Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome or disease (PCOS) is a collection of features found in a woman with polycystic ovaries. The characteristic features include:

• Menstrual irregularity – usually infrequent and sometimes heavy and prolonged periods; occasionally no periods.
• Excess male hormones usually manifest by increased facial or bodily hair – hirsutism, or increased acne
• Difficulties conceiving due to failure of ovulation (releasing an egg), although many women with this condition conceive normally.

What causes polycystic ovaries?

It is not understood what causes polycystic ovaries. We do know that they appear in adolescence and perhaps even earlier. We also know that there is a possible hereditary link, although the genetics of this link have not been identified.

Why do some women develop period irregularities and other symptoms?

In some women the polycystic ovaries produce hormones erratically and not in the correct proportion to each other. These ovarian hormones – namely estrogen and progesterone, act on the Pituitary gland to produce abnormal amounts of LH and FSH. This results in erratic ovulation or no ovulation and hence erratic periods and sometimes no periods. The polycystic ovary also produces increased amounts of male hormone, for example testosterone, resulting in acne and unwanted hair often found with this condition. The hormonal disturbances and other symptoms are aggravated by obesity that is often found in women with the symptoms mentioned above and in women with polycystic ovaries.

Polycystic ovarian syndrome is known to be associated with increased resistance to insulin, meaning the natural insulin may not work so effectively leading to disturbance in carbohydrate and fat metabolism. Obesity often occurs in association with polycystic ovaries. The relationship is unclear although it may be related to the effect on insulin action and we also know that excess body fat acts as a gland increasing oestrogen levels, further aggravating the hormonal imbalance. In addition, women with PCO who are overweight are at increased risk of cardiovascular disease and diabetes. Weight reduction is important to help restore the hormonal balance, natural ovulation and in addition reduce the risks of coronary artery disease and diabetes.

Diagnosis of polycystic ovaries or syndrome

• Polycystic ovaries can only be diagnosed by ultrasound scan, the ovaries are most clearly seen by vaginal ultrasound. The diagnosis is by US finding of >/= 12 follicles 5 – 9 mm and / or a volume of > 10 mls. in the affected ovary.
• Blood tests can help to diagnose polycystic ovarian syndrome:
  • LH (usually high) in relation to FSH
  • Testosterone and other androgens (usually raised)

Polycystic ovaries in a woman who is not wishing to conceive and who has no symptoms related to them does not require treatment.

There are three situations where polycystic ovaries or polycystic ovarian syndrome may require treatment:

1. Absent or irregular ovulation leading to difficulties in conceiving.
2. Increased unwanted bodily or facial hair.
3. Irregular or infrequent periods

Disorders of ovulation in a woman with polycystic ovaries can be treated by:

• Drug treatment to “induce” ovulation The most commonly used drug in this situation is clomiphene. In cases where clomiphene does not work, gonadotrophins (FSH) are needed and these are given as injections. Both these drugs require monitoring to ensure that they are producing the desired response and because of the risk of multiple pregnancy and hyperstimulation syndrome.
• Surgical treatment to the ovaries This is reserved for cases where ovulation cannot be triggered with clomiphene and gonadotrophin (injection) therapy. The technique involves using electrical energy (diathermy) or laser beams to “drill” holes in the tiny cysts that surround the ovary.
• If this strategy proves ineffective, then pursuing in vitro fertilization (IVF) is the next treatment option.

PCOS patients are advised to control their weight. This is particularly so in those women who have a raised body mass index (BMI). The best measure of fat content is the Body Mass Index (BMI). The ideal BMI is between 18 and 25. BMI is calculated in the following way: Weight in kg, divided by your height in metres squared.