Polycystic Ovary Syndrome

Polycystic ovaries (PCO) refer to the appearance of the ovary as seen by imaging techniques such as ultrasound. In a normal ovary, one or two small developing follicles are seen whereas in a polycystic ovary many follicles are present. Polycystic Ovary Syndrome (PCOS) means a combination of 2 or 3 of the following:
  • irregular periods
  • increased hair growth or acne or raised levels of male hormones
  • polycystic ovaries.
PCOS is very common in women from India and the Middle East, occurs in around 5-8% of Caucasian, Maori and Polynesian women, but is rare in Asian women.


Symptoms

Symptoms vary with severity of the syndrome, ethnicity, and lifestyle. Persistent acne, increased body hair and irregular periods result from increased androgen (male hormone) production by the polyfollicular ovary.

There are two phenotypes

There are two phenotypes of PCOS women - lean and overweight. Lean women with PCOS will have symptoms from puberty. Heavier women with PCOS may be relatively asymptomatic in their teens while maintaining a fit and lean physique and only develop menstrual irregularity when a more sedentary lifestyle after school leads to weight gain which in turn exacerbates androgen levels and symptoms.

PCOS is associated with longer term health risks, including diabetes (especially those with a family history), raised blood pressure, abnormal cholesterol, sub fertility and cancer of the womb. Mostly these can be avoided or delayed by a healthy lifestyle, such as not smoking, maintaining a strong exercise ethic, and avoiding weight gain.  We don’t really know what causes PCOS and it seems unlikely to be just one factor. Genes do matter - brothers and sisters of women with PCOS often have similar changes in their blood tests.

What to do when PCOS is diagnosed....

PCOS is managed rather than cured. Early diagnosis is encouraged. Women with PCOS should maintain significant levels of exercise and a slim BMI (body mass index) (ideal BMI 19-22) so that the risks of type 2 diabetes and subfertility are minimised.  Antiandrogen therapy to block male hormone production helps women with acne and hirsutism.  Subfertility is not inevitable but may relate to infrequent ovulation. PCOS women with abdominal weight gain will often recommence regular ovulatory menses with more exercise and weight loss. Very lean PCOS women may need assistance to ovulate and there are several interventions which are useful. PCOS women should be aware, however, that they may be more at risk of pregnancy related complications especially gestational diabetes.

Self help tips:

  • Exercise very diligently, don’t smoke and If possible, maintain your weight in the lower BMI range for your ethnicity (e.g.19-22 for Caucasians).
  • Don’t ignore irregular periods as this can increase risk of cancer of the womb.
  • Anti-androgen treatment can significantly improve recurrent acne and/or male type hair patterns.
  • Seek expert medical help. If you are not pregnant after 3- 6 months of trying, especially if you are lean and/or have irregular periods.
  • Consider trying for a pregnancy by around 30 years age so that age related factors are not an additional issue.

By Dr Stella Milsom, Endocrinologist