Polycystic Ovary Syndrome (PCOS), What is the treatment?

Polycystic Ovary Syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, affecting about10% of women in this age group.

Why does it occur?

It is not known why some women develop the syndrome although it is likely to be a genetic disorder. The word ‘polycystic’ means many cysts and women with this condition have several cysts in their ovaries. Women with this condition have an imbalance of the female hormones that prevents their ovaries form releasing an egg every month and the many unreleased eggs in the ovaries result in the characteristic polycystic appearance of the ovaries.

Since both fertility and a normal menstrual cycle rely on a regular release of an egg each month from the ovary, these women have difficulty in conception and low, irregular or absent periods.

Many women with PCOS also tend to produce too much male hormone (which normally all women produce in small quantities) which results in male pattern hair growth, for example on the chin, chest inner thighs etc., and the formation of acne.

These women tend to gain weight quite rapidly and the obesity makes the hormonal imbalance worse hence resulting in a ‘chicken and egg’ situation.

What are the symptoms and signs of PCOS?

• Infrequent or absent periods
• Infertility and Miscarriage
• Acne
• Excess body hair
• Scalp hair loss
• Weight gain and obesity
• High blood pressure
• Elevated insulin levels and diabetes
• Slightly enlarged ovaries containing at least ten cysts 2-8mm in diameter

How is it diagnosed?

The doctor may suspect that polycystic ovarian syndrome is the cause from the symptoms listed above. Hormonal blood tests and a pelvic ultrasound scan are used to confirm the diagnosis.

What is the treatment?

Although PCOS is not completely reversible, there are a number of treatments that can reduce or minimise bothersome symptoms. Most women with PCOS are able to lead a normal life without significant complications if they seek timely and appropriate treatment.

Lifestyle measures: There is some evidence to show that reduction of excess weight can improve most of the problems related to polycystic ovarian syndrome by helping to restore the normal hormone balance, since fat plays a part in the production of certain hormones.

The treatment varies depending on which particular aspect the woman finds most troublesome.

• Irregular periods: If the main concern of the woman is the symptom of irregular periods, then the usual treatment is the oral contraceptive pill which will almost always restore regular periods. This treatment is obviously not suitable for women trying to conceive.
• Infertility: The irregular and infrequent ovulation caused by PCOS can make it difficult to conceive. Ovulation can be induced artificially using medications. The most commonly used drug is clomiphene (Clomid) which is taken in tablet form for 5 days. If the tablets fail, hormone injections can be used to stimulate the ovaries. Careful supervision by a specialist is necessary as there is a danger that the ovaries become overstimulated, leading to multiple pregnancies or the potentially life threatening ovarian hyperstimulation syndrome (OHSS). In selected cases where the women are unresponsive to medical treatment, surgery in the form of laparoscopic ovarian drilling can be used to diathermise part of the ovary, thereby correcting hormonal imbalance and allowing ovulation to occur.
• Excessive hair growth: Local techniques such as depilatory creams, shaving, waxing, bleaching, plucking and electrolysis may prove useful but need to be repeated. Suppression of male hormone production with tablets such as the oral contraceptive pill or an anti-male hormone drug such as Cyproterone acetate may reduce excessive hair growth if used for at least 9 months. Laser hair removal is the best available long-term method and may be performed if the other modalities do not help.
• Obesity: A change in lifestyle, paying particular attention to diet and exercise can help weight loss. Studies have shown that the many symptoms including irregular menstruations, risk of early death and debilitating complications can be significantly reduced if certain lifestyle changes are undertaken, including a controlled diet, vigorous exercise and weight reduction.

Other medications used to treat PCOS

Metformin and other insulin sensitising drugs – Metformin improves the effectiveness of insulin produced by the body. It is used to treat the insulin abnormalities associated with PCOS in selected patients. This medication can decrease the ovary’s production of androgens and restore the body’s normal hormone balance resulting in improvement of some signs and symptoms of PCOS.

Complications of PCOS

Insulin Resistance Syndrome

Women with PCOS are unusually resistant to Insulin, a hormone essential in metabolising the carbohydrates and maintaining blood sugar levels. Because of this they are at an increased risk of developing type 2 diabetes, heart attack and stroke at a much younger age than other women.

Diabetes

More than 50% of women with PCOS will have diabetes or pre-diabetes before the age of 40.

 Heart Disease

Women with PCOS have heart disease at an early age; in some studies 40% have calcification in their coronary arteries before age 45 (compared to 20% of women without PCOS). They have also been found to have a 50% increase in coronary events (heart attacks) compared to controls.

 High Blood Pressure

Women with PCOS are at a greater risk of high blood pressure particularly after the age of forty.

 Cholesterol 

LDL (bad) cholesterol levels are higher and HDL (good) cholesterol levels are lower in women with PCOS compared with others.

Cancer

Women with PCOS are at a higher risk of endometrial (uterine) cancer if left untreated.