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Polycystic Ovarian Syndrome

 

Polycystic Ovary Syndrome (PCOS) is a hormone or endocrine syndrome or group of clinical symptoms.

If you suspect that you may have PCOS it is important that you see a health professional. An early diagnosis can not only help women manage the side effects of PCOS but also reduces the potential long-term health risks that are seen in women with PCOS.

Symptoms of PCOS

Symptoms of PCOS may present in many different ways - some women have uncomfortable and sometimes, quite distressing symptoms, whilst others have quite mild symptoms. Not everyone with PCOS will have all the symptoms and very few women will have the same set of symptoms. Symptoms may be present from puberty but might also begin later in life.

Symptoms can include:

  • Periods that are irregular, infrequent or heavy
  • Excess facial or body hair
  • Acne on both the face and the body
  • Hair loss
  • Difficulty in becoming pregnant

Other symptoms can include:

  • Depression, low self esteem, mood changes, anxiety
  • Sleep apnoea

Period problems

The average menstrual cycle is 28 days long with one ovulation (between 21-35 days is also considered normal). Due to high levels of androgens (male hormones) and insulin, the monthly cycle of ovulation and menstruation is often disrupted in women with PCOS. Although some women with PCOS will still have regular periods, most will experience some changes to their cycle. The periods may be irregular (cycles defined as eight or less menstrual cycles per year or menstrual cycles longer than 35 days) or may stop altogether. As menstrual cycles lengthen, ovulation may stop entirely or only occur occasionally. Some women with PCOS may also experience heavier or lighter bleeding during their menstrual cycle.

Excess hair (hirsutism)

Hirsutism is an excess of hair on the face and body due to the high levels of androgens stimulating the hair follicles. This excess hair is thicker, darker hairs rather than the pale thin hairs you commonly see on your face and arms. The hair typically grows in areas where it is more usual for men to grow hair such as the sideburn area, chin, upper lip, around nipples, lower abdomen, chest and thighs. Up to 60 per cent of women with PCOS have hirsutism. Women with PCOS from ethnic groups prone to darker body hair (e.g. Sri Lankan, Indian and Mediterranean populations) often find that they are more severely affected by hirsutism.

Acne

In women with PCOS, an increase in male hormones or androgens may increase the size of the oil production glands on the skin which can lead to increased acne. Acne is common in adolescence, but young women with PCOS tend to have more severe acne.

Hair loss (alopecia)

Due to high androgen levels, some women may experience hair loss or thinning of scalp hair in a ‘male-like' pattern (receding frontal hair line and thinning on the top of the scalp rather than the sides).

Reduced fertility or infertility

Not all women with PCOS will have fertility problems. High levels of androgens (male hormones) and high insulin levels can affect the menstrual cycle and prevent ovulation (the release of a mature egg from the ovary). Ovulation can stop completely or it can occur irregularly. This can make it more difficult for women with PCOS to conceive naturally, and some women may also have a greater risk of miscarriage. However, this does not mean that all women with PCOS are infertile. Many women with PCOS have children naturally without any extra medical infertility treatment. Other women with PCOS can fall pregnant and have children with medical assistance. As being overweight exacerbates infertility in PCOS, one of the most important approaches to improve fertility is to prevent weight gain, exercise regularly and lose weight if overweight.

Other symptoms

Psychological effects

Self-esteem and a sense of one's body image may be affected by the symptoms of excess hair, acne, hair loss, obesity and fertility problems. Other psychological reactions may occur relating to issues of femaleness, sexuality and femininity and can contribute to mood changes and social isolation and can lead to depression. If you are suffering from the emotional effects of PCOS, it is important to seek advice from your GP, counsellor or a psychologist.

It is very important to address these issues as psychological problems can make it very difficult to motivate yourself to change to a healthy lifestyle and look after yourself better.

Sleep apnoea

Women with PCOS, particularly when they are overweight or insulin resistant, can be at an increased risk of developing sleep-disordered breathing or sleep apnoea.  Sleep apnoea occurs when the upper airway is obstructed during sleep - this can be due to pressure from excessive fatty tissue in the neck partially blocking the airway. This can lead to sleep loss, fatigue, tiredness and reduced quality of daily life.

Medical Management of PCOS

This will depend on the symptoms and needs to be individualised. Several options are available for each symptom and balancing risks and benefits is important.

Androgen excess

Symptoms of male hormone excess or androgen excess (excessive hair growth (hirsutism), acne or scalp hair loss (alopecia)) can be treated in a number of ways.

Improving fertility

General tips for improving fertility and information about medications that may be required to induce ovulation.

Insulin resistance

Insulin resistance is a state where the body can’t carry out the normal actions of insulin. One of the roles of insulin is to keep the levels of glucose in the blood stable. In PCOS, high levels of insulin can increase the production of male hormones (androgens such as testosterone) in the ovaries.

Menstrual regularity

The oral contraceptive pill (‘the Pill’) is commonly prescribed for women with PCOS. The Pill can regulate menstrual periods and reduce menstrual cramps.

Natural therapies

Complementary therapies include herbal medicine, nutrition, acupuncture, homeopathy, osteopathy, chiropractic, traditional Chinese medicine, aromatherapy, reflexology, and remedial therapy such as massage and kinesiology.

Weight loss

Weight loss reduces insulin resistance and can therefore improve the symptoms of PCOS that are associated with insulin resistance (high androgen levels, menstrual irregularity, lack of ovulation and risk factors for type 2 diabetes and cardiovascular disease). Weight loss is best achieved through a combination of lifestyle changes.