Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS)

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Polycystic Ovary Syndrome (PCOS)

PCOS is a common condition that affects the way your ovaries work. It’s fairly common, with an estimated 1 in 5 UK women suffering from the condition.

The first signs of PCOS normally become apparent at puberty and can include unpleasant symptoms such as severe period pain, excess hair growth and irregular periods amongst others. There’s currently no cure for PCOS, but there are treatments available that can effectively manage symptoms.

The condition is classed as an endocrine and metabolic disorder, and has been found to run in families.

There are three criteria for PCOS, and to be diagnosed with the condition, you must present with at least two of them.

If your doctor suspects PCOS, they might refer you for blood tests and an ultrasound to check hormone levels and the appearance of your ovaries.

D4U Doctor

Dr. Daniel Cichi

GMC No. 6163403

Our Health Care Team

“Whilst PCOS isn’t a life-threatening condition, it can cause serious complications such as infertility, obesity, and an elevated risk of developing type 2 diabetes. Luckily, there are treatments available to manage symptoms. PCOS can also have a detrimental effect on a woman’s mental health due to the unpleasant symptoms it can cause.”

What is PCOS?

PCOS is an endocrine and metabolic disorder that affects a woman’s ovaries. Whilst it’s not life-threatening, the symptoms can cause great amounts of distress for sufferers, and it can have detrimental consequences on mental health and overall well being.

Symptoms often start around puberty but it can take several years for a woman to be diagnosed, with the symptoms sometimes being misinterpreted as other conditions. The condition can affect a woman’s periods, fertility, weight and body image as well as having psychological consequences.

PCOS is a surprisingly common condition; it’s thought to affect around 20% of women in the UK, though some might not show any symptoms.

What are the symptoms of PCOS?

Polycystic ovary syndrome does have several symptoms that many women with the condition experience before diagnosis. Some of the most common indicators that you might have PCOS include:

  • Irregular periods
  • No periods (amenorrhoea)
  • Excessive hair growth, often male-pattern (hirsutism)
  • Weight gain
  • Thinning hair
  • Hair loss on head
  • Oily skin
  • Acne
  • Fatigue
  • Headaches
  • Difficulty losing weight
  • Difficulty conceiving naturally (infertility)
  • Insulin resistance

None of the symptoms above are pleasant to experience, and whilst some women with PCOS experience most of the above, some women might only experience a few. However, if you find that you recognise several of the symptoms above, we recommend scheduling an appointment with your GP to investigate what’s causing them.

How is PCOS diagnosed?

PCOS is diagnosed by assessing whether you have 2 or more of the three diagnostic criteria. These three factors that help doctors to decide whether you have the condition are:

  • Having irregular/no periods or ovulation
  • Having excess androgens (male hormones) in your body
  • Having cysts (more like fluid-filled sacs) surrounding the eggs in your ovaries. This makes it difficult for the ovaries to release an egg each month (ovulate)
  • Because of these criteria, it’s entirely possible to have PCOS without actually having any cysts. As long as you present with irregular periods and excess male hormones, there’s a good chance you’ll be diagnosed with the condition. On the flip side, you can also have cysts on your ovaries without having PCOS. It can be confusing, which is why some healthcare professionals are calling for the name of the condition to be changed to something which is more representative of the diagnostic criteria.

    Your doctor may perform a physical examination to check for physical symptoms such as hirsutism as well as sending you for blood tests and potentially an ultrasound scan. Blood tests will check for elevated androgen and insulin levels whilst an ultrasound on your pelvis should show whether there are any cysts on your ovaries and whether they’re enlarged. These tests will help your GP determine whether or not you qualify for diagnosis. If it turns out that you do have PCOS, your doctor might want to refer you to a specialist, usually an endocrinologist or a gynaecologist depending on your symptoms.

    Can PCOS be cured?

    Unfortunately, there’s no cure for the condition at the moment. In fact, the cause of PCOS isn’t yet understood, meaning that researchers aren’t able to treat any underlying cause as they don’t know what it is. However, there are several effective treatments to manage your symptoms.

    Treatments for PCOS:

    Treatments are generally based on whatever symptoms you experience. You might only need one medication to sort your condition out, or you might need a combination of a few. It’s important to know that some of the medications listed for the symptoms of PCOS are used off-label and it’s up to each doctor whether or not they deem the treatment suitable for your condition. However, in many cases they’ve been proven to be effective.

    Abnormal periods:

    This can include symptoms such as irregular periods (not being able to tell when your cycle will start or stop each time), infrequent periods, severe period pain and no periods at all. This might be because your ovaries aren’t producing enough progesterone, but a blood test should be able to show this. Hormonal contraceptives are often prescribed to relieve these symptoms, often stimulating a regular period each month. It’s also worth noting that some hormonal contraceptives might stop your periods completely. Some women may need painkillers to cope with extreme period pain. In summary, the medicines available for these symptoms are:

    • Hormonal contraceptives
    • NSAIDs (non-steroidal anti-inflammatories)

    Hirsutism:

    Women with PCOS often find that they have male-pattern hair growth on their face, back, arms, neck and chest as well as other areas. This is down to the excess production of androgens (male hormones) that cause thick, dark hairs. Some contraceptive pills are prescribed to reduce the amount of androgens produced by your body, but there are also topical treatments such as eflornithine cream (Vaniqa) that achieve the same result. In summary, medicines for hirsutism can include:

    • Some contraceptive pills
    • Vaniqa (eflornithine) cream

    Weight gain:

    It’s a common myth that only overweight women are affected by PCOS. Whilst being overweight is more common in women with the condition, there are also women of a healthy weight who’ve also been diagnosed with it. PCOS can cause weight gain and make it harder to lose weight than women who don’t have the condition. This can lead to several problems associated with being overweight, as well as psychological issues and low self-esteem. Women with PCOS often need medical help to lose weight, and the effects can also help to relieve some of the symptoms of the condition. Some options that are available are:

    • Orlistat
    • Mysimba
    • Saxenda

    Whilst some of these medicines are available on the NHS, Saxenda can only be bought privately. It’s proven to be highly effective at reducing and controlling weight in patients with a BMI of over 35. If this applies to you and you choose to take Saxenda as your weight-loss treatment, complete our patient questionnaire on the product page and one of our doctors will review your request.

    Thinning hair/ hair loss on head

    The excess production of androgens can also cause male-pattern hair loss as well as hair growth. One way of combating this is to take medicines belonging to the antiandrogen family. Finasteride has been mentioned previously as a treatment for hirsutism, but due to its androgen-reducing properties, it can also slow down the thinning and loss of hair on the scalp. Another treatment that might be suitable for hair loss is Regaine for women.

    Infertility:

    This is one of the most common symptoms of PCOS and can also be one of the most difficult to deal with amongst women who want to conceive. Luckily, there are treatments available to help. Many women with PCOS find that the issue behind their infertility lies with not ovulating regularly. Luckily, most women with PCOS are able to get pregnant with treatment. Medicines to help with infertility include:

    • Clomifene
    • Tamoxifen
    • Metformin

    It’s also important to know that PCOS can also increase your risk of having a miscarriage, so speak to your GP about what you can do to reduce this risk. Although some women with PCOS do struggle with infertility, you should still use contraception if you don’t want to become pregnant.

    Insulin resistance:

    Whilst this is often a symptom that’s most associated with type 2 diabetes, women with PCOS also experience high levels of insulin in their blood, but don’t worry, this doesn’t mean you do have type 2 diabetes. Luckily, metformin is often prescribed off-label to control insulin levels which also has a knock-on effect by reducing other symptoms of the condition. As you might have already noticed, metformin is listed as a treatment for infertility above. In summary, the medicine for insulin resistance (off-label) is:

    • Metformin

    Depression/Anxiety:

    Because of the unpleasant symptoms of the condition as well as hormonal fluctuations, it’s common for sufferers to experience mental health problems. Medicines for this symptom include:

    • Antidepressants

    Counselling might also be an option either instead of or as well as medication. Talk to your doctor as soon as possible if you notice that you’re feeling depressed.

    Are there any long-term risks of having PCOS?

    Unfortunately, women with PCOS have an elevated risk of some conditions. With proper management and lifestyle changes, these risks can be decreased. Some of the conditions that you may be at risk of developing if you have PCOS are:

    • Type 2 diabetes
    • High cholesterol
    • Infertility
    • Obesity
    • Endometrial cancer (if you have fewer than 4 periods in 12 months)
    • Heart disease
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