WHAT IS PCOS?
Polycystic Ovarian Syndrome (PCOS) is a hormone or endocrine syndrome (group of clinical symptoms) first described by doctors in the 1930s. In PCOS, characteristically there is an excess of androgens (male hormones) and lack of regular ovulation (release of an egg from the ovary). It is sometimes also referred to as “Stein Leventhal Syndrome”.
PCOS (with clinical symptoms) affects between 5-10% of all women of childbearing age. However around 20-25% of premenopausal women have polycystic ovaries, generally with no symptoms, and therefore do not have the ‘syndrome’.
WHAT CAUSES PCOS?
The exact cause is unknown but there appears to be an hereditary and lifestyle component, e.g. sisters of PCOS sufferers have up to a 50% chance of having the disorder, and 70% of women with PCOS are overweight and not physically active.
The ovary produces excessive androgens (eg testosterone), which may be caused by the body not producing and/or processing the hormone insulin normally. Women with PCOS have a greater risk of developing diabetes and so we test regularly to exclude a diagnosis of diabetes.
The ‘cysts’ seen in the ovary in PCOS are primordial follicles or developing follicles that have ‘stalled’ in their development, giving a ‘pearl necklace’ appearance on pelvic ultrasound. In a normal ovary only one egg matures and is released (ovulation) each menstrual cycle.
WHAT ARE THE SYMPTOMS OF PCOS?
The following is a list of common signs and symptoms:
- Menstrual abnormalities – some women have normal regular periods whereas most will have some changes to their cycle. Sometimes bleeding is heavy (especially when there is a long time between bleeds), but it can also be lighter (when only a small portion of the endometrium is shed). The periods may become irregular or may stop altogether. In the teenage years this may be normal and can delay diagnosis of PCOS.
- Hirsutism - this is an excess of hair on the face and body due to increased androgens. The hair can increase in the sideburn area, chin, and upper lip, around nipples, lower abdomen, chest and thighs.
- Acne - can increase on face and body with the increase in androgens.
- Weight problems or obesity - two thirds of PCOS sufferers are affected. The weight gain is usually in the abdominal region giving a ‘pear’ shape. This shape carries a higher risk of cardiovascular disease including high blood pressure and heart disease. The weight gain is associated with the body not processing insulin normally. Insulin resistance (which is why we use Metformin to treat the condition in ART – Assisted Reproductive Therapy) is caused by weight gain – not the converse. The remainder of PCOS sufferers have normal weight or are underweight.
- Reduced fertility or infertility - this is related to the lack of egg release (ovulation) and can be further affected by a person being overweight.
- Lipid abnormalities - with the increase in androgens, menstrual problems and changes in insulin, there is an increased risk of lipid abnormalities, including high cholesterol, low HDL & high LDL.
- Low self-esteem - a sense of one’s body image may be affected by the symptoms of hirsutism, acne, hair loss, obesity and fertility problems. Other psychological reactions may occur relating to issues of femininity and sexuality and can contribute to depression, social isolation and other mood changes.
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