PCOS – or Polycystic Ovary Syndrome – affects over half a million women of childbearing age. So why do we know so little about it? Emma Bangay outlines the important facts.
PCOS is a condition in which a woman’s levels of the sex hormones oestrogen and progesterone are out of balance, which leads to the growth of ovarian cysts (benign masses on the ovaries).
‘Polycystic means the ovaries have many cysts or follicles that rarely grow to maturity or produce eggs capable of being fertilised,’ explains Danielle Mortimer, Director of PCOS Aware
The Facts:
PCOS is a hormonal condition involving high levels of insulin or male hormones known as ‘androgens’, or both. The cause of this is unclear but the name of the condition can lead to confusion about what the main problem is with PCOS, says Danielle Mortimer, Director of PCOS Aware. ‘It is not the ovaries but the increased levels of male type hormones that cause the ovaries to work differently causing many of the problems associated with the condition.’
The Causes:
In some cases, PCOS runs in the family, whereas for other women, the condition only occurs when they are overweight. Those at risk are women of child bearing age, but it occurs in girls as young as 11 up to menopause age.
‘Unfortunately, the exact cause of PCOS is unknown,’ says Danielle, adding that there may be a genetic factor and many women who struggle with weight issues. ‘Researchers are currently investigating a correlation between the body’s ability to make insulin and PCOS. PCOS occurs in all groups but also appears to follow family and ethnic lines. It is more prevalent in Indigenous, Asian and North African women. Lifestyle patterns, nutrition and exercise, can make the condition better or worse,’ she explains.
The Symptoms:
Symptoms can be highly visible or deeply painful, physically and emotionally, says Danielle. They include:
– Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
– Infrequent, absent, and/or irregular menstrual periods
– Hirsutism — increased hair growth on the face, chest, stomach, back, thumbs, or toes
– Cysts on the ovaries
– Acne, oily skin, or dandruff
– Weight gain or obesity, usually with extra weight around the waist
– Male-pattern baldness or thinning hair
– Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
– Skin tags — excess flaps of skin in the armpits or neck area
– Pelvic pain
– Anxiety or depression
– Sleep apnoea — when breathing stops for short periods of time while asleep
The Diagnosis:
Many women report that their GP was unfamiliar with Polycystic Ovary Syndrome and how to diagnose and manage the condition, so with many symptoms, a diagnosis can be like trying to find the pieces to a puzzle, laments Danielle. ‘To ensure an accurate diagnoses, a complete medical history needs to be collated so a proper treatment plan can treat all aspects of the syndrome rather than each symptom,’ she says.
Diagnostic Tools:
– Medical history: Information about menstrual periods, weight changes, and other symptoms.
– Physical exam. Measure blood pressure; body mass index (BMI), and waist size. Check the areas of increased hair growth – allow the natural hair to grow for a few days before the visit.
– Pelvic exam. Check to see if your ovaries are enlarged or swollen by the increased number of small cysts.
– Blood tests. Check the androgen hormone and glucose (sugar) levels in the blood.
– Vaginal ultrasound (sonogram). A test that uses sound waves to take pictures of the pelvic area. It might be used to examine the ovaries for cysts and check the endometrium (lining of the womb). This lining may become thicker if periods are not regular.
The Everyday Effects:
The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilisation. This is called ovulation.
In women with PCOS, the ovary doesn’t make all of the hormones it needs for an egg to fully mature, explains Danielle. ‘The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent. Plus, the ovaries make male hormones, which also prevent ovulation.’
The Treatments:
There is no single, quick test to identify PCOS; a diagnosis will depend on the skill and knowledge of the GP, says Danielle. ‘But once diagnosed, the best way of managing the syndrome is through permanent lifestyle changes – like daily exercise and a low G.I. diet – as well as medication,’ she assures.
The Lifestyle Changes You Can Make:
– Treatment is determined by the symptoms of PCOS. ‘Research has shown that even a five to 10 per cent loss of weight in those who are overweight can restore normal hormone production and help regulate periods and improve fertility.’
– ‘PCOS is a long-term condition and long-term management is needed,’ says Danielle. ‘It is important to relieve symptoms and reduce the risk of diabetes by preventing weight gain through a healthy lifestyle, or by losing weight if you are already overweight.’
– Birth control pills. For women who don’t want to get pregnant, birth control pills can:
– Control menstrual cycles
– Reduce male hormone levels
– Help to clear acne
– Diabetes medications. Research is indicating there is strong link between PCOS and Type 2 Diabetes.
– Fertility medications: ‘Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used.’
– Surgery: ‘Ovarian drilling’ is a surgery that may increase the chance of ovulation. ‘It’s sometimes used when a woman does not respond to fertility medicines,’ says Danielle.
– Medicine for increased hair growth or extra male hormones. Medicines called anti-androgens may reduce hair growth and clear acne.
The Cure:
There is no cure for PCOS, however with proper treatment many of the symptoms can be controlled and possibly even eliminated, advises Danielle. ‘With appropriate treatment hirsutism, acne, irregular periods, weight gain, and infertility all can be treated. Although there is no cure, all women with PCOS should seek the care of a physician to optimise their health and prevent progression of symptoms.’
If you are showing any of the above symptoms, or want to know more about PCOS, visit your local GP for information. And ask questions about all the facts and treatments.
Follow Emma: Website | Instagram