Polycystic Ovary Syndrome (PCOS)

What is polycystic ovary syndrome?
Polycystic ovary syndrome is a condition where the normal function of the ovaries has changed. There are three characteristic features that help with the diagnosis of polycystic ovary syndrome. To be diagnosed with PCOS, you need to have 2 or more of the features. However, many women have signs of all three features because they tend to go hand in hand.

  • Ovaries have many (more than 12) tiny cysts: These cysts are small blister-like-lumps (about 5-8 mm) that form on the surface of the ovaries. Women produce an egg every month and these eggs, if not released, may be retained as small cysts. Polycystic means containing many cysts.
  • Hormonal imbalance: An important job of the ovaries is to make “female” hormones, such as oestrogen and progesterone. They also make very small amounts of the “male” hormone, testosterone. All of these hormones are secreted into the bloodstream and carried all around the body. When the level of testosterone in the blood goes over a certain level, it can cause some of the common symptoms of PCOS like acne and hair growth.Women who are overweight also tend to become less sensitive to normal levels of a hormone called insulin. So in order to have the same effect on the body, more insulin is pumped into the bloodstream. This process (known as insulin resistance) itself may lead to difficulty in losing weight. Luteinising hormone (LH) and follicle stimulating hormone (FSH) are two other hormones which may be altered in PCOS. LH:FSH ratio is often increased.
  • Failure to ovulate every month (an ovulation): When an egg is released from the ovary, this is called ovulation. Sometimes, too much testosterone can disturb the normal growth of the egg (and follicle) in the ovary. So if the egg doesn’t develop fully, it won’t be released. Normally, if an egg isn’t fertilised after it is released, it means the uterus needs to get rid of its lining – this is your period, which happens roughly two weeks after ovulation. If the egg isn’t released in the first place, then periods may become delayed, infrequent, irregular or sometimes even disappear.
How common is polycystic ovary syndrome? And who does it affect?
It is very common to have polycystic ovaries – about 1 in 4 women have got multiple cysts on their ovaries (ultrasound appearance of polycystic ovaries) but do not have signs of the other two features. Overall, about 7 in 100 women suffer with Polycystic Ovary Syndrome (PCOS).

What are the symptoms of polycystic ovary syndrome? (PCOS)?
Common symptoms seen in many patients with PCOS are excess unwanted hair (particularly on the face, chest and abdomen), thinning of hair on the scalp, acne and weight gain. Many women also have problems with irregular (or absent) periods and infertility as a result – although over 50% of women with PCOS achieve spontaneous pregnancy without any medical help. Symptoms can be graded from mild to severe depending on the impact they have on the patient. Some of these symptoms can be quite distressing and have a big impact on self-esteem – many women also suffer from depression as a result.

How is polycystic ovary syndrome diagnosed?
A diagnosis of PCOS is made if you display two or more of the features as described above. The clinical history of symptoms and findings from the examination can help to make a possible diagnosis. Some blood tests will need to be done to test the hormone levels in the blood, and an ultrasound scan of the ovaries can show whether there are many cysts.

Do the ovarian cysts always need removal?
Not all ovarian cysts need removal. Functional (follicular) cysts often will resolve spontaneously. Surgery may be needed if the cysts are persistent or if there are symptoms (see above). If there is a suspicion of cancer, urgent surgery is indicated to make a diagnosis and also as treatment.

What is the treatment for polycystic ovary syndrome?
There is no way of reversing the formation of cysts on the ovaries, but it is important that those women who have been diagnosed with PCOS get treatment to control their symptoms – particularly if the symptoms are severe and cause a lot of worry, or if infertility becomes an issue.

One possible cause of PCOS is being overweight or obese, and having PCOS can also cause weight gain. So losing weight, although it may be more difficult to achieve, is a good way of improving other symptoms and increasing the chance of re-starting regular ovulation. A diet with a low glycaemic index can also help with patients who have insulin resistance.

You can ask your GP or a dietician for help with planning healthy eating and exercise. Another positive effect of this lifestyle change can be to reduce the risk of diabetes, high blood pressure and heart disease in later life.

Unwanted hair growth can be treated with regular hair removal methods such as shaving or waxing. Excess hair growth is caused by increased levels of testosterone in the blood. There are some drugs which can help control testosterone levels or prevent its effects. One of these, cyproterone acetate, is combined with oestrogen to form one oral contraceptive pill called Dianette. There are other alternative combinations which you can ask your specialist about. Oral contraceptive pill prevent recruitment of eggs in ovaries and hence stop the condition from getting worse. Women who are not trying to get pregnant can control their PCOS by going on the pill.

These drugs are also effective as a treatment for acne, regulating periods and to prevent more cysts from forming (by preventing any eggs from starting development in the ovaries). It is important to have regular periods to reduce the risk of developing cancer later in life.

Though many women manage to get pregnant spontaneously without any medical help, some women may need help with ovulation induction drugs such as clomiphene citrate. Please ask your specialist who will advise you on how to take this drug and what monitoring is required.

Can nutrition help PCOS?
Our nutritional therapist, Laura Southern says “a healthy eating plan can help manage and alleviate some PCOS symptoms. The right diet will have a positive impact on blood sugar and insulin management, as well as helping with cell sensitivity and hormone balance.” The optimal diet for a PCOS sufferer should consist of the following:

Decrease or Eliminate:
  • Sugars: White refined sugar, artificial sweeteners etc
  • Natural sweet sugars: Honey, dates, agave, too much fruit
  • Carbohydrates: White bread, white rice, white pasta (be mindful of wholegrains, especially wheat)
Eat Plenty of:
  • ‘Good’ fats: Nuts, seeds, cold pressed oils, oily fish, avocado and coconut
  • Green leafy vegetables: Spinach, broccoli, kale, asparagus, rocket, broccoli, Brussel Sprouts etc.