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PCOS: Polycystic Ovarian Syndrome

PCOS: Polycystic Ovarian Syndrome - woman holding stomach

Author: Obstetrician Dr Peter England

PCOS Polycystic Ovarian Syndrome is regularly shortened to the term PCOS.

It is important to diagnose PCOS correctly, for both your long- and short-term health implications.

With appropriate treatment and diagnosis PCOS symptoms and implications can all be addressed satisfactorily.

The underlying cause of PCOS is not yet fully known.

The cause of Polycystic Ovary Syndrome likely has a genetic basis. It is much more likely to be present in families with type 2 diabetes. Or, if there might be a family history of irregular menstruation in your female relatives.

Excessive weight gain over time or pre-existing obesity can be a factor in the cause of PCOS.

What is PCOS?

Think of your ovaries as being fully functional, but a little bit lazy.

The physical anatomy is all there.

The eggs are there.

But you are not ovulating.

Due to changes in the hormonal environment, you can find that your periods are irregular, or infrequent. This happens because you are not ovulating very often, or at all. From the lack of ovulation, you can have a build-up of male hormones, that are also produced by the ovaries.

With PCOS, you can also have a change of female (estrogen) hormones into male hormones. When these hormones change, they can cause:

  • acne,
  • unwanted male hair patterns,
  • thinning of scalp hair,
  • associated body image disturbance and
  • depression or low mood.

When you are first diagnosed with PCOS, many women confirm there has been a noticeable change in weight over the preceding years. This weight gain needs further investigation.

In addition to the points listed above, due to a lack of ovulation, PCOS can result in problems if you are planning to have a baby.

Polycystic Ovarian Syndrome Diagnosis

When you first visit a gynaecologist to discuss possible PCOS, we will review some of your vital signs and ask you about your medical history, including:

  • Blood Pressure
  • Pulse
  • Your weight – and compare it to previous years (has there been a change?)
  • Male pattern hair distribution
  • Review your scalp hair
  • Discuss irregular periods – are they being missed, or very spaced out?
  • Look at your skin for acne signs and body hair distribution.
  • Internal ultrasound, – a vaginal ultrasound is conducted to look at your ovaries.

On ultrasound, we might notice if the ovaries have multiple small cysts (POLYCYSTIC) appearance.

When you ovulate, you release an egg. You usually release an egg follicle that grows to 2-2.5cm across and pops mid cycle releasing the egg.

In PCOS this frequently does not occur, and then ovulation does not occur. Instead, a small cyst of 5-8mm in size is grown and no egg is released. After a few years, increased cysts appear. You can spot these cysts on ultrasound, and usually once 15 or more are evident, a diagnosis of PCOS will be made.

PCOS is a disorder of hormonal production.

Your doctor will arrange blood tests to look at the hormonal profile in your blood stream, which will be of assistance in the diagnosis.

We will also look at hormones produced by the pituitary gland that normally drives the menstrual cycle.

We will check your male hormone levels to see if they are in the normal range or elevated.

A glucose tolerance test can also be considered to check diabetes if there has been any weight gain or family history of diabetes.

Long term health implications of PCOS

It is important to seek medical advice if you think you may have PCOS. Over time PCOS can lead to:

  • Type 2 Diabetes
  • Sleep Apnoea
  • High Blood Pressure

All have serious implications for your cardiac health and life expectancy.

A visit to a dietitian can be useful to help you reduce simple carbohydrates and focus on increasing complex carbohydrates intake.

Obvious foods to look at reducing – white bread, white rice, pasta, and potato. All these foods are broken down into pure glucose in the blood stream and this energy is stored as increased fat. The increased fat causes the derangement in hormone levels. Fat cells can alter female hormones into male hormone precursors and lead to unwanted signs and symptoms as mentioned above.

PCOS treatment is aiming to reduce the impact of male hormones on the skin, acne, hirsutism and to trigger ovulation.

Regular exercise is important for women with PCOS

It’s advised that you exercise at least three times a week. To start, you could consider:

  • Gym work,
  • walking,
  • swimming,
  • bike riding

Choose an exercise that you enjoy to help ensure you will continue. Walking multiple times a week is a great place to begin.

The exercise will also assist to improve any low mood or mental health concerns that can be present when you have PCOS.

Medications to treat PCOS

The Oral contraception pill can be used to manage PCOS. This will ensure a regular period and prevent the uterine lining becoming excessively thick.

The pill will provide contraception if that is required.

There are 2 types of pill that are specifically designed to help women with PCOS to act against the male hormones that are present.

One of these contains a hormone called cyproterone.

These brands are often under the names:

  • Brenda
  • Estelle
  • Juliet
  • Diane

An alternate hormone is drospirenone and can be found in the oral pill under the trade names of:

  • Yaz
  • Yasmin

Commencing on these oral pills will lead to regular, more predictable periods, which is a great improvement, given that often women with polycystic ovaries have very irregular, and often very heavy or prolonged periods. Over several months, the pill will help to improve some of the annoying symptoms that can be quite depressing for some women.

Over 3-6 months, you will notice an improvement in skin and hair distribution.

It’s important for the lining of the uterus to shed for women with PCOS.

As mentioned, many women with PCOS don’t ovulate, this leads to a build-up in the lining of the uterus. Not only does the lining of the uterus become thick and prone to heavy bleeding, but the lining can become unhealthy and increase your risk of endometrial or uterine cancer later in life.

Being on the oral pill with an appropriate formulation for you, can prevent this risk from happening.

Other tablets that can be used are:

  • Metformin

Metformin is used to treat high blood sugar levels that are caused by a type of diabetes mellitus or sugar diabetes called type 2 diabetes. 

If the pill is not being tolerated to treat thinning scalp hair, you might be prescribed a diuretic called Spironolactone.

Dermatologists will use other kinds of treatments.

If you don’t like the oral contraceptive pill, you can consider a progesterone containing IUD – you may know it as Mirena or Kyleena – it keeps the periods noticeably light and the uterus in a strong healthy state, rather than the overstimulated state that tends to occur in the PCOS condition. However, the IUDs do not have any beneficial effect on acne or hirsutism.

For more information, speak with your GP, or ask for a gynaecological referral.

Read more about how PCOS impacts fertility and the treatments available.