Michael Ah-Moye FRCOG,
CEO and Consultant Gynaecologist
What are polycystic ovaries?
The term Polycystic ovaries was coined in the 1930’s because it was thought that the ovaries contained many cysts, which was incorrect as the “cysts” are in fact just follicles. A follicle is where an egg develops. Polycystic ovaries are usually larger in size and contain more follicles than normal.
What is polycystic ovary syndrome ( PCOS )
It is important to know that having polycystic ovaries does not necessarily mean that the woman has Polycystic Ovary syndrome. Some women have polycystic ovaries without any symptoms. Only women manifesting symptoms are classified as having the syndrome. Studies show that 20 – 25% of all women have polycystic ovaries, but less than 10% will have the syndrome.
Polycystic ovary syndrome (known as PCOS) is, therefore, a common hormone disorder. It can cause a woman’s menstrual cycle to be longer than normal, be irregular and infrequent, and in severe forms, there may be no periods at all. PCOS can affect a woman’s ability to conceive and may affect her appearance with excess body and facial hair, acne and oily skin, and a tendency to be overweight.
What causes PCOS?
There is no known cause for PCOS and why some women develop it while others don’t. However, we do know that it often runs in the family, so there may be a genetic link to the condition.
What are the symptoms of PCOS
- Irregular periods where there are longer gaps in between periods or no periods at all
- Increase in facial and body hair known as hirsutism
- Loss of hair on the head
- Oily skin and acne
- Problem with fertility
Most of the symptoms of PCOS are due to the abnormal hormone levels associated with the condition and can vary tremendously from woman to woman. The hormones that are abnormal, are raised levels of the male hormone testosterone and also insulin which is a hormone linked to diabetes.
Women trying to fall pregnant may also face difficulties, due to ovulatory problems associated with PCOS. There also appears to be an increased risk of miscarriages.
Mood swings and depression
Women with PCOS are more likely to experience higher levels of depression and low self-esteem, caused both by the hormonal imbalances of the condition or by the symptoms it presents. If you are experiencing mood swings, do get help from your doctor for both your PCOS and your depression, even if it means a referral to a mental health specialist.
As already mentioned some women with polycystic ovaries do not have the syndrome and therefore do not have any symptoms. Many are diagnosed when they seek help for their infertility. Others have symptoms but are unaware of what causes them. Symptoms to look out for: irregular, infrequent periods and an increase in facial or body hair.
The best investigations to diagnose polycystic ovaries are ultrasound scan of the ovaries and hormone tests to check the levels of Anti-Mullerian Hormone (AMH) and testosterone.
What are the long-term consequences of PCOS
Irregular periods can increase the risk of uterine cancer, acne can cause scarring, and weight can become harder to manage. Getting diagnosed and treated sooner rather than later is the best way to lower the risk of these problems.
Insulin resistance and diabetes
In PCOS the body responds less well to insulin which leads to a higher level of insulin and increased glucose level. Raised insulin may lead to irregular periods, weight gain, increased testosterone and fertility problems. It is estimated that 10-20% of women with PCOS go on to develop diabetes in later life. Furthermore, women with PCOS have an increased risk of diabetes if they are over 40 yrs old, have a family history of diabetes, have developed gestational diabetes in previous pregnancies and those who are obese.
A very small number of PCOS women who have significantly fewer periods per year than normal are at risk of developing endometrial cancer due to the womb lining remaining thicker. There are means of reducing the risk which involve hormones and depends whether the woman is trying to conceive or not.
PCOS women are more prone to raised blood pressure which may be linked to obesity and insulin resistance.
Snoring and drowsiness
There appears to a link between PCOS and snoring leading to tiredness and drowsiness.
What can be done to reduce the long-term consequences of PCOS?
Diet and Weight loss
A healthy lifestyle is important to help reduce the symptoms of PCOS. First of all a healthy balanced diet is strongly advised. This should include plenty of fruits and vegetables and whole food e.g. wholemeal bread, brown rice and whole grain cereals, lean meat, fish and chicken. Consume less carbohydrates and salt, avoid alcohol and exercise regularly.
If you are overweight it is advisable to lose weight. The benefits of losing weight are:
- Lower risk of developing diabetes and insulin resistance
- Lower risk of heart problems
- Lower risk of cancer of the womb
- Improving your fertility and the chance of pregnancy
- Improve regularity of your periods
- Improve skin condition with less acne and hirsutism
- Less depression and mood swings
It is important to note that losing a small amount of weight can make a significant difference to the symptoms of PCOS and at the same time make you healthier.
Regular health checks
Make sure you have your blood pressure and blood sugar checked by your GP regularly, at least once a year especially if you are overweight and have a family history of diabetes.
How to get pregnant with PCOS?
Most women with the milder form of PCOS do conceive naturally, though in general, it takes them longer to do so than average. On the other hand, women with the moderate to severe form of PCOS will have more difficulty conceiving naturally and often require help from fertility specialists. They have what is termed “ovulatory disorders.”
For women with ovulatory disorders, the first line treatment is trying fertility
tablets such as clomifene citrate which stimulates ovulation although the tablets themselves can reduce conception as they adversely affect the womb lining (endometrium) where embryos implant. This is why there is no benefit in taking fertility tablets if a woman is already ovulating on her own.
An alternative is to use fertility injections which are more powerful and works differently to the tablets in that they do not affect the womb lining. There is, however, a higher risk of multiple births and requires ultrasound monitoring to reduce the risk.
Another option is In-Vitro Fertilisation (IVF) should the above be unsuccessful. Whereas women with PCOS have a problem conceiving naturally, their chance of being successful through IVF is the same as other women without PCOS.
It is pertinent to note that because women with PCOS have more follicles than normal, there is a tendency to produce more eggs during IVF leading to a condition known as Ovarian Hyperstimulation Syndrome (OHSS).
Our fertility experts at Herts & Essex Fertility Centre have devised a protocol to treat PCOS patients with a special trigger to ripen the eggs. This is designed to reduce many times the risk of OHSS in patients with too many eggs, as opposed to the standard trigger which itself initiates the whole process of OHSS in those particular women.
Finally, is there a cure for PCOS?
Unfortunately, there is no cure for PCOS.
Medical treatments are aimed to manage and reduce the symptoms or consequences of having PCOS. Medication alone has not been shown to be any better than healthy lifestyle changes (weight loss and exercise). Many women with PCOS successfully manage their symptoms and long-term health risks without medical intervention. They do this by eating a healthy diet, exercising regularly and maintaining a healthy lifestyle.