Polycystic Ovarian Syndrome (PCOS)

What is Polycystic Ovarian Syndrome?

Polycystic Ovarian Syndrome (PCOS) is a common condition, caused by a hormonal imbalance in the ovaries. It is one of the leading causes of infertility in women. Normally, the ovary produces oestrogen (the female hormone), testosterone (the male hormone) and progesterone (the pregnancy hormone, produced after ovulation). With PCOS, oestrogen may be produced in normal amounts, while testosterone may be produced in excess – and this imbalance may prevent ovulation, which means that progesterone may not be produced at all in some months.

What causes PCOS?

We are still unsure why women develop PCOS. In some cases, it may run in families; in other women it may only occur if they are overweight, and then correct itself once they lose weight.

How do I know if I have PCOS?

As many as ten percent of women of childbearing age have PCOS, but most don’t even know they have it. The condition is usually diagnosed when they try unsuccessfully to get pregnant.

Symptoms include:

  • irregular periods, heavy bleeding, or no periods at all
  • period pain, bloating and tenderness
  • increased or male pattern hair growth (hirsutism)
  • acne
  • obesity
  • difficulty conceiving.

Another problem related to PCOS is a higher than normal miscarriage rate.

How can we test for PCOS?

We can confirm PCOS through an ultrasound scan or by blood tests to measure hormone levels – but if these are normal, we cannot rule out the condition. Conversely, some women who do not have problems with their periods or excessive hair growth can have ovaries which on ultrasound appear to be polycystic.

It is also important to remember that the presence of polycystic ovaries is not always bad news.  Many younger women can have severe side-effects from the syndrome caused by the hormone imbalance associated with polycystic ovaries,  however, as women age, the follicle number drops and the hormone imbalance corrects itself.  The result is that women who suffer polycystic ovary syndrome in their teens and twenties can sometimes end up having more eggs in their thirties without the syndrome and therefore a better chance of conception.

What is the treatment for PCOS?

There are a number of options available, depending on the main issue you are experiencing.

Irregular heavy bleeding can be treated with the oral contraceptive pill (OCP), both to regulate the cycle and to prevent over-growth of the endometrium (lining of the womb). Progesterone can also be given to replace what is not being produced monthly.

Excessive hair growth can also be treated using the OCP, as well as drugs that act against testosterone. With these drugs, it is vital to use a reliable form of contraception as they may cause genital abnormalities in a male baby if the woman becomes pregnant.

For infertility, there are a number of treatments:

  • Weight loss can be more difficult because of the higher levels of testosterone, but it has a very beneficial effect on balancing hormones and restoring regular periods in obese women. So exercise and a change of diet could have a significant impact.
  • Insulin sensitisers, such as Metformin, reduce the impact of insulin resistance and can also assist in weight loss.
  • Ovulation inducing drugs such as Clomiphene (Serophene or Clomid) can stimulate the ovaries
  • If you do not respond to Clomiphene, injectable drugs (FSH) can be used, but these require specialist facilities and close monitoring of the response to avoid severe side effects and multiple pregnancies
  • IVF treatment may be necessary in very difficult situations.

In some women, PCOS can lead to the development of diabetes, with all its complications, and to heart disease. If your doctor suspects you have PCOS, you will need tests to make sure you are not currently a diabetic and that your blood fats (lipids) are normal.

Contact us to find out more about PCOS.

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