Polycystic Ovary Syndrome

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Women's Wellness
Polycystic Ovary Syndrome

Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic Ovary Syndrome, commonly known by its initials PCOS, is a condition that affects the functions of a woman’s ovaries. This includes irregular ovulation and the development of fluid-filled sacs, causing the enlargement of the ovaries. Many women with the condition will find themselves struggling to conceive. Women with PCOS have higher levels of male hormones present and are also less sensitive to the hormone insulin.

Although it is not known how many women suffer with PCOS, it is estimated that as many as one in ten women experience the condition. More than half will not demonstrate any PCOS symptoms.

Unfortunately women with PCOS are at an increased risk of developing serious health problems, such as high cholesterol and type 2 diabetes.

There is no cure for the condition, but there are a number of PCOS treatments which can help to ease symptoms, including medicines to help fertility problems, irregular periods and excessive hair growth, another common PCOS symptom. If fertility medication does not work, doctors may recommend a surgical procedure called laparoscopic ovarian drilling.

Lifestyle changes have also been shown to improve the symptoms of PCOS in some women. Eating a healthy balanced diet and losing weight if you are overweight or obese may help.

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What are the symptoms of Polycystic Ovary Syndrome (PCOS)?

There are a number of common PCOS symptoms. If you are experiencing some or all of these then you should speak to your doctor.

Period problems: Irregular or absent periods are a common sign of PCOS. This is caused by irregular ovulation or a failure to ovulate.
Weight gain: It is common for women with PCOS to be overweight or obese. This is because the condition makes it more difficult for the body to use insulin and when this hormone builds up in the bloodstream, it increases the production of male hormones called androgens. High androgen levels trigger weight gain, with this excess weight settling in the abdomen. The presence of abdominal fat is associated with an increased risk of heart disease, type 2 diabetes and other serious health conditions.
Excessive body hair: High levels of male hormones are also responsible for excessive hair growth (hirsutism). You may find that you have thick, dark hair present on your face, neck, stomach, lower back, chest, thighs or buttocks.
Hair loss: While PCOS can cause excessive hair growth on the body, it can also cause hair on the head to get thinner or fall out.
Acne: Acne and oily skin are most commonly caused by hormonal chances, including the changes caused by PCOS.
Difficulty conceiving: As PCOS can cause absent or irregular ovulation, this makes it far more difficult for a woman to conceive.

PCOS symptoms usually become apparent in your late teens or early 20s. You may not experience all the above symptoms and some women find they only experience problems with their periods and/or difficulty conceiving. All PCOS symptoms can vary from mild to severe.

What causes Polycystic Ovary Syndrome (PCOS)?

It is not known exactly what causes polycystic ovary syndrome, but there are several things which may have a part to play.

High levels of male hormones: If you have high levels of male hormones, called androgens, then this can prevent you from ovulating, leaving you with irregular or absent periods and fluid-filled sacs on the ovaries, making it difficult to conceive. Androgens are also responsible for hirsutism and acne, two common PCOS symptoms.
Insulin resistance: If your body doesn't process insulin correctly, this leads to high glucose levels in your blood, putting you at risk of weight gain and potentially developing type 2 diabetes. Elevated insulin levels also cause a rise in androgens.
Genetics: PCOS can run in families, so if your mum, sister, aunt or another close relative suffers with PCOS, then you are at a higher risk of the condition.
Low-grade inflammation: Women with PCOS tend to have chronic low-grade inflammation. Your doctor may want to carry out tests in order to identify the extent of the inflammation in the body.

How is it diagnosed?

If you are experiencing PCOS symptoms, you should make an appointment to see a doctor. They will ask you questions about your symptoms. Although you may find it embarrassing, it is important that you answer open and honestly. Rest assured that our expert consultants will treat you with the respect and dignity you deserve.

A physical exam will be carried out to check for external PCOS symptoms, such as excessive hair growth and acne. A sample of blood will be taken to test your hormone levels and glucose levels.

The doctor will want to carry out an transvaginal ultrasound scan to see whether there are any fluid-filled sacs present on your ovaries. An ultrasound probe will be inserted into the vagina and the images will appear on a screen to allow the doctor to see clearly what is going on inside your body. Although this may sound a little daunting, rest assured that the probe is lubricated and the scan itself does not hurt, although some women report feeling a mild discomfort. If you are concerned about this, speak to your doctor.

How is Polycystic Ovary Syndrome (PCOS) treated?

Although there is no cure for polycystic ovary syndrome, there are a number of PCOS treatments which will help to ease symptoms and improve your quality of life.

Lifestyle changes

If you are overweight or obese, the best thing you can do to manage the symptoms of PCOS is to lose weight. This will also lower the chances of you developing long-term health problems caused by PCOS.

The safest and most effective way to lose weight is through regular exercise and a healthy, well-balanced diet. Your PCOS diet should include at least five daily portions of fruit and vegetables, whole foods, such as brown rice and wholegrain cereals, fish, chicken and lean meats. Ideally, you should be doing at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, as well as strength training three times a week.

You should aim to get to a healthy BMI of 18.5 to 24.9.

Medication

There are a number of different types of medication available to treat the various symptoms of PCOS. Hormonal contraceptives, such as pills or an IUD, will help to regulate periods and treat acne and excess hair growth. Fertility drugs can induce ovulation if you have been trying to conceive.

Medicines which block the release of male hormones can be used to treat hirsutism and hair loss. A cream called eflornithine can be used to slow down the growth of unwanted facial hair, and you will be able to see the effects within four to eight weeks.

Other medicines include acne treatments, weight-loss medicine, such as orlistat, if you are overweight and statins if you have high cholesterol.

Surgery

Laparoscopic ovarian drilling (LOD) is a minor surgical procedure which can be used to treat fertility problems caused by PCOS if your body does not respond to medication.

You will be put under general anaesthetic, meaning you will not be able to feel any pain, and a Under general anaesthetic, your doctor will make a small incision in your lower abdomen and a long, thin surgical instrument called a laparoscope will be used to treat the ovaries by destroying the androgen-producing tissues. LOD effectively addresses the hormone imbalance and restores normal ovarian function.

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Frequently Asked Questions

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When should I see a doctor?

Although PCOS cannot be cured, the symptoms can be successfully managed. If you are experiencing symptoms of PCOS, such as excessive hair growth, acne, hair loss or irregular periods, you should see your doctor for further tests.

If you are trying to get pregnant but have not conceived after one year of trying, then you should go to the doctor. Tests will be carried out to find out what may be causing the infertility, including PCOS. Once the cause has been found, you can then be treated accordingly.

What can I do to manage symptoms of PCOS at home?

The best way to manage your PCOS symptoms at home is to follow a healthy diet plan, making sure you get enough fruit and vegetables, wholefoods, protein, fibre, iron and magnesium. A dietician will be able to put together a healthy eating plan for you to follow.

You should exercise regularly, aim to get between eight and ten hours of quality sleep a night and keep your stress levels in check. This will help to regulate cortisol to balance your hormones.

Does PCOS go away on its own?

There is currently no cure for PCOS and it does not go away on its own. Even after menopause, once a woman’s menstrual periods have stopped permanently, you will continue to have high levels of androgens and insulin in your body. This means that you are still at risk of complications from PCOS, such as developing type 2 diabetes or high cholesterol. If you are postmenopausal and experiencing PCOS symptoms, you should speak to your doctor.

How does PCOS affect your body?

PCOS can affect your body in a number of different ways. Not all women with PCOS will experience these.

Infertility: PCOS is one of the most common causes of female infertility as the condition causes delayed or absent ovulation. However this is treated with medication or occasionally surgery, and many women with PCOS go on to get pregnant.
Type 2 diabetes: Women with PCOS, particularly if they are overweight or obese, are at an increased risk of developing type 2 diabetes. People with PCOS often don’t process insulin properly, leading to elevated levels which may develop into diabetes.
Sleep apnoea: Women with PCOS who are also overweight or obese are at an increased risk of developing sleep apnoea, a condition that causes interrupted breathing during sleep.
Pregnancy complications: If you are able to get pregnant with PCOS, the condition puts you at a higher risk of pregnancy complications. These include gestational diabetes, pre-eclampsia, hypertension and miscarriage. The risks are higher if you are obese.
High blood pressure and high cholesterol: PCOS puts you at a heightened risk of high blood pressure and high cholesterol, which can cause stroke and heart disease. These are serious health conditions which can be fatal.
Endometrial cancer: Any woman who experiences absent or highly irregular periods (fewer than three to four menstrual bleeds a year) is at a higher risk of developing endometrial cancer (cancer of the womb lining). As irregular or absent periods are a common symptom of PCOS, then women with the condition should seek help to regulate their menstrual cycle, reducing their risk of cancer.

Can PCOS trigger acne?

Acne and oily skin are very common symptoms of polycystic ovary syndrome. Luckily there are a number of prescription medicines which can help to manage this particular PCOS symptom. Acne treatments include topical antibiotics, antibiotic tablets, the combined oral contraceptive pill, topical retinoids and azelaic acid. Your doctor will be able to recommend which treatment is best for you.

How does my diet impact PCOS symptoms?

As mentioned before, women with PCOS who are overweight or obese are at a heightened risk of PCOS complications, such as sleep apnoea and developing endometrial cancer. Weight loss can improve insulin sensitivity, cutting the risk of developing complications such as diabetes. Being overweight or obese can also trigger certain PCOS symptoms, for example irregular periods. So losing weight, by eating a healthy balanced diet, will both cut the risk of PCOS complications as well as improving symptoms.

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