Polycystic ovarian syndrome (PCOS)

What is PCOS?

Polycystic ovarian syndrome (PCOS) is a very difficult condition to diagnose, since it is classified as a syndrome, not a disease – this means it is a collection of symptoms, rather than one diagnosable condition. There are several symptoms, but you don’t have to present all of them to be diagnosed with PCOS. ‘Polycystic’ suggests you have cysts on your ovaries, but actually ‘polycystic ovaries’ are actually not the same as ‘polycystic ovarian syndrome’ in some key ways. Not all women with PCOS have the multiple follicles that appear on ultrasounds like cysts, and not all women with cysts or immature follicles have PCOS.

Many of the symptoms associated with PCOS are caused by high levels of androgens in your body, or in fact a sensitivity to androgens in your cells – we’re not sure. Androgens are typically called ‘male hormones’, even though women need androgens like testosterone, and men need oestrogens, to function normally. A small amount of androgens are produced by all women in the ovaries and adrenal glands, however high levels of androgens can prevent ovulation and cause disruptions to the menstrual cycle.

How is PCOS diagnosed?

Physical examinations, ultrasounds, blood tests and medical history are used to diagnose PCOS. A diagnosis is made when at least two of the criteria are present, these include:

  • The visible size of one or both ovaries is increased
  • 12 or more immature follicles (called cysts, but not true cysts) are visible on at least one ovary
  • There are high levels of androgens in the blood
  • Symptoms suggest high levels of androgens, for example male-pattern hair growth (facial hair, etc.)
  • Menstrual irregularities – missed periods, long cycles, inability to fall pregnant
  • A lack of menstrual periods completely (amenorrhoea)

Symptoms of PCOS

Symptoms of PCOS tend to develop shortly after puberty, but may develop during the later teen or early adult years. Because symptoms can be attributed to other causes or stay unnoticed, especially when a young woman is on hormonal birth control, PCOS can go undiagnosed.

Women with PCOS tend to have missed/irregular periods, which are a result of a lack of ovulation. Although some women develop immature follicles that have a cyst-like appearance under ultrasound of their ovaries, many do not.

The symptoms of PCOS include:

  • Irregular periods
  • Excess or unwanted hair growth
  • Acne
  • Fertility problems
  • Depression and anxiety
  • Weight gain
  • Fatigue
  • Thinning head hair
  • Infertility
  • Mood changes
  • Pelvic pain
  • Headaches
  • Sleep problems

What does a ‘syndrome’ mean?

The word syndrome means ‘a group of symptoms that consistently occur together’ or ‘a condition characterised by a set of associated symptoms’.

How is PCOS different to PCO?

Polycystic ovaries (PCO) refers to ovaries that have a high number of true ovarian cysts (which can be completely normal), but are not affected by any other symptoms traditionally associated with PCOS.

While the names of the two conditions are similar, the actual conditions, and medical treatments and risks are very different. PCOS is a condition that has both short and long-term consequences, while PCO is a normal variant in a woman’s ovaries. PCOS is often related to insulin and blood sugar regulation, since insulin causes androgen release from the ovaries – this can cause the increase in androgens in the blood, causing the cascade effect.

How we treat PCOS

There is no cure for PCOS but there are treatments that can help alleviate the symptoms, these include:

  • Lifestyle changes including diet modifications to manage insulin resistance and weight loss
  • Oral contraceptives
  • Insulin-sensitising agents
  • Antiandrogenic medication
  • Removing or hiding unwanted hair
  • Acne treatments

Lifestyle changes

In most cases the first thing a healthcare provider will recommend for a woman with PCOS is a specific lifestyle change, such as a change in diet, weight loss, or more physical activity. Being more physically active and losing weight can minimise certain PCOS symptoms and related conditions. Here’s why:

  • Weight loss can help restore ovulation and return your menstrual cycle to normal by helping to regulate your insulin response
  • Weight loss can reduce the chances of diabetes and lowers cholesterol levels
  • Many women find that weight loss reduces excessive hair growth and acne
  • Physical activity can help reduce depression that is associated with PCOS

There is no single diet or activity plan that is known to work better than another. Your healthcare provider can help design a plan that is best for you.

Oral contraceptives

Hormonal contraceptives can be used as a long-term treatment for women with PCOS who do not wish to become pregnant. The pill tends to be the primary PCOS management option. Oral contraceptives contain a combination of female hormones that can help with:

  • Reduce the level of androgens produced by the ovaries
  • Clearing acne and reduce excess hair growth

There is no one oral contraceptive that works best for women, and your healthcare provider will be able to advise you as to which is the best for you.

Insulin-sensitising agents

These types of medication increase the body’s response to insulin and keep glucose levels more stable. For women with PCOS these medications can help:

  • Increase weight loss
  • Make periods more regular
  • Clear acne
  • Reduce excess hair growth
  • Lower cholesterol levels

After using these medications for roughly four to six months, women with PCOS may begin to ovulate naturally.

Antiandrogens

These medications can either limit the effects of androgens or prevent the body from producing them. In women with PCOS anti-androgens can:

  • Reduce excess hair growth
  • Help clear acne
  • Lower androgen levels

Antiandrogens are often taken in conjunction with contraceptives to prevent pregnancy, as these drugs can cause birth defects. You should talk to your healthcare provider about the risk associated with these treatments, especially if you want to become pregnant.

Removing or hiding unwanted hair

There are many ways to hide or get rid of excess or unwanted hair. Women with PCOS can use methods such as:

  • The daily application of a cream that slows the growth of hair
  • Shaving, plucking, waxing, bleaching or using creams that dissolve hair
  • Electrolysis or laser hair removal

Acne treatments

Acne treatments such as retinoids, antibiotics and antibacterial agents can be used to treat acne and may come as pills, gels or creams. Your specific treatment will depend on the severity of your acne and how long it has been visible. You may benefit from specific treatment from a dermatologist.

How diet and lifestyle affects PCOS

Women with PCOS often have higher levels of insulin than normal, a condition known as insulin resistance. Insulin is a hormone produced in your pancreas that helps your cells turn sugar into energy.

If you don’t produce enough insulin or you are insulin resistant, your blood sugar levels can rise. If you are insulin resistant, your body may try to make more insulin in order to keep your blood sugar levels normal. If your insulin levels are too high, it can cause your ovaries to produce more androgens.

Insulin resistance can also be caused by having a higher body mass index (BMI), but paradoxically insulin resistance can make it difficult to lose weight. A diet that is high in refined carbohydrates can cause insulin resistance, and make weight loss more difficult.

If you suspect you have PCOS, a formal diagnosis can lay the pathway for your treatment options.