Polycystic ovarian syndrome (PCOS) is a common condition that affects a woman’s ovaries and their functioning. It is quite common and occurs in 5% to 10% of women of childbearing age, affecting all races and nationalities. Some women may not have any symptoms. It is the leading cause of infertility in females.
The exact cause is unknown. For reasons that are not well understood, in PCOS the hormones get out of balance. Genetics may be a factor. PCOS seems to run in families, so your chance of having it is higher if other women in your family have it or have irregular periods or diabetes. PCOS can be passed down from either your mother’s or father’s side.
Features of PCOS:
It is called as a syndrome as it comprises various features which may not be all present. Even if some of the features are present, the woman may have PCOS. The main features of the syndrome are:
- Polycystic ovaries where the ovaries become enlarged and contain many fluid-filled sacs (follicles) which surround the eggs. Most women with PCOS grow many smallcysts on their ovaries. That is why it is called polycystic ovary syndrome. Polycystic ovaries contain a large number of harmless follicles that are up to 8mm (approximately 0.3in) in size. The follicles are under-developed sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means that ovulation doesn’t take place. The cysts are not harmful but lead to hormone imbalances.
- Irregular periods, which mean the ovaries don’t regularly release eggs (ovulation). The ovaries of women with PCOS produce higher than normal amounts of androgens(male hormones) which can interfere with the development and release of eggs. Normally when an egg matures, the follicle (sac within the ovary that contains eggs) releases the egg so it can travel to the uterus for fertilization. With PCOS, the eggs in these follicles may not mature or in some case egg maturation is altered. Instead of being released during the menstrual cycle, the follicles build up in the ovaries and form cysts. Because they are not ovulating and releasing an egg each month it is common for women with PCOS to have irregular or missed periods.
- Physical signs such as excess facial or body hair caused by the high levels of androgen in the body.
- The body may have a problem using insulin, called insulin resistance. Malfunction of insulin production, formation or action is often found in women with PCOS. When the body doesn’t use insulinwell, blood sugar levels go up. Over time, this increases the chance of getting diabetes.
The symptoms of PCOS usually become apparent during the late teens or early twenties. Not all women with PCOS will have all of the symptoms, and each symptom can vary from mild to severe. Many women only experience menstrual problems and/or are unable to conceive. The symptoms can include:
- Irregular periods or no periods at all.
- Difficulty getting pregnant as a result of irregular ovulation or failure to ovulate. PCOS is one of the most common causes of female infertility. Many women discover they have PCOS when they’re trying to get pregnant and are unsuccessful. During each menstrual cycle, the ovaries release an egg (ovum) into the uterus (womb). This process is called ovulation and usually occurs once a month. However, women with PCOS often fail to ovulate or ovulate infrequently, which means they have irregular or absent periods and find it difficult to get pregnant
- Excessive hair growth (hirsutism) usually on the face, chest, back or buttocks
- Weight gain
- Thinning hair and hair loss from the head
- Oily skin or acne
Management of PCOS:
While there is no cure, the symptoms can be treated. Treatment depends on symptoms and whether a pregnancy is being planned.
Regular exercise, a healthy diet, weight control, and not smoking are all important parts of treatment for PCOS. The symptoms and overall risk of developing long-term health problems from PCOS can be greatly improved by losing excess weight. Weight loss of just 5% can lead to a significant improvement in PCOS. In addition, medicine is prescribed to balance the hormones. Medications are also available to treat symptoms such as excessive hair growth, irregular periods and fertility problems.
If fertility medications are ineffective, a simple surgical procedure called laparoscopic ovarian drilling (LOD) may be done that destroy the androgen producing tissue in the ovaries that’s producing androgens, such as testosterone. With treatment, most women with PCOS are able to get pregnant.
It is important to manage and control PCOS because of the risks it can pose in later life. Controlling it lowers the risks of developing the following health problems in later life:
- Type 2 diabetes that causes a person’s blood sugar level to become too high
- Depression and mood swings because the symptoms of PCOS can affect confidence and self-esteem
- High blood pressure and high cholesterol which can lead to heart disease and stroke
- Sleep apnoea that causes interrupted breathing during sleep
- A higher-than-average risk of developing cancer of the womb lining (endometrial cancer).
The diagnosis of PCOS would need a number of hormone tests to find out whether the excess hormone production is caused by PCOS or another hormone-related condition. An ultrasound scan can show whether the follicles in the ovaries (polycystic ovaries). A blood test may also be done to measure hormone levels and to screen for diabetes or high cholesterol. A diagnosis of PCOS can usually be made if other rare causes of the same symptoms have been ruled out and the patient meets at least two of the following three criteria:
- Irregular periods or infrequent periods indicating that the ovaries don’t regularly release eggs (ovulate)
- Blood tests showing high levels of “male hormones”, such as testosterone (or sometimes just the signs of excess male hormones, even if the blood test is normal)
- Scans showing polycystic ovaries
Dr Zareena A Khalid,
Senior Consultant, Women’s Health,