Polycystic ovary syndrome is the name given to a condition in which women with polycystic ovaries also have one or more additional symptoms. It was first ‘discovered’ in 1935 by Doctors Stein and Leventhal, so for many years it was known as the Stein-Leventhal syndrome.
The term polycystic ovaries describes ovaries that contain many small cysts (about twice as many as in normal ovaries), usually no bigger than 8 millimetres each, located just below the surface of the ovaries. These cysts are egg-containing follicles that have not developed properly due to a number of hormonal abnormalities.
Polycystic ovaries (PCO) are very common, affecting around 20 per cent of women. Polycystic ovary syndrome (PCOS) is also very common, affecting 5–10 per cent of women.
PCOS affects women in different ways, so not all women will have all these symptoms. Some women may have only mild symptoms, while others may have a wider range of more severe symptoms.
Polycystic ovary syndrome (PCOS):
• affects millions of women in the UK and worldwide
• runs in families
• is one of the leading causes of fertility problems in women
• if not properly managed, can lead to additional health problems in later life
• can affect a woman’s appearance and self-esteem.
Although PCOS is treatable, it cannot be cured.
Symptoms can include:
• irregular periods, or a complete lack of periods
• rregular ovulation, or no ovulation at all
• reduced fertility – difficulty becoming pregnant, recurrent miscarriage
• unwanted facial or body hair (hirsutism)
• oily skin, acne
• thinning hair or hair loss from the scalp (alopecia)
• weight problems – being overweight, rapid weight gain, difficulty losing weight
• depression and mood changes.
Symptoms usually start in adolescence, although some women do not develop them until their early to mid twenties. The condition has long-term health implications as women with PCOS may have an increased risk of developing diabetes and heart disease.
Pro.Med has helped many women to successfully manage and treat the unwanted symptoms of facial and body hair , thinning hair and oily skin and acne
The symptoms of PCOS are associated with abnormalities in some of the hormones that control the menstrual cycle. These abnormalities typically include: higher than normal levels of LH and of androgens, and below normal levels of FSH and progesterone. The most important androgen is testosterone, which is oroduced by all women from the ovaries. Testosterone is a normal and essential product of the ovary because most of it is converted, within the ovarian follicle, to oestrogen, which is the main female hormone.
Women with PCOS produce higher than average amounts of testosterone from the ovaries, and it is this that results in many of the symptoms of the condition. Testosterone is often thought of as a ‘male hormone’, but this is not the case – it is just that men produce 10 times as much testosterone as women. Women with PCOS usually have a testosterone measurement that is either slightly above the female range or at the upper end of the normal range for women.
It is also thought that another hormone – insulin – may be involved in the development of PCOS. Insulin is a hormone produced by the pancreas to regulate the level of glucose in the blood. Many women with PCOS have been found to have a condition known as insulin resistance, in which the body’s tissues are resistant to the effects of insulin (particularly on the ability of insulin to get glucose into muscle tissue), so the body has to produce more insulin to compensate. It seems that these high levels of insulin then affect the ovaries, contributing to the abnormal hormone environment.
Doctors do not yet fully understand what causes these hormonal abnormalities. It may be that there are several causes, which could explain why different women have such different symptoms. Much research is still going on in this area. It is currently thought that there is a hereditary link, whereby some women inherit a greater chance of having PCOS, but whether or not these women actually develop PCOS depends on a number of additional factors. These factors include diet and lifestyle.
The ‘cysts’ in polycystic ovaries are not harmful, do not require surgical removal and do not lead to ovarian cancer. However, the abnormal menstrual cycles in some women with PCOS can make them more susceptible to certain health problems in later life.
Women who have very infrequent periods – fewer than four a year – may have an increased risk of developing endometrial cancer, if the womb lining (endometrium) becomes too thick. Fortunately, this type of cancer is still quite rare and the risk can be minimised, and probably eliminated, by using appropriate treatments to regulate periods. Possible treatments include the oral contraceptive pill (either combined pill or mini pill), progestogen tablets or a progestogen releasing coil.
Women with PCOS who have insulin resistance have an increased risk of developing a type of diabetes known as non-insulin-dependent diabetes (type 2 diabetes). This is much more likely to occur in women who are overweight, but can sometimes occur in women of normal weight too.
Women with insulin resistance may also be at risk of developing heart disease in later life. However, although risk factors for heart disease may be increased with PCOS, there is, as yet, no clear evidence that heart attacks are more common in women with the condition than in those who do not have PCOS. These risks can be reduced to a large extent by preventive measures such as good nutrition and exercise. Preventive measures are particularly important for women who are very overweight, and for women who have a family history of diabetes or heart disease.
PCOS affects women in different ways, so not all women will have all the related PCOS symptoms. Some women may have only mild symptoms, while others may have a wider range of more severe symptoms.
PCOS is usually diagnosed using a combination of an ultrasound scan to check for polycystic ovaries and blood tests to detect hormonal abnormalities. Your doctor should also check your blood pressure level and, if you are overweight, your blood sugar level. Once a diagnosis has been made, your doctor may refer you to a specialist – usually a gynaecologist (a doctor specialising in caring for a woman’s reproductive system) or an endocrinologist (a doctor specialising in the hormonal system).
Medical treatments cannot currently offer a ‘cure’ for PCOS, so they tend to be aimed at managing the symptoms. The good news is that many of the symptoms and the health risks can be managed successfully without medical intervention, through good nutrition, exercise and adopting a generally healthy lifestyle.
Information on the following pages will provide you with a quick overview on how to effectively manage individual PCOS symptoms, more information on each of the symptoms are available in Verity's Information Booklets which you receive by becoming a member
The main long-term health risks to be aware of with PCOS are endometrial cancer (cancer of the womb lining) and type 2 diabetes.
Endometrial cancer develops over several years if the womb lining (endometrium) is not lost regularly. With periods every few weeks, your risk is low; if, however, you have less than two or three periods a year, there is an increased risk, which needs to be dealt with. Your doctor can prescribe a low-dose contraceptive pill or progesterone tablets every few months to bring on a period and clear the womb lining from your body You don’t need to have an induced period every month, either – once every three months seems to be sufficient. If you are worried because you have not had a period for over a year, your doctor can arrange an ultrasound scan to check that the womb lining is normal.
Type 2 diabetes is more common in women with PCOS than women without it. It occurs because there is too much sugar (glucose) in the bloodstream. Untreated, this causes damage to your organs. Many women with PCOS are insulin resistant, which means they are making a lot of insulin to keep their blood sugar down to a normal level. These high levels of insulin can lead to weight gain, irregular periods, infertility, higher levels of testosterone – many of the symptoms of PCOS – and a greater risk of diabetes. You can reduce this risk by improving your insulin resistance, which means getting fitter and losing weight – even small amounts of weight loss can help. Your GP should check for early signs of diabetes, perhaps on a yearly basis. This is particularly important if you are overweight or have diabetes in your family. You may also be prescribed an insulin-sensitising medication such as metformin.
Heart disease is another long-term health risk with PCOS. Women with PCOS, especially if they are overweight, can have unhealthy amounts of fats in their bloodstream, which may increase the risk of heart disease and stroke. It makes sense to have your fasting blood-fat levels checked so that if they are high you can improve your diet and fitness to reduce them. If you are a smoker, it is vital that you stop – ask your GP for advice. Your GP may treat you with statins to lower your blood-fat levels and may also be able to prescribe nicotine-replacement therapy.
Books
• What to Do When the Doctor Says It's PCOS: The Most Important Things You Need to Know
by Milton Hammerly and Cheryl Kimball (Fair Winds Press)
• The PCOS Protection Plan
by Colette Harris and Theresa Cheung (Hay House)
Websites
www.verity-pcos.org.uk
British Heart Foundation