Polycystic ovary syndrome, whats new14 January 2009
Polycystic ovarian syndrome (PCOS) is a very common condition affecting at least 1 in 7 women of reproductive age.
The condition can present with a variety of symptoms which include
PCOS Symptoms can include:
- irregular periods (cycle greater than 35 days or lack of periods)
- infertility; difficulty in becoming pregnant
- recurrent miscarriages
- unwanted facial and or body hair (hirsutism)
- oily skin, acne
- being overweight, rapid weight gain especially around the waist and abdomen (central obesity) ; difficulty in losing weight
The condition is diagnosed when two out of the three following conditions are present.
- Lack of periods or periods with a cycle longer than 35 days.
- Presence of hirsutism or acne or evidence of high level of male hormone (testosterone) in the blood
- Appearance of polycystic ovaries on ultrasound. The word polycystic is a bit of a misnomer in that the so called ‘cysts’ in PCOS are actually in strict scientific terms ‘follicles’ but the original definition has stuck.
2 out of 3 criteria are required for diagnosing the syndrome
- Unknown but probably results from a combination of several related factors.
- Women with PCOS frequently have a mother or sister with PCOS. But there is not enough evidence yet to say there is a genetic link to this disorder.
- An imbalance between the a hormone produced by the brain (pituitary) called luteinizing hormone (LH) and follicle-stimulating hormone (FSH), resulting in a lack of ovulation and an increased testosterone production, a male sex hormone.
- Many women with PCOS have a weight problem. So researchers are looking at a relationship between PCOS and the body's ability to make insulin. Insulin is a hormone that regulates the change of sugar, starches and other food into energy for the body's use or for storage. Many women with PCOS have insulin resistance, in which the body cannot use insulin efficiently. Since some women with PCOS make too much insulin, this leads to high circulating blood levels of insulin, called hyperinsulinemia. It is believed that hyperinsulinemia is related to increased levels of male hormones and it is possible that the ovaries react by making too many male hormones, androgens. This can lead to acne, excessive hair growth, weight gain (obesity), and ovulation problems as well as type 2 diabetes. In turn, obesity can increase insulin levels, causing worsening of PCOS. If there is evidence of being overweight a blood test to assess whether there is a tendency to develop diabetes (Oral glucose tolerance test) is sometimes recommended
Treatment of PCOS
Lifestyle change and change in diet are absolutely paramount. The long-term consequences of PCOS should also be highlighted. Prophylactic use of drug call Metformin in women with impaired glucose tolerance to prevent progression of diabetes may be useful in selected cases but this has to be decided by the doctors on a case by case basis at present. The effectiveness of Metformin in relation to ovulation induction has been evaluated and the most recent studies concluded that clomiphene citrate (CC) should still be the first choice therapy for women with therapy naïve PCOS (no previous treatments). In women who do not respond to clomiphene
combination with Metformin may be considered.
PCOS is a very common problem that has both short-term effects upon reproductive function and longer term effects upon the risk of diabetes and cardiovascular disease. Treatment of this condition should not only include drug therapy but also lifestyle changes.
Mr Joseph Aquilina FRCOG is a Consultant Obstetrician and Gynaecologist at St.Bartholomew’s and The Royal London Hospitals. He provides a specialist service in Gynaecological Ultrasound and is recognised as a Preceptor for training in gynaecological scanning by the Royal College of Obstetricians and Gynaecologists. He offers a comprehensive one-stop service in the management of PCOS, menstrual disorders and pelvic pain. He is available for consultations at the London Bridge on Tuesday afternoons/early evening. Appointments can me made by telephoning Mr Aquilina’s personal assistant on 020 8504 5381 (Tel/Fax) or e-mail firstname.lastname@example.org