What is PCOS?

PCOS is a condition that causes irregular or absent periods and elevated androgen (male hormone) levels which can cause acne, excess facial/body hair growth and male pattern hair thinning.

The cause of PCOS is not completely understood.  It is thought that abnormal levels of a pituitary hormone LH (that normally trigger ovulation) and androgens interfere with the normal function of the ovaries.  The follicles (eggs) in the ovaries are unable to grow to a size that would trigger ovulation.  The small follicles accumulate in the ovary which is where the syndrome derives its name.  Ovaries produce oestrogen and progesterone (female hormones).  As a result of the ovulation cycle being interrupted the levels of these hormones become imbalanced.  Androgen levels produced from the ovaries may also be increased because of the high levels of LH.

What symptoms and problems does it cause?

Period problems

If ovulation does not occur the lining of the uterus does not uniformly grow and shed so becomes thicker and sheds irregularly so that when a ‘period’ does occur it can be heavy and prolonged.  Often have fewer than six to eight menstrual periods per year.  Long term this irregular cycle can lead to overgrowth called hyperplasia and possibly endometrial cancer.

Acne and Unwanted Hair Growth

Hirsuitism (male pattern hair growth) occurs on the chin, neck, sideburn area, chest and upper abdomen. This can obviously be embarrassing and require regular shaving or waxing.

Infertility

Obviously if a woman is not ovulating regularly it is more difficult to become pregnant and assessment should be sought after 6 to 12 months of trying to become pregnant.

Insulin abnormalities and Diabetes

PCOS is associated with elevated insulin levels. Insulin helps to regulate glucose levels in the body.  When blood glucose levels rise despite increased insulin then depending on severity a person can be diagnosed as having impaired glucose tolerance or even diabetes.

Among women who have PCOS and are obese, 35 percent will develop impaired glucose tolerance by age 40 and up to 10 percent will develop type 2 diabetes.

Diagnosis

Diagnosis is partly clinical (irregular periods and hirsuitism) and partly from tests with ultrasound for polycystic ovaries and bloods tests for raised androgen levels. Blood tests looking for impaired glucose tolerance and diabetes can also be done once a diagnosis is made.

Treatments

1.Weight loss is the simplest and most effective treatment of PCOS in those that are overweight and will potentially correct all of the symptoms and problems. A loss of 5 to 10 percent of body weight is often all that is needed to return periods to a regular cycle.

2. When fertility is not required the most common treatment is the oral contraceptive pill to regulate the period and prevent overgrowth of the lining of the uterus. Certain pills can also be effective in the treatment of acne and hirsuitism.  The Mirena IUCD is also effective at preventing overgrowth of the lining of the uterus.

3. If the pill or Mirena does not suit then 10 to 14 days of progensterone alone every 1-3 months will induce a period more regularly but not aid acne or hirsuitism and is not contraceptive.

4. Hair treatments – shaving, waxing, electrolysis or laser treatments can be used.  Some contraceptive pills contain a progesterone that can be effective in reducing hair and there are also other tablets that can be tried.  Any treatment though needs at least a 6 months trial before results may be seen.

5. Infertility – again weight loss is the number one treatment for two reasons. It does not involve taking any tablets and once pregnant would reduce the risks of obesity that are associated with pregnancy. Clomophine is a drug which is often used to try to induce ovulation.  If that is not effective then sometimes metformin (a diabetes drug) is added. If this fails to achieve ovulation referral to an infertility specialist is needed and daily injections with FSH may be needed.

 

This post has been written by Dr Vanessa King, please click the link to see more information or contact details for Dr Vanessa King.