Polycystic ovarian syndrome (PCOS) is the most common endocrine condition in reproductive age women with up to 20% affected. It is also one of the most common causes of infertility. PCOS is characterised by a lack of ovulation, irregular periods, elevated androgens (male hormones) and sometimes increased acne and hair growth. The name of the condition refers to the nature of patient’s ovaries where there are an increased number of small cysts seen on ultrasound. This finding alone, however, is not essential or diagnostic in itself.
The cause of PCOS is not fully understood though it is known to involve an increase in the body’s cells resistance to insulin. Insulin is a hormone that lowers blood sugar levels. Women with PCOS have increased levels of insulin and glucose. Higher levels of insulin can lead to many of the symptoms of PCOS. Women with PCOS also have a higher long term risk of developing diabetes. There is also an increase in androgens hormone levels such as testosterone. Certain families have a genetic pre-disposition to developing PCOS with multiple women in the same family being affected.
The presentation of PCOS can vary but can include the following:
- irregular periods or no periods at all, or alternatively heavy, frequent and unpredictable periods.
- an increase in body hair which may affect the abdomen, chest, thighs or face.
- hair loss on the head
- being overweight, experiencing an increase in weight or having difficulty losing weight
- increased acne and oily skin
- reduced fertility
PCOS is also known to have an association with depression and psychological problems.
Over the longer term there are some other health risks associated with PCOS that include:
- cardiovascular disease
- type II diabetes
- endometrial hyperplasia – a thickening of the lining of the uterus that can progress to endometrial cancer over the longer term without treatment.
Diagnosis of PCOS is based on a combination of clinical presentation, targeted blood tests and ultrasound findings.
The management plan for each PCOS patient depends upon their specific symptoms and concerns. For all patients a multifaceted approach is taken which includes lifestyle changes (such as attaining a healthy weight, dietary changes and exercise) in addition to potential array of medication options.
Infertility and PCOS
One of the hallmark features of PCOS is a lack of ovulation and therefore treatment for infertility is centred on addressing this. Ovulation induction is usually achieved with the oral aromatase inhibitor Letrozole. Aromatase is an enzyme involved in the production of estrogen. Alternatively Clomiphine Citrate (Clomid) which is acts on estrogen receptors can be trialled. Where these options don’t work hormones that stimulate the production of oestrogen and progesterone (the gonadotrophins FSH, and LH) can be administered via injection.
