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FAQ – Polycystic Ovarian Syndrome (PCOS)

Read more about Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is one of the most common female  disorders. PCOS is a complex, heterogeneous disorder of uncertain etiology, but there is strong evidence that it can to a large degree be classified as a genetic disease.

PCOS produces symptoms in approximately 5% to 10% of women of reproductive age (12–45 years old). It is thought to be one of the leading causes of female subfertility and the most frequent endocrine problem in women of reproductive age.

The principal features are anovulation, resulting in irregular menstruation,  amenorrhea ovulation-related infertility, and polycystic ovaries; excessive amounts or effects of androgenic hormones, resulting in acne and hirsutism  and insulin resistance often associated with obesity, Type 2 diabetes, and high cholesterol levels .The symptoms and severity of the syndrome vary greatly among affected women.

What are the symptons of PCOS?

Some women have no symptoms. Most, however, will have irregular periods or no periods at all. Often women with PCOS find it hard to get pregnant. The abnormalities in hormones can cause many other problems too:

  • Acne and excessive body hair (hirsutism) may develop as a result of increased testosterone levels, and some women develop male-pattern balding.
  • Women with PCOS often gain, and find it hard to lose, weight – more than half are  overweight usually with central or apple shaped obesity which is particularly linked to diabetes  and heart disease.
  • High Blod pressure
  • A symptom, thought to be linked to insulin resistance is a diffuse velvety thickening and pigmentation of the skin, especially around the neck, armpits, groin, below the breast, and of the elbows and knuckles, known as Acanthosis nigrans.
  • Many suffer embarrassment because of their appearance, and can become socially isolated and depresed

What are the causes of PCOS?

The precise cause of PCOS is uncertain. Genetics may play a part as it often runs in a family but other factors are important too.

Women with PCOS have abnormalities in the production and metabolism of female and male sex hormones such as oestrogen and androgens, which can lead to raised levels of the male hormones in some. These abnormalities disrupt the activity of the ovaries which become enlarged, with a thick outer capsule beneath which cysts may form (these cysts result from problems with egg production and release).

There is also a lack of sensitivity to the hormone insulin (known as insulin resistance) which controls blood sugar levels. As a result the body pumps out high and higher amounts of insulin, which in turn causes raised levels of blood fats and an increased risk of thrombosis.

Being overweight aggravates this situation, so it can become a vicious circle – women with PCOS are especially likely to put on weight and this worsens the condition, so they put on more weight.

Around five to ten per cent of women have the syndrome. It develops during adolescence with the onset of periods.

What treatment is available for PCOS?

Losing just five to ten per cent of body weight may be all that’s needed to correct the hormonal imbalance, thus restoring ovulation and fertility, and helping improve acne and hirsutism.

Hormone therapy is also used to regulate periods, and treat acne and hirsutism.

Other treatments include standard acne treatments and methods to remove excess facial and body hair, such as electrolysis.

Newer treatments include a drug called metformin that counteracts insulin resistance. Although this is not yet licensed, doctors can prescribe it if they feel it’s appropriate. There is also research underway into ovarian surgery.

How is PCOS diagnosed?

The diagnosis is based on the patient’s symptoms and physical appearance.

If the diagnosis seems likely, because the patient’s history contains many of the symptoms described already, certain investigations are done to provide confirmatory evidence or to indicate another cause for the symptoms.

These include:

  • blood tests such as:
    • female sex hormones (particular time points in the cycle are important for some of these)
    • male sex hormones
    • sex-hormone-binding globulin
    • glucose
    • thyroid function tests
    • other hormones, eg prolactin.
  • ultrasound examination.

At the London Medical and Aesthetic clinic , we can  do the initial blood investigations  ensuring they are carried out at the correct time of the cycle if appropriate. Then an  ultrasound scan may be arranged.

Once the diagnosis is made, nothing more needs to be done for some women, eg if their fertility is not an issue, if their weight is within normal limits, and if they do not have excess body hair.

If any of the symptoms are an issue – further advice and treatment, and possibly specialist referral, is needed.

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