What is PCOS?

PCOS is a hormonal imbalance found in women which causes a variety of problems including infertility, menstrual problems, heart disease and diabetes. It is seen in approximately 5-10% of all women. PCOS appears to run in families. It is quite common to finds that a patient with PCOS has a sister or mother with a similar clinical picture.

What are the common symptoms/associated problems?

• Infrequent or absent periods
• Acne
• Excessive dark hair growth on the face, back stomach, thumbs or toes
• Weight gain or obesity
• High cholesterol
• High blood pressure
• Insulin resistance or Type 2 diabetes

PCOS causes the associated problems because polycystic ovaries are unable to produce the normal levels of hormones required to release one egg at ovulation each month. Multiple cysts start to develop as normal at the beginning of the cycle, but none of them reach the critical size needed for ovulation. Therefore progesterone is not produced and a bleed does not occur. The cysts formed also produce excessive amounts of male hormone.

PCOS is diagnosed in different ways. Your doctor will take a medical history and perform an examination. She will check your blood pressure and Body Mass Index (BMI). A pelvic ultrasound may be indicated. Blood test to determine male hormone levels, as well as fasting cholesterol and blood glucose may be required.

Treatment of PCOS

There is no cure for PCOS, and there is no one treatment plan for PCOS. The appropriate treatment depends on what the patients goal is – control of symptoms, optimising your fertility or prevention of diabetes and heart disease.

Combined oral contraceptive pill

This is used for women who have no desire to conceive at the time. It controls the irregular bleeding pattern and reduces the excessive hair growth. However it only masks the symptoms of PCOS which will recur when the pill is stopped.

Diabetes medications

A drug traditionally used in diabetes has proved useful in the management of PCOS. Metformin (Glucophage) lowers testosterone levels by changing the way insulin affects glucose levels. This slows hair growth and ovulation may resume after a few months. It has also been shown to reduce body mass in some studies.

Fertility medications

Absence of ovulation is the main reason for the infertility problems associated with PCOS.

Medication to lower male hormones/reduce hair growth

Drugs which lower male hormone levels are called anti-androgens. Aldosterone (Aldactone) reduces acne and hair growth. Anti-androgens can also be combined into oral contraceptives such as Dianette.

Vaniqa cream is successful in reducing hair growth in some women. Other measures such as electrolysis or laser can also work well in women with PCOS.

Surgery

This is often used as a treatment option when medication has failed to induce ovulation. Laparoscopy is performed under anaesthetic, usually as a day case. Small holes are drilled into the surface of the ovary and this temporarily reduces male hormone production.

Lifestyle changes

Obesity is commonly associated with PCOS. Alteration of the diet and exercise are vital parts of trying to tackle this difficult problem. Processed foods and high sugar content foods should be replaced with whole grain foods, fruit and vegetables, and lean meat and fish. This reduces blood glucose levels and improves the way the body handles insulin, reducing male hormone levels. Research has shown that even a 5-10% reduction in body weight can restore regular periods and therefore ovulation.

Other health problems associated with PCOS

Women with PCOS have greater chances of developing certain serious diseases than women without PCOS

• 50% of women with PCOS will have developed diabetes or pre-diabetes before 40 years of age
• Women with PCOS are 5 times more likely to develop heart disease
• They are more likely to have high cholesterol
• They are more likely to have high blood pressure
• The risk of cancer of the womb is greatly increased in women who are not having periods due to the imbalance of hormones brought about by PCOS

It is important to try and control PCOS at a younger age to prevent the development of future problems. It is important to treat all the symptoms and not just focus on one such as trying for a baby. Regular diabetes testing should be done. The importance of a healthy diet, regular exercise and not smoking can not be underestimated in trying to prevent the above mentioned problems.