Polycystic ovary syndrome, or PCOS, is a common condition and the leading cause of infertility among women in the UK. But there is much that can be done to help...
What is it?
Polycystic ovary syndrome (PCOS) is a hormonal condition of the ovaries, and it affects millions of women in the UK. Although it's thought one in five women have polycystic ovaries, more than half of these women show no symptoms.
Often, PCOS is diagnosed during the late teens or early twenties. Symptoms can include extra hair appearing on the face, chest, back or bottom, thinning of the hair on the head, weight gain, mood swings and acne – but in some cases, the only symptoms will be irregular periods (or no periods at all) and a difficulty in conceiving. In these cases, the condition might not be diagnosed until a woman is trying for a baby.
PCOS makes it harder to conceive because of ovarian cysts which prevent healthy ovulation. The cysts are actually underdeveloped sacs in which eggs would usually develop.
Normally, each month, the ovaries mature with several sacs, which enlarge and ripen. Then at least one of the sacs will release an egg (ovulation). But polycystic ovaries develop many more of these sacs, more than twice as many. The sacs fail to mature properly and are unable to release eggs. As such, ovulation does not take place.
The exact cause of PCOS is not known, although it is suspected that genes have a part to play because it can run in families. If any close female relatives have the condition, then you might well be more likely to have it yourself.
The syndrome is certainly associated with hormonal imbalance – and having higher than normal levels of insulin in your body is linked to PCOS.
You might have higher levels of insulin because you are overweight, or it might be that the tissues in your body are resistant to insulin – which then causes your body to produce even more to compensate.
When there are high levels of insulin, this can cause the ovaries to produce too much testosterone – and that interferes with the healthy development of those sacs from which eggs would normally be released.
So, as well as higher levels of insulin, some women with PCOS are also found to have higher levels of testosterone. Some might also have higher levels of luteinising hormone (LH). This hormone is designed to stimulate ovulation, but it can actually interfere with it when there is too much.
Some women have raised levels of prolactin (the hormone that stimulates the production of breast milk), while others might have low levels of sex hormone binding globulin (SHBG), which is designed to reduce the effect of testosterone in the body and follicle stimulating hormone (FSH), which stimulates the ovaries to produce eggs.
There are some longer term risks associated with PCOS, including type 2 diabetes and high cholesterol levels. There is also an increased chance of developing cancer of the womb lining, but this type of cancer is still rare, and measures can be taken to reduce the likelihood of it happening.
How will I be diagnosed?
Symptoms of PCOS can vary significantly from woman to woman – and some of the symptoms cross over with other issues (such as thyroid problems). For these reasons, your GP will want to talk to you at some length about what you have been experiencing.
As well as discussing your symptoms, your doctor might order a blood test, to check your hormone levels and to see if your cholesterol levels are high, and also an ultrasound scan, which will be used to check your ovaries for cysts.
If PCOS is diagnosed, your GP will probably refer you either to a gynaecologist, or to an endocrinologist (a doctor who specialises in hormones).
What about treatment?
While PCOS can not be cured, there are various treatments available, and yours will depend entirely on your symptoms and the severity of them. Some women do not really require any treatment at all and PCOS can be managed with a healthy diet and lifestyle.
If you are overweight, your doctor is likely, in the first instance, to advise you to get yourself to a healthy BMI. The excess weight might well be contributing to higher insulin levels and, according to the NHS, reducing your weight by as little as 5% could have a significant impact on your PCOS.
Hormone treatment: If you have irregular or non-existent periods, you might be prescribed with the contraceptive pill, which will help to kick start a regular cycle. Alternatively, you might be offered progesterone tablets. Obviously, contraceptive pills won't be the answer if you are trying to conceive.
Surgery: PCOS can be treated with a procedure known as laparoscopic ovarian drilling (LOD). It sounds scary, but it's a fairly non-invasive procedure. Under general anaesthetic, the surgeon will make a small incision in your abdomen, and use special instruments to laser/burn away the tissue on the ovaries which is producing the troublesome male hormones.
The method has been shown to reduce levels of testosterone and LH, and raise levels of FSH. Although its effects might not be permanent, if you have been trying to conceive, LOD could alleviate the PCOS long enough for you to fall pregnant.
Treatment for hair growth/hair loss: The contraceptive pill might also be useful for keeping hair in the right places, and stopping it growing in the wrong places! Otherwise, there are various medicines you might be offered for these symptoms.
Some NHS authorities may also prescribe eflornithine cream, which can be used to slow down the growth of facial hair. Hair removal cream which is gentle enough for the face can be purchased from pharmacies.
Treatment for acne: If your PCOS is playing havoc with your skin, your doctor might prescribe you with some medicine to help with acne. However, if you are wanting to get pregnant, some medication, such as isotretinoin, is unsuitable, as it is unsafe during pregnancy. If you are not wanting to conceive, the oral contraceptive pill might be enough to sort out your skin.
Will I be able to get pregnant?
Having PCOS doesn't necessarily mean you won't be able to have a baby – take heart, most women with it manage to! However, having PCOS might mean you need some medical help in order to conceive.
As discussed above, minor surgery might fix your ovaries long enough for you to become pregnant. Your symptoms may return, however, once you have had your baby.
In terms of medicine, you might be offered clomifene or metformin, both of which stimulate the ovaries to release an egg every month. If neither of those work, another option is a medicine called gonadotrophins – but this one is more likely to overstimulate your ovaries, meaning there is a higher chance of you conceiving multiple babies.
The UK charity Verity is dedicated to supporting women with PCOS. The website is packed with information and advice, including how to manage your symptoms with a stress-free, healthy lifestyle.
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