Polycystic Ovary Syndrome

What is Polycystic Ovary Syndrome?

Around one in five women of reproductive age have small cysts on their ovaries. Polycystic ovaries is the term which describes the appearance of the ovaries when they are seen on an ultrasound scan.

A small fraction of women with polycystic ovaries will be troubled by certain symptoms (irregular periods, obesity, hirsuitism, acne) and in that case their condition is given the term polycystic ovary syndrome (PCOS).

So not all women with polycystic ovaries have polycystic ovary syndrome, but all women with PCOS do have polycystic ovaries.

What causes it?

Insulin, the most important hormone which regulates the body's use of sugar, appears to play an important role in the development of polycystic ovary syndrome (PCOS). It appears that many women with polycystic ovary syndrome (PCOS), produce too much insulin or the insulin they produce does not function well. Insulin affects the maturation of the ovarian follicles and interrupts ovulation. As a result the ovaries produce hormones (including androgens) in incorrect proportions. The pituitary gland senses that the ovary is not working properly and in turn releases abnormal amounts of luteinising hormone(LH) and follicle-stimulating hormone (FSH).

The irregularities of insulin metabolism in patients with polycystic ovary syndrome appears to contribute to their tendency to gain weight and their difficulty to lose it. These women have also higher chances of developing diabetes later in life.

The Symptoms of PCOS

Menstrual irregularities

This imbalance of hormone production from both the ovaries and pituitary may result in either irregular ovulation or no ovulation at all (known as "anovulation"). Menstrual periods may therefore become irregular - perhaps heavier than usual, perhaps occurring after long gaps (oligomenorrhoea) or perhaps not at all (amenorrhoea).

Fertility

Because ovulation is irregular and therefore less frequent, pregnancy is more difficult to achieve; As ovulation is closing related to regular periods, women with PCOS will have a better chance to get pregnant once their monthly cycles have returned to normal.

Miscarriage

While miscarriage seems an unfortunate chance event for most couples, it is now known that women with PCOS who have high circulating levels of LH may be at greater risk. The explanation is probably that too high a level of LH in the bloodstream makes it more difficult for the egg to develop within the follicle, and for an embryo to implant within the uterus.

Hirsuitism and acne

One of the hormones which may be released in unusually high amounts from the ovary is testosterone, the "male" sex hormone which circulates in both men and women. Excessive testosterone levels in women may be a cause of acne on the face and back, or unwanted hair on the face, chest, arms and legs. The levels of testosterone in women with PCOS are still much lower than found in men.

Long term health issues

Heart Disease

Obese women with polycystic ovaries are at greater risk of heart disease. Excess weight is linked to high blood pressure and excessive levels of cholesterol in the bloodstream, both known risk factors for heart disease. A high fibre, low fat and low sugar diet at a young age may help reduce these risks in later life - as will stopping smoking.

Diabetes

Diabetes in later life, in which the body becomes unable to use sugar efficiently, is also associated with Polycystic Ovary Syndrome. An intrinsic error to insulin metabolism appears to contribute to the hormonal imbalance and to obesity that acompanies this syndrome. Medication might be needed, but weight loss and a lower intake of carbohydrates will also help.

Atypical endometrial hyperplasia and endometrial Cancer

If the lining of the womb (endometrium) becomes thick and is not shedding in the form of a period in frequent intervals, then there is a risk, although still relatively small, to develop endometrial cancer in the long future.

However this risk is eliminated if the woman has at least three to four periods per year. If the endometrium appears thick or irregular on an ultrasound scan, a D&C (dilatation and curettage) operation might be advised.

There is no link between the cysts of polycystic ovaries and ovarian cancer

The small cysts detected in polycystic ovaries do not get any bigger; in fact, they usually disappear only to be replaced by other similar cysts. They remain small (no bigger than 8 millimetres) and do not require removal by surgery.

Diagnosis

The history and the physical examination will usually present the symptoms and signs of Polycystic Ovary Syndrome. Blood tests will check the levels of hormones and glucose.

A pelvic ultrasound may be done to look at the ovaries. It also can be used to check the lining of the uterus to see if it is thickened.

Treatment

With proper treatment, PCOS can be managed and your symptoms can be relieved. PCOS is a lifelong condition, and it can be treated according to the individual needs of each woman. Treatment depends on your symptoms and whether you want to become pregnant.

Lifestyle Changes

It is well known that the body's hormone balance can be upset by excessive body weight. Correcting the excessive weight can reverse sometimes the problem.

Lowering insulin levels is a key to managing PCOS. Daily exercise improves the body's use of insulin. Polycystic ovary syndrome may be relieved by daily exercise for at least 30 minutes a day.

In some women with PCOS, weight loss will lower insulin levels enough to allow ovulation to begin. It also may help relieve some of the symptoms of PCOS, such as less new hair growth and less risk of endometrial hyperplasia.

Changes in the type of foods that is consumed may help lower insulin levels. Women with PCOS should decrease their intake of foods high in carbohydrates. Carbohydrates are found in bread, pasta, potatoes, and foods that are sweet.
Medical treatment

To treat irregular menstrual periods, the doctor may prescribe either the hormone progesterone or birth control pills.

Women who wish to become pregnant may be given medications to help them ovulate.

Some women with PCOS will be prescribed medication to lower their insulin levels.

Doctor may also prescribe birth control pills and other medications to help slow the growth of new body hair. It may take a number of months before any results are evident. These medications likely will not remove hair that is already there but will prevent to be replaced by new one. Unwanted hair can be removed by electrolysis, or other hair removal methods.