PCOS in a nutshell
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. It affects about 8-13% of women.PCOS can cause irregular menstrual cycles, difficulty falling pregnant, acne, excess hair growth and excess weight gain. Like all syndromes, PCOS is a collection of problems that are found together. Not all women with PCOS have the same symptoms. To be diagnosed with PCOS, a woman must have two of three possible issues: Lack of ovulation (anovulation), high testosterone levels (hyperandrogenism), and ovaries that have multiple fluid-filled sacs (polycystic).
About once a month, the ovaries are supposed to make a structure called a follicle. As the follicle grows, it makes hormones, and then it releases an egg around day 14 of the menstrual cycle. This is called ovulation. In women with PCOS, the ovaries don’t work as they should. The ovaries make many small follicles instead of one big one. Hormone levels can get out of balance and ovulation doesn't happen every month the way it is supposed to.
The symptoms vary from woman to woman and change over time. Some women have very few mild symptoms, while others are affected more severely by a wider range of symptoms. The symptoms are related to abnormal hormone levels such as testosterone and insulin resistance. Testosterone is a hormone that is produced in small amounts by the ovaries in all women.
Women with PCOS have slightly higher than normal levels of testosterone and this is associated with many of the symptoms of the condition including irregular periods (more or less often) or no periods, hair growth on the face and chest, loss or thinning of scalp hair, acne (pimples) that can be severe, emotional problems (anxiety, depression, poor body image) and difficulties getting pregnant (infertility).
Insulin is a hormone that controls the level of glucose (a type of sugar) in the blood. If you have PCOS, your body may not respond to insulin (this is known as insulin resistance) so the level of glucose is higher and this can lead to weight gain, a hard time losing weight, irregular periods, and higher levels of testosterone.
Obesity is common in women with PCOS. They also have an increased risk of diabetes, high blood pressure, and heart disease.
If you have few periods or no periods at all, the lining of your womb (known as the endometrium) may be more likely to thicken. Having regular periods usually prevents this. If the endometrium persistently thickens, it can be a risk factor for endometrial cancer.
Unknown cause
The cause of PCOS is not yet known but it sometimes runs in families. If any of your relatives (mother, aunts and or sisters) are affected with PCOS, your risk of developing PCOS may be increased.
A diagnosis is made when you have any two of the following: irregular, infrequent periods or no periods at all, an increase in facial or body hair and/or blood tests that show higher testosterone levels than normal and an ultrasound scan that shows polycystic ovaries.
PCOS is a lifelong condition, but it can be treated in several ways. Treatment depends on the symptoms and whether or not a woman wants to become pregnant. Long-term treatment may be needed to help prevent endometrial cancer, diabetes, and heart disease.
Following a balanced diet and taking regular exercise are the best ways in which you can help yourself. This improves the body's use of insulin and can help reduce the long-term health risks associated with PCOS. If you are overweight, losing weight will help you, and if your periods are irregular or non-existent, they may become more normal. The benefits of losing weight include a lower risk of insulin resistance, an increased chance of ovulation and becoming pregnant, a reduction in acne and a decrease in excess hair growth over time, and improved mood and self-esteem.
Women who wish to become pregnant can sometimes be given medications to help them ovulate. Some women with PCOS will be prescribed medications that lower their insulin levels. Sometimes surgery to reduce the number of follicles producing hormones on the ovary is offered if medical treatment is unsuccessful.
Combined oral contraceptive pills and other medications can help slow the symptoms and regulate the menstrual cycle. It may take several months for you to notice any results. These medications likely will not remove hair that is already there. Unwanted hair can be removed by shaving, electrolysis, or other hair removal methods.
Treatment should be tailored to each woman’s needs, symptoms, and particular situation and may change over time. Consult with your local specialist gynaecologist to find out the best treatment approach for you.
*Dr Simon Emvula is an obstetrician-gynecologist.