What is Polycystic Ovary Syndrome?

Overview  |  Symptoms  |  Complications  |  Causes  |  Diagnosis  |  Treatment

Polycystic ovary syndrome (PCOS), once referred to as Stein-Leventhal syndrome, is common and is a condition that affects your ovaries. Ovaries are a pair of reproductive organs that are located on either side of your uterus. Each month during ovulation, an egg is released into your fallopian tube leading to your womb. Prior to ovulation, the egg develops within a small swelling – a tiny cyst called a follicle – on your ovaries, several may grow, but typically only one develops and is released.  With polycystic ovaries, more follicles than usual grow, but rather than any developing into an egg, they remain on your ovaries and become cysts.

If you are suffering from PCOS at least two out of three of the following occur and, more often than not, all three:

  • ovulation will not occur each month and for some women it might not happen at all. This means it is likely that you will not have a period
  • you will have a high level of male hormones in your body
  • it is likely that you will have nearly a dozen or so follicles (cysts) on your ovaries

Symptoms of PCOS

Symptoms of PCOS usually develop in your late teens to early 20s. Each woman is affected differently, some will suffer mildly while others may have more severe symptoms. Some women may not have any symptoms associated with PCOS. However, a lot of women do find that PCOS affects their menstrual cycle and fertility.

  • 7 out of 10 women will suffer from problems with their periods. This may range from irregular bleeding, light bleeding or none at all.
  • Infertility may occur  as women with PCOS do not ovulate regularly or not at all.
  • Oily skin
  • Acne
  • Thinning hair or hair loss
  • Hirsutism (excess hair growth) is common in women that suffer from PCOS and happens in more than half of cases. Excess hair grows on the face, chest and abdomen.
  • Nearly 4 in 10 women with PCOS suffer from being overweight.
  • Depression

Complications of PCOS

As women that suffer from PCOS are resistant to insulin, there is an increased chance of developing high blood pressure, a high cholesterol, diabetes in pregnancy and type 2 diabetes. Due to the infrequency of periods, it is also said that PCOS sufferers have a slightly higher risk of developing womb cancer. 

Causes of PCOS

It is unknown what the exact cause of PCOS is, however, there are several factors which experts believe contribute to the development of polycystic ovaries.

Insulin Resistance: Insulin, a hormone produced in the pancreas, is used by your body to control the level of sugar in your blood. When you are resistant to insulin, your body produces extra. When you have raised insulin levels, your ovaries produce excess testosterone which wreaks havoc with the growth of follicles.  Being resistant to insulin can cause weight gain which in turn make symptoms of PCOS worse.

Hormones: Women with PCOS are likely to have elevated levels of luteinizing hormone (LH). LH is made in the pituitary gland and is a hormone which stimulates the ovaries in conjunction with insulin to produce testosterone. An excess amount of LH, when combined with a raised level of insulin, creates too much testosterone, disturbing the normal growth of follicles. 

Genetics: PCOS often runs in families, therefore if a relative – aunt, sister, mother – suffers from PCOS then there is an increased risk that you may develop it too. Therefore, though it has not been proven, experts believe there may be a link between genetics and PCOS. 

How is PCOS Diagnosed?

Your doctor will discuss your symptoms and recommend that you get a blood test; in most cases an ultrasound scan will also be advised. The blood test is used to measure the levels of hormones including LH and testosterone, these tend to be elevated in women suffering from PCOS. An ultrasound scan – a painless exam that is used to generate images of your organs – is used to look at your ovaries to examine whether cysts are present.

Treating PCOS

Unfortunately, there is not a cure for PCOS and, therefore, the aim of treatment is to manage symptoms.

Weight loss

One of the first things doctors advice women with PCOS to do is to lose weight if they are overweight. As being overweight is linked to insulin resistance, losing weight is useful in reducing the excess insulin associated with PCOS. This will also lead to a reduction in the amount of testosterone your body is producing, which will improve ovulation, help with excess hair growth and acne. Additionally, weight loss will decrease the risk of long-term health problems associated with PCOS, including diabetes and high blood pressure. Weight loss can be achieved with a healthy diet and regular exercise regime.

Acne Treatment

Acne treatment for PCOS is the same as what would usually be used to treat regular acne.

Hair Removal

For women that suffer from excess hair growth due to the raised level of testosterone, there are several options available to reduce or remove unwanted hair.

  • With mild unwanted hair, traditional methods can be used such as waxing, shaving and the use of hair removal creams. For a longer-lasting approach laser treatment or electrolysis is a good option but, more expensive.
  • Oral medication may be given to reduce levels of testosterone which will in turn treat excess hair growth. These include the combined pill and cyproterone acetate (anti-testosterone). This option of treatment is likely to take some time to work. You may need to wait up to 9 months for the medication to take effect. It is advised to continue taking them as hair excess hair growth will return once the treatment has stopped.
  • Sometimes doctors may prescribe a cream called eflornithine which, when rubbed onto the affected areas, works by blocking a particular enzyme in hair follicles reducing the rate of growth.

Periods and Fertility

Part of PCOS is the infrequency or lack of periods and, while some women may not consider this a problem, due to the increased risk of womb cancer from absent periods, doctors advise that this should be treated. A contraceptive pill or a progestogen hormone is usually recommended to induce bleeding.

There are various fertility treatments available and, if you are trying to conceive, it is likely that your doctor will advise that you take medication – usually clomifene or metformin. This will reduce insulin levels and increase fertility.