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

What is it?

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

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
  • 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.

    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.

    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.

    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.

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

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

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