a view of your ovaries; and
• blood tests to check your levels of male hormones, insulin, glucose, cholesterol, or luteinizing hormone.

Are there any complications from PCOS?

PCOS can increase your chances of developing health problems later in life. This is why it is important to have regular medical check-ups. Even though some PCOS symptoms may lessen after the menopause, this is likely to be the time when many of the long-term associated conditions appear. These can include the following.

• Type 2 diabetes. The difficulty in processing insulin that most women with PCOS have tends to get worse with age. By the time they reach menopause, about 50 per cent 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 an exercise programme 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 go up, resulting in an increased risk of heart disease and heart attack. Women with PCOS can also have reduced levels of HDL-cholesterol (the ‘good’ form of cholesterol) and raised triglycerides (another form of fat in the blood).
• Metabolic Syndrome. Metabolic syndrome is a cluster of signs and symptoms (including abdominal obesity, high blood pressure, abnormal cholesterol levels and insulin resistance) that put you at risk of heart disease.
• 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 known for certain.

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, and your feelings regarding pregnancy.

Medications

• You may be prescribed a progestogen (a synthetic version of the female hormone progesterone) or the contraceptive pill to induce regular periods.
• Some low-dose contraceptive pills on the market (such as Diane-35 ED, Juliet-35 ED) contain an oestrogen and a small amount of the anti-androgen (a substance which blocks the effects of male hormones) cyproterone acetate. This is very effective in keeping excess hair growth under control and improving acne.
• 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 electrolysis or laser. Your doctor will advise what’s best for you.
• 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 must be prescribed by a specialist doctor as it can have side effects and should not be used in 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. 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.

With all these medicines, you should be aware that they may take some time to work. Also remember that you will have to remove any existing hair growth, as medicines aren’t effective in getting rid of excess hair. Use a method such as bleaching, waxing or electrolysis.

Fertility treatment may include the use of drugs such as clomiphene citrate (e.g. Clomid) which stimulate the ovary to grow follicles so that an egg is released mid-cycle, or injections of synthetic hormones, similar to the ones you produce naturally.

Surgical treatments

As a treatment for infertility your doctor may suggest you have surgery called laparoscopic ovarian drilling, which uses either a hot needle or laser to cauterise the ovary in several places. This procedure can stimulate ovulation and increase your chances of conceiving. However, surgery is generally considered a last resort because scar tissue can form on the ovaries as a result, which may in fact reduce your ability to get pregnant.

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 and these measures alone successfully help some women with PCOS to become pregnant when they try to conceive. Exercise and diet are also the key factors in reducing your risk of metabolic syndrome, diabetes and heart disease.

 

Last Reviewed: 29 April 2009

myDr, 2001
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