Polycystic ovarian syndrome (PCOS) is a hormonal disorder affecting about 10 of every 100 women of child bearing age in Australia. PCOS is defined as the woman exhibiting 2 out 3 of the following:
- Absent or irregular periods.
- Polycystic looking ovaries on ultrasound.
- Raised testosterone and other androgen hormone associated markers.
It is uncertain exactly why PCOS occurs, but it is treatable. Treatment is targeted at the issues from the PCOS, which can differ from patient to patient.
PCOS can lead to period disruptions, including absent, irregular, or heavy periods. It can also lead to troublesome spotting and bleeding between periods. This is generally due to lack of ovulation in the menstrual cycle due to the hormonal disturbances caused by the PCOS which in turn affects the period each month.
It can be difficult getting pregnant due to irregular ovulation during the menstrual cycle.
The raised level of male hormones (androgens) leads to excessive hair growth (hirsuitism), which can occur on the face, chest, back, lower abdomen or thighs. Also, the skin can become oily, leading to acne and pimples.
PCOS and weight issues unfortunately go hand in hand. The PCOS can cause weight gain, but also difficulty in losing weight also. This is often due to insulin resistance, which occurs in about 70% of women with PCOS. Insulin is made by the pancreas and helps the cells of the body use sugar. High levels of insulin in PCOS reduce this effect on cells, making weight loss greater and affecting ovulation also.
The ovaries in PCOS can be large and full of small fluid filled cavities with immature eggs in them which aren’t be ovulated each month due to the hormonal disturbances being caused by the PCOS. Bulky enlarged ovaries can cause pelvic pain.
Investigations will usually be targeted at the symptoms the woman is experiencing, with a PCOS diagnosis being confirmed after the test results are back.
Blood tests are important to rule out other causes of period disturbance, anovulation, or hair growth other than PCOS.
Ultrasound will help to identify polycystic ovaries, but will also check the overall structure of the ovaries and uterus to rule out any other causes of period or fertility issues, or excessive hair growth.
Hysteroscopy and curette may be required if there are concerns there may be a polyp in the uterus leading to the period disturbance, or if the lining of the uterus is overly thickened leading to concerns it may be abnormal.
Laparoscopy may be required to check the pelvis if pelvic pain is a major symptom for the woman, especially if endometriosis is suspected. This condition can still be present with PCOS.
The aim of management is to manage the symptoms of concern of the PCOS and reduce the long-term risks of excessive weight such as type 2 diabetes, heart disease and uterine cancer.
Whatever the symptoms, lifestyle changes are paramount for the overweight woman with PCOS. Even a weight loss of 5-10% of total body weight can restore regular ovulation, regular periods and fertility success. Dieticians, specialist nurse practitioners and exercise professionals form a pivotal role in long term successful weight loss and weight management.
Medications to manage period issues
Most young women will get good period control from the contraceptive pill, which will lead to a regular, manageable period. Some contraceptive pills also have androgen blocking properties, providing good resolution of acne and hair growth issues.
If the contraceptive pill is not appropriate, insertion of a Mirena IUD may manage periods quite well also.
Medications to assist fertility and ovulation
Clomiphene is used to induce ovulation by normalising the body’s hormones and encouraging the pituitary gland to secrete a hormone called FSH which stimulates the ovary to mature and egg for release. This works well in women with PCOS to induce regular ovulation, which in turn often also leads to regular, more manageable periods.
Metformin is a drug which acts on high insulin levels to assist the clomid to successfully cause ovulation. Metformin is often a good drug to use in women with PCOS.
Medications for hair growth issues
Along with the androgen blocking contraceptive pills already mentioned, Vaniqa cream can also be very helpful with prevention of new hair growth after existing hair is removed by waxing, electrolysis etc. Vaniqa blocks the androgen hormone effect at the level of the hair follicle as is easily applied to problem areas.
Controlled clomid ovarian stimulation and follicle tracking