PCOS

What is PCOS?

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Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. 1 PCOS is a health problem that affects one in 10 women of childbearing age. Women with PCOS have a hormonal imbalance and metabolism problems that may affect their overall health and appearance. PCOS is also a common and treatable cause of infertility. 2

Background epidemiology

PCOS is a common disorder, often complicated by chronic anovulatory infertility and hyperandrogenism with the clinical manifestations of oligomenorrhoea, hirsutism and acne. Many women with this condition are obese and have a higher prevalence of impaired glucose tolerance, type II diabetes and sleep apnoea than is observed in the general population. They exhibit an adverse cardiovascular risk profile, characteristic of the cardiometabolic syndrome as suggested by a higher reported incidence of hypertension, dyslipidaemia, visceral obesity, insulin resistance and hyperinsulinemia1

How is PCOS diagnosed?

The condition is usually diagnosed based on the following factors1,3:

  1. increased androgens (male hormones, such as testosterone), as shown by excess hair growth, acne or raised blood testosterone levels
  2. lack of regular ovulation (irregular menstrual periods or failure to release an egg from the ovary)
  3. a characteristic appearance of the ovaries on ultrasound (polycystic ovaries – PCO).

Usually the diagnosis of PCOS requires the presence of at least two polycystic ovaries. Having polycystic ovaries alone is not enough to make the diagnosis of PCO. Where required, your doctor will exclude other, rare conditions that may present as PCOS.

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Why does it occur?

The exact cause of PCOS is not known. Most experts think that several factors, including genetics, play a role:

  • High levels of androgens.

Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne.

  • High levels of insulin.

Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal.

Many women with PCOS have insulin resistance, especially those who are overweight or obese, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes. 2,3,4.

The Symptoms

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The symptoms and signs are often different for each woman but the following characteristics are common2-5:

  • difficulty in becoming pregnant (because of lack of ovulation)
  • ultrasound appearance of ovarian cysts (polycystic ovaries)
  • periods that are absent (amenorrhoea) or infrequent (oligomenorrhoea)
  • excess male hormones, causing symptoms such as hairiness (hirsutism) or acne
  • weight gain and an increase in fat, especially around the abdomen or tummy area
  • prediabetes or diabetes
  • abnormal levels of blood fats (lipids, such as cholesterol and triglycerides).

Diagnosing PCOS

There is no specific test for PCOS but your doctor will consider your symptoms and usually complete a physical examination, blood tests and a transvaginal ultrasound3.

If you are trying to become pregnant, you may be referred to a gynaecologist or a fertility clinic5.

Treating PCOS

Medical treatments aim to manage and reduce the symptoms or consequences of having PCOS. Many women with PCOS successfully manage their symptoms and long-term health risks without medical intervention. They do this by eating a healthy diet, exercising regularly and maintaining a healthy lifestyle2,3,5.

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Improving Fertility

Some of the effective medications and methods available to help you become pregnant3,6:

HORMONAL THERAPIES

Oral contraceptive pill 

The oral contraceptive or birth control pill (‘the pill’) can help regulate menstrual periods and reduce menstrual cramps. It contains oestrogen and progesterone which take over the body’s normal hormonal control of the menstrual cycle and ovulation. It also helps to reduce the testosterone level, which reduces such symptoms as hairiness and acne.

Clomiphene citrate

Typically, a doctor will begin what is known as ‘ovulation induction’ (the use of medicine to promote ovulation) with clomiphene citrate. It works best for those women whose ovaries are capable of functioning but who need a little assistance.

 

Gonadotrophins

If clomiphene citrate does not work, the next stage of treatment is usually to start administering a category of medication called gonadotrophins – injectable forms of FSH and hCG.

Follicle stimulating hormone (FSH) stimulates development of the fluid-filled sacs containing the eggs.

Luteinising hormone (LH) is sometimes used together with FSH to stimulate the development of follicles.

Human chorionic gonadotrophin (hCG) causes the final maturation and release of an egg.

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LAPAROSCOPIC OVARIAN SURGERY

When hormonal treatments have not been successful, a laparoscopic ovarian diathermy operation may be recommended by your doctor. It is a small procedure, done under a general anaesthetic. A laparoscopic needle is inserted into the pelvic area to view the ovaries, fallopian tubes and uterus. A series of small drill-holes or burns is made into each ovary, releasing male hormones stored in the cysts and temporarily restoring ovulation.

ASSISTED REPRODUCTIVE TECHNOLOGY (ART)

Assisted reproductive technology (ART ) is a general term referring to methods used to unite sperm and eggs by artificial or partially artificial means. The most common ART procedures include:

  • in vitro fertilisation (IVF),
  • intrauterine insemination (IUI), and
  • intracytoplasmic sperm injection (ICSI).
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  1. Royal College of Obstetricians and Gynaecologists (RCOG). Long-term Consequences of Polycystic Ovary Syndrome. Green-top Guideline No. 33. 2014 https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_33.pdf downloaded 07/05/18
  2. Polycystic ovary syndrome (PCOS). FACT SHEET FROM THE OFFICE ON WOMEN’S HEALTH. https://www.womenshealth.gov/files/documents/pcos-factsheet.pdf downloaded 07/05/18
  3. Teede H et al. Assessment and management of polycystic ovary syndrome: summary of an evidence based guideline. MJA. 2011;195(6):S65-S112
  4. Jean Hailes for women’s health. http://jeanhailes.org.au/health-a-z/pcos accessed 1/6/2015 downloaded 07/05/18
  5. Royal College of Obstetricians and Gynaecologists (RCOG). Polycystic ovary syndrome: what it means for your long-term health. https://www.rcog.org.uk/en/patients/patient-leaflets/polycystic-ovary-syndrome-pcos-what-it-means-for-your-long-term-health downloaded 07/05/18
  6. American Society for Reproductive Medicine (ASRM). Medications for Inducing Ovulation. A Guide for Patients. ASRM 2006; http://www.asrm.org/topics/topics-index/ovulation-drugs downloaded 07/05/18

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