Polycystic ovary syndrome (PCOS)

What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a complex hormonal condition that is thought to affect up to between 12 and 20% of women of reproductive age. It is estimated that about 70% of these cases are undiagnosed.

PCOS can make it difficult for women to fall pregnant, affects their menstrual cycle, healthy weight maintenance and often results in high levels of insulin or male hormones (known as androgens) or both. This can result in excessive facial and body hair and a tendency to acne. As a result of too much insulin being produced the bodies metabolic and digestive system is affected. In some women PCOS does run in the family. For others the condition only occurs when they gain excessive weight.

The underlying defect associated with the development of PCOS is probably related to the pulsing of a hormone called GnRH that arises in part of brain called the hypothalamus.

Signs and symptoms of PCOS?

PCOS can be a complex condition to identify because there are several symptoms and you do not have to have all of them to be diagnosed with PCOS.

• irregular menstrual cycle
• irregular infrequent or heavy periods
• excessive weight with a high BMI
• excessive facial and body hair or scalp hair loss
• acne on your face and on your body
• mood changes/depression/anxiety
• type 2 diabetes
• high blood cholesterol level

Diagnosis of PCOS?

There are a number of signs and symptoms women with PCOS can have. However, not every woman with PCOS will have every symptom and each woman will be quite unique. There is often a common pattern in PCOS symptoms which include an irregular menstrual cycle, weight gain and problems conceiving. A diagnosis of PCOS can be made when at least two out of three of the following criteria are met. (‘ The Rotterdam Criteria’).

1. The ovaries are polycystic on ultrasound
2. There are high levels of male hormones in the blood. There are symptoms suggesting an excess of androgens such as excessive hair growth and acne
3. There is menstrual dysfunction such as lack of periods, irregular periods and lack of ovulation

Treatment for PCOS

There are a number of ways to manage the symptoms and the impact of PCOS. It is important to seek help if you are concerned that you may have the condition. Treatment options will vary for individual women depending on the severity of their condition. If you are trying to conceive it is important to consult Dr Kliman as this condition can cause ovulation to stop completely or occur irregularly.

Treatment Options

• A healthy lifestyle is one of the most important aspects of managing PCOS successfully. Having an overall lifestyle change in both diet and exercise is beneficial in managing weight and improving emotional well-being. A loss of weight may reduce severity of some symptoms and will reduce the risk of developing type 2 diabetes and cardiovascular disease.
• Hormonal contraception: Dr Kliman can prescribe a hormonal contraception pill that will help regulate your menstrual cycle. This medication can also reduce menstrual cramps, acne and excessive hair growth. A number of pills have a hormone combination that is better in managing PCOS.
• Metformin is an insulin sensitive drug that improves menstrual regularity and ovulation. Metformin is also used to treat insulin resistance and diabetes. Whilst Metformin does not always improve menstrual regularity, it does help reduce hair growth, has a positive effect on cholesterol levels and insulin and may assist in weight loss and prevention of weight gain, therefore reducing the risk of diabetes in those at risk. Metformin has been around for over 60 years and is a drug with few serious side effects.
• Clomiphene citrate/ Letrozole If you are trying to conceive you may be prescribed a medication known as Clomiphene citrate or an alternative drug called Letrozole. This is used to increase the number of eggs which are matured and released by the ovaries.

Long Term Risks of PCOS

PCOS is associated with the following long-term health risks.

• insulin resistance
• increased risk of the development of diabetes
• cholesterol and blood fat abnormalities
• cardiovascular disease

Early diagnosis is important as it can allow symptoms to be managed and may prevent the development of long-term health problems.