Polycystic Ovary Syndrome

Reema had been gaining excessive weight every month and her periods were getting irregular.

She blamed the periods for her weight gain and wanted to meet a gynaecologist. She was told she had PCOS and that just filled her with fear . Her friends had told her that PCOS was not curable and one may face a lot of difficulty having babies. She was very scared now and wanted to find out what to do.

What is polycystic ovary syndrome?

PCOS is a condition that can affect periods, fertility, hormones and aspects of one’s appearance. It can also affect long-term health. This is a very common condition affecting upto one in five women.

What are polycystic ovaries?

Polycystic ovaries are slightly larger than normal ovaries and having more than double the number of follicles (fluid-filled spaces in the ovary that release the eggs).

What are the symptoms of PCOS?

The symptoms of PCOS include:

• irregular periods or no periods at all

• an increase in facial or body hair (hirsutism)

• being overweight, experiencing a rapid increase in weight or having difficulty losing weight

• difficulty becoming pregnant (reduced fertility).

What causes PCOS?

The cause of PCOS is not yet known. The symptoms are related to abnormal hormone levels:

• Testosterone is a hormone that is produced in small amounts by the ovaries in all women. Women with PCOS have slightly higher than normal levels of testosterone and this is associated with many of the symptoms of the condition.

• Insulin is a hormone that controls the level of glucose (a type of sugar) in the blood. In PCOS, body may not respond to insulin (this is known as insulin resistance), so the level of glucose is higher. High levels of insulin can lead to weight gain, irregular periods, fertility problems and higher levels of testosterone.

How is PCOS diagnosed?

Having polycystic ovaries on ultrasound does not mean you have PCOS. A diagnosis is made when you have any two of the following:

• irregular, infrequent periods or no periods at all

• an increase in facial or body hair and/or blood tests that show higher testosterone levels than normal

• an ultrasound scan that shows polycystic ovaries.

What could PCOS mean for my long-term health?

If your blood glucose does not stay normal, this can lead to diabetes. One or two in every ten women with PCOS go on to develop diabetes. Women with PCOS tend to have high blood pressure, which is likely to be related to insulin resistance and to being overweight.

If you have fewer than three periods a year, the lining of the womb (endometrium) can thicken and this may lead to endometrial cancer in a small number of women. There are various ways to protect the lining of the womb using the hormone progestogen.

The symptoms of PCOS may affect how you see yourself and how you think others see you. It can lower your self-esteem. PCOS can lead to fatigue or sleepiness during the day. It is also associated with snoring.

What can I do to reduce long-term health risks?

Have a healthy lifestyle. The main ways to reduce your overall risk of long-term health problems are to

• eat a healthy balanced diet. This should include fruit and vegetables, whole-grain cereals, brown rice , lean meat, fish and chicken. You should cut down the amount of sugar, salt and caffeine that you eat and drink. You should not drink more alcohol than is recommended (14 units a week for women).

• eat meals regularly, especially breakfast

• take exercise regularly (30 minutes at least three times a week).

• You should aim to keep your weight to a level that is normal.

The benefits of losing weight include

• a lower risk of insulin resistance and developing diabetes

• a lower risk of heart problems

• a lower risk of cancer of the womb

• more regular periods

• an increased chance of becoming pregnant

• a reduction in acne and a decrease in excess hair growth over time

• improved mood and self-esteem.

You only have to lose a small amount of weight to make a difference to your symptoms and your health. There is no cure for PCOS. Medical treatments aim to manage and reduce the symptoms or consequences of having PCOS. 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.

Polycystic ovary syndrome (PCOS) can't be cured, but the symptoms can be managed.

Treatment options can vary because someone with PCOS may experience a range of symptoms, or just one. The main treatment options are discussed in more detail below.

• Lifestyle changes

• In overweight women, the symptoms and overall risk of developing long-term health problems from PCOS can be greatly improved by losing excess weight. Weight loss of just 5% can lead to a significant improvement in PCOS.

• Medications

• Irregular or absent periods

• The contraceptive pill may be recommended to induce regular periods, or periods may be induced using an intermittent course of progestogen tablets (which are usually given every three to four months, but can be given monthly).

• This will also reduce the long-term risk of developing cancer of the womb lining (endometrial cancer) associated with not having regular periods.

• Other hormonal methods of contraception, such as an intrauterine (IUS) system, will also reduce this risk by keeping the womb lining thin, but they may not cause periods.

• Fertility problems

• With treatment, most women with PCOS are able to get pregnant.

• The majority of women can be successfully treated with a short course of tablets taken at the beginning of each cycle for several cycles. If these aren't successful, you may be offered injections or IVF treatment. There's an increased risk of multiple pregnancy (rarely more than twins) with these treatments.

• A medication called clomifene is usually the first treatment recommended for women with PCOS who are trying to get pregnant. Clomifene encourages the monthly release of an egg from the ovaries (ovulation).

• An alternative to gonadotrophins is a surgical procedure called laparoscopic ovarian drilling. This treatment can be as effective as using gonadotrophins, but it doesn't increase your risk of multiple pregnancies.