Overview
In a usual monthly cycle one egg ripens in an ovary and is released. In PCOS that release happens irregularly or not at all, the small immature follicles stay on the ovary, and the body makes more androgens, the male-type hormones every woman makes in small amounts.
It is one of the commonest hormone conditions in women of childbearing age. The name is misleading: the polycystic ovaries seen on a scan are not cysts that need removing, and a woman can have PCOS without them. It affects periods, skin and hair, fertility, and, over the longer term, the risk of diabetes and heart disease.
Symptoms
Symptoms usually start in the teens or early twenties and vary a great deal from one woman to another.
- Periods that are irregular, far apart, very light or absent
- Coarse hair growing on the face, chest, tummy or back
- Acne, and skin that is oilier than before
- Thinning of the hair on the scalp
- Difficulty becoming pregnant
- Weight gain, and difficulty losing weight
- Dark, velvety patches of skin on the neck, armpits or groin
- Low mood, anxiety or distress about appearance
When to see a doctor
See a doctor in the next few days if periods have stopped or come less often than every two months, if hair growth or acne is troubling, if a year of trying for a baby has not worked, or if the symptoms are affecting your mood, your work or your relationships.
Causes
The exact cause is not known. What is understood is the pattern: the ovaries make more androgens than usual, and the signals that would normally ripen and release one egg each month do not work properly.
, the hormone that moves sugar out of the blood, is closely involved. In many women with PCOS the body responds poorly to insulin and makes more of it, and high insulin levels push the ovaries to make still more androgens. PCOS often runs in families, and a family history of type 2 diabetes is common.
Risk factors
- A mother, sister or aunt with PCOS or with irregular periods
- A family history of type 2 diabetes
- Being overweight, or gaining weight quickly
- Little physical activity
- , whether or not weight is a problem
Complications
When periods are very infrequent the lining of the womb is not shed regularly and can thicken, which over years raises the risk of cancer of the womb lining. This is one reason doctors try to bring on a bleed several times a year.
PCOS also carries a higher long term risk of type 2 diabetes, raised , high , fatty liver and heart disease, and of diabetes and high blood pressure during pregnancy. Anxiety, depression and eating difficulties are common and deserve treatment in their own right.
Prevention
PCOS itself cannot be prevented, but its effects can be reduced and most of its complications can be pushed away.
- Being physically active on most days
- A diet built on vegetables, pulses, whole grains and fruit, with fewer sugary drinks, sweets and fried snacks
- Losing even a small amount of extra weight, which often restores more regular periods
- Having blood sugar, and checked as the doctor advises
- Not smoking or chewing tobacco
- Getting help early for low mood or anxiety
Diagnosis
There is no single test. PCOS is diagnosed when at least two of three things are present: periods that are irregular or absent, raised androgens either seen as extra hair and acne or measured in the blood, and many small follicles in the ovaries on an scan.
Blood tests also rule out other causes of the same symptoms, such as thyroid problems or a raised prolactin level. Because ovaries normally look multi-follicular in the first years after periods begin, an ultrasound is usually not used to make the diagnosis in adolescents. Blood sugar, and are checked because of the long term risks.
Treatment
Treatment is aimed at whatever is troubling the woman most, and changes as her plans change.
- Diet, activity and weight management, which help every part of the condition
- Hormonal contraception, to give regular bleeds and protect the womb lining, and to help acne and hair growth
- Medicines that block the effect of androgens, for unwanted hair and acne
- Medicines that improve the body's response to
- Tablets or injections that bring on ovulation, when a pregnancy is wanted
- A small keyhole operation on the ovaries, or assisted conception such as IVF, if simpler fertility treatments do not work
- Support for mood, anxiety and eating difficulties
There is no cure, and treatment is chosen for this stage of life rather than for ever. Reviews every year or so keep track of periods, weight, blood sugar and .
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“PCOS means I will never be able to have children.”What is true?
Fact
PCOS is a common cause of difficulty conceiving, not a sentence of infertility. Many women conceive on their own, and for others there are treatments that bring on ovulation, along with fertility procedures where those are needed.
Myth“Only overweight women get PCOS.”What is true?
Fact
Weight gain is one common feature, and losing extra weight helps, but PCOS is identified from irregular periods, raised male-type hormones and the appearance of the ovaries, not from body weight. Slim women get it too.
Myth“The cysts have to be removed by an operation.”What is true?
Fact
The so-called cysts are small immature follicles sitting in the ovary, not the kind of cyst that is cut out. Treatment is with lifestyle changes and medicines. Surgery on the ovaries is used only occasionally, as one option for fertility when medicines have not worked.
Myth“Periods will settle by themselves after marriage or after a baby.”What is true?
Fact
PCOS does not go away because of marriage or childbirth. It is a long term condition, and the pattern of symptoms can change over the years. Periods that stay irregular still need attention, because the womb lining needs to be shed regularly.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Is PCOD different from PCOS?
In everyday use in India the two words are used for the same thing. Doctors generally use PCOS, polycystic ovary syndrome, because it is a syndrome of hormone changes affecting the whole body rather than a disease of the ovaries alone. If a report says PCOD, ask which of the diagnostic features were actually present.
My scan says polycystic ovaries. Does that mean I have PCOS?
Not by itself. The appearance on a scan is only one of the three features, and it is common in young women who do not have the condition. A diagnosis needs at least two of the three: irregular or absent periods, signs or blood tests showing raised androgens, and the ovary appearance.
Will I have to take medicines for the rest of my life?
Not necessarily. Treatment follows what you need at the time: hormonal contraception while regular periods and clearer skin matter most, ovulation treatment when you want to conceive, and lifestyle measures throughout. Medicines are reviewed as your needs change.
Does PCOS end at menopause?
Periods stop at menopause, so the period-related problems end, and troublesome hair growth often eases. The metabolic side does not simply disappear, so blood sugar, blood pressure and cholesterol are still worth checking as the years go on.
