Polycystic Ovarian Syndrome (PCOS)

PCOS is a complex hormonal condition that can be associated with multiple problems including irregular and abnormal menses, infertility, skin and hair problems. 

It is very important to distinguish  between polycystic ovarian syndrome and so called “polycystic ovaries”.  Polycystic ovaries, now known as multifollicular ovaries, refers to the presence of more than 12 or 15 follicle in each ovary without displaying the symptoms and signs of the full PCO syndrome.  It is very common to see multifollicular ovaries, especially in young women, without necessarily implicating the whole syndrome problem.

PCOS is relatively common.  It may affect 5 to 15% of women in the reproductive age group (between adolescence and menopause).  A high percentage of those cases unfortunately remain undiagnosed.  PCOS is one of the most common causes of infertility.  

We still do not fully understand the cause of PCOS, however, family history and genetics play a significant role in the development of the condition.  Hormones and lifestyle are also significant.  Usually insulin resistance is present in 20 to 25% in women with PCOS.  They usually have high levels of insulin that does not work efficiently in metabolising sugar.  They also have a high level of androgens which are usually referred to as male hormones.  This is a misconception as these hormones exist normally in the female at certain levels.  Making the diagnosis of PCOS can be confusing and challenging to patients and sometimes to medical practitioners.  The description of the ovaries on ultrasound can also be a little confusing.  In general, to be diagnosed with PCOS, women need to have two of the following criteria:

1. Abnormal menstruation which can be exhibited by irregular or absent periods.
2. Multifollicular appearing ovaries on ultrasound.  This does not mean the presence of cysts on the ovaries, rather it refers to the presence of multiple small follicles that can give the ovaries “a cystic appearance”.
3. Skin or hair problems which can be exhibited by acne or excessive facial or body hair.  This may also involve hair loss on the scalp when the levels of testosterone is high.  

Treatment of PCOS

It is very important to remember that PCOS is not a disease.  It is a syndrome which means it is combination of signs or symptoms.  Treatment of this syndrome is usually directed at the symptoms and the problems that may arise as a result of it.  The main lines of treatment would include:

1. Lifestyle modification and weight reduction.  Those alone may convert the cycles from irregular cycles that occur without ovulation, to ovulatory, regular menses that can help fertility and resolve other symptoms.
2. Medical treatment, for example, the contraceptive pill would be our first option to manage any irregular or absent menstrual cycles.  This option would be obviously useful if fertility is not desired.  Having regular cycles through the pill would stop the risk of the lining of the uterus becoming too thick.  The pill would also help reduce other undesirable symptoms such as hair and skin changes.
   Another medical treatment option would be Metformin, which would help, in particular, in patients with insulin resistance.  Metformin has also been found to help induce ovulation with or without other medications.  
3. Ovulation stimulation medication including Clomid.  This selective oestrogen receptor modulator can help induce ovulation and usually regular follow up of ovulation with ultrasound is necessary so that the couple can try timed intercourse.
4. Surgical options are reserved usually for patients who do not have success with less invasive approaches.
5. Assisted reproductive technologies including IVF or IUI.  This is usually the last resort and the success rate for women with PCOS is usually very high.  

Managing this condition may require a multidisciplinary team which we, here at Create Health, pride ourselves working with an amazing number of professionals including dietitian, psychologist, psychiatrist, endocrinologist and physiotherapist.  

If you have any questions or enquiries do not hesitate to contact us via e-mail or make an appointment to see one of our experienced specialists.

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