Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a condition that affects the normal functioning of a woman’s ovaries. The ovaries usually produce ova (eggs) and the hormones estrogen and progesterone. These hormones influence the menstrual cycle and the production and release of eggs from the ovaries. In healthy women, ovulation occurs every month. At this point, the eggs are released into the fallopian tubes. Before this, these eggs develop tiny cysts within, known as follicles.

Polycystic ovary syndrome is diagnosed if at least two of the following occur: 1

• A minimum of 12 small cysts (follicles) form in the ovaries. These cysts are not big enough to trigger ovulation.
• The balance of the hormones produced in the ovaries is altered, particularly if the amount of testosterone produced increases.
• The individual does not ovulate each month or does not ovulate at all. In this case, the affected woman may not have a period.

In many cases, affected women will experience all three of these effects.

Although PCOS is a relatively common condition, occurring in approximately 5 to 10 percent of women, the exact cause is not known. 2 It is usually diagnosed during adolescence or in young adulthood, and symptoms include irregular or absent periods, excessive hair growth and difficulty falling pregnant.

PCOS is a chronic condition with no cure. After menopause, once ovarian function has declined, the symptoms of the condition will typically improve. Before this, treatment is aimed at managing the signs and symptoms and preventing complications.

Certain lifestyle changes, such as diet and exercise, are the most typical treatment methods for adolescent girls and women experiencing the condition. Medication is typically reserved for the occurrence of complaints, such as anovulation, hirsutism and menstrual irregularities.

Symptoms of polycystic ovary syndrome include: 2 3

• Menstrual irregularity: If ovulation does not occur, women will experience irregular or missed periods.
• Weight gain: Approximately half of all women with PCOS will experience weight gain that is difficult to manage.
• Unwanted hair growth: Also called hirsutism, affected areas may include the face, arms, chest and back.
• Hair loss or thinning: Primarily experienced on the head, normally in middle aged women.
• Difficulty becoming pregnant: Some women may find it difficult to fall pregnant and may require fertility treatments.
• Acne: Unwanted acne may develop, as well as other skin disorders such as skin tags, darkened patches of skin, oily skin and excessive sweating.
• Changeable mood: Some women may experience mood swings, anxiety and/or depression.
• Pelvic pain
• Headaches
• Difficulty sleeping
• High blood pressure (hypertension)
• Acanthosis nigricans: Brown or grey, velvety and sometimes verrucous patches of hyperpigmented skin. Usually found over the nape of the neck, the vulva, armpit, groin, navel, submammary areas, elbows and knuckles.

Symptoms of polycystic ovary syndrome usually begin to occur around the time of puberty, though some women may only develop symptoms in late adolescence or early adulthood. The symptoms experienced and the severity of these symptoms may also vary from woman to woman.

People experiencing possible symptoms of polycystic ovary syndrome should talk to their doctor. In addition, the free Ada app can be used to carry out a symptom assessment.

The exact causes of polycystic ovary syndrome are not clear. There are, however, a number of factors which are thought to play a role. These factors include: 1 4

• Insulin production: Produced in the pancreas, insulin is a hormone with the key function of controlling blood sugar levels. In the ovaries, it also helps to produce the male sex hormone testosterone. Women with PCOS have an insulin resistance, meaning that their bodies are not affected by normal levels of insulin in the usual way. This causes their bodies to produce increased amounts of insulin, resulting in unusually elevated levels of testosterone being present in the ovaries. This testosterone interferes with the ability of the follicles in the ovaries to fully develop.
• Luteinising hormone (LH): Produced in the pituitary gland, luteinising hormone works to help the ovaries to ovulate and assists insulin in the production of testosterone. High levels of the hormone are found in roughly half of all women with PCOS.
• Weight: Although not a cause of PCOS in itself, being overweight can make insulin resistance worse by causing the the body to produce increased levels of insulin.
• Genetic factors: It is thought that there may be a hereditary element to PCOS, but the links between genetics and the development of the condition are not yet fully understood.

Women experiencing symptoms of polycystic ovary syndrome should consult a doctor. A doctor will begin a diagnosis by asking questions about the symptoms and checking blood pressure. Following this, a number of tests can be used to confirm a diagnosis. These include: 1 5

• Blood tests: Used to measure hormone levels. In women with PCOS, levels of testosterone and luteinising hormone (LH) will typically be elevated.
• Ultrasound: Used to scan the ovaries for the small cysts typical of PCOS.

Before confirming a diagnosis of polycystic ovary syndrome, doctors will also need to rule out other conditions that may be responsible for the symptoms, such as premature ovarian failure and Cushing’s syndrome.

If a diagnosis of polycystic ovary syndrome is confirmed, individuals may be referred to a specialist: either a gynecologist – a specialist in the female reproductive system – or an endocrinologist – a specialist in conditions relating to hormones.

Women who display only minor symptoms of PCOS should be carefully monitored by medical professionals. This is because, characteristically, the condition is known to develop and become more serious over time. 2

There is currently no cure for polycystic ovary syndrome. The aim of treatment, therefore, is to manage the symptoms and reduce the risk of complications developing. Treatment typically involves one or more of the following options, depending on the symptoms experienced and the health of the affected woman:

• Lifestyle changes, particularly weight loss, but also including exercise and the maintenance of a healthy diet
• Medications

Weight loss is considered to be the most effective method of promoting regular periods and lowering the risk of long-term complications as a result of PCOS. Research suggests that losing as little as five percent of body weight can be enough to achieve this. 2 6 Weight loss is best achieved through regular exercise and healthy dietary choices. Women who wish to lose weight should discuss the best ways of achieving this with their doctor.

Metformin, though not designed specifically for the treatment of PCOS, may be prescribed by doctors to help treat the condition. Metformin helps the body to become more sensitive to insulin, helping to equalize the balance of hormones in women with a hormone imbalance. 7 Metformin should only be used in cases where lifestyle changes fail to help manage the condition and then should be used in combination with lifestyle changes.

The first line of treatment for women who are infertile but wish to become pregnant is clomifene, a non-steroidal anti-oestrogen medication that helps to increase FSH secretion, which in turn may lead to follicular menstruation and ovulation. Letrozole, a medication not specifically designed to help with ovulation but which, as some research suggests, can be more effective than clomifene, may also be prescribed in some cases. 2

In women who do not desire to become pregnant, oral contraceptives (OCs, with combined estrogen and progesterone) are commonly prescribed. OCs help to promote regular menstrual periods and can help to reduce excess hair growth and acne. 2

A hormonal substrate named progestin may also be prescribed to help promote regular periods, though this method does not help with acne or hair growth and does not prevent pregnancy. 2

Women with polycystic ovary syndrome are more likely to develop other conditions, including: 1

• Type-2 diabetes
• Pregnancy complications, such as gestational diabetes, pregnancy-induced hypertension and preterm delivery
• High cholesterol levels
• High blood pressure
• Being overweight
• Sleep apnea
• Non-alcoholic fatty liver disease (NAFLD)
• Reduced quality of life

These conditions may also increase the risk of developing heart disease and having a stroke later in life. The best way to avoid these potential complications is to effectively manage PCOS.

Good to know: PCOS can also increase the risk of miscarriage in those who are pregnant. The best way to minimise this risk is to devise an appropriate antenatal care plan with one’s doctor.

Read more about Miscarriage ».

Although it's not possible to prevent polycystic ovary syndrome, early diagnosis can help to prevent complications such as infertility or diabetes.

• PCOS