Your guide to polycystic ovarian syndrome (PCOS)

Polycystic ovarian syndrome, also known as polycystic ovary syndrome or PCOS, is a condition that can have an impact on how a woman’s ovaries work. The main effects are irregular ovulation and periods, higher levels of androgen ('male' hormones), and enlarged ovaries.

What are the ovaries?

The ovaries are two small organs, about the size and shape of an almond. There is one on either side of the womb (uterus), and they form part of the female reproductive system. There are two main functions of the ovaries:

• One ovary releases an egg around every 28 days as part of the menstrual cycle.
• The ovaries also produce and release the sex hormones oestrogen and progesterone. These hormones play a vital role in reproduction.

What is polycystic ovarian syndrome?

Polycystic ovary syndrome is a common condition that affects how a woman’s ovaries work. In a healthy period (menstrual cycle), the ovaries release an egg each month. When you have polycystic ovarian syndrome, the egg may not develop or be released during ovulation as normal. This can lead to missed or irregular periods.

Polycystic ovary syndrome is characterised by three main features. These are: 

• Irregular periods 
• Hormone imbalance
• Polycystic ovaries, which is when the ovaries become enlarged due to the number of fluid-filled sacs or follicles that they contain

You do not need all three to be diagnosed with polycystic ovary syndrome. Normally, two will give an indication that you have polycystic ovarian syndrome. 

What causes polycystic ovarian syndrome?

The exact cause of polycystic ovarian syndrome is not known, although it is thought to relate to an imbalance in the hormones, such as insulin.

Insulin is produced by the pancreas to control the sugar levels in the body. The hormone helps to remove glucose from the blood, which is then broken down to produce energy.

With PCOS, the body becomes resistant to the action of insulin, so glucose isn’t removed from the blood. To compensate for this resistance, the body produces more insulin. This increase in the production and activity of insulin causes the body to increase the production of other hormones, such as testosterone.

An imbalance in hormones can lead to problems in the ovaries. Excess testosterone interferes with the development of the follicles (small sacs in the ovaries where the eggs develop). As a result, the egg may not develop or be released during ovulation as part of a healthy period. This can lead to missed or irregular periods.

PCOS has also been found to run in families. If your mother, sister or aunt has the condition then your risk of developing PCOS is thought to be higher.

What are the symptoms of polycystic ovarian syndrome?

PCOS symptoms include: 

• Irregular periods
• Weight gain 
• Excessive hair growth (hirsutism) on the face, chest and back 
• Thinning hair on the head
• Hair loss on the head
• Oily skin or acne
• Difficulty getting pregnant

These symptoms usually become apparent in your late teens or early 20s and not all women will have all of these symptoms, which can vary from mild to severe. However, PCOS can develop later in life, sometimes due to substantial weight gain.

What are the treatments for polycystic ovarian syndrome?

There is no cure for polycystic ovary syndrome. However, there are a range of PCOS treatments that can manage the symptoms. Medication will normally be the first course of action and several are available to treat the different symptoms.

For irregular or absent periods, your doctor may recommend the contraceptive pill. This can help to induce regular periods. A course of progestogen tablets may also be prescribed for the same reason.

There are several medicines available that can help with unwanted hair growth (hirsutism) and hair loss (alopecia). These include:

• Types of combined oral contraceptive tablets (such as co-cyprindiol, Dianette, Marvelon and Yasmin)
• Cyproterone acetate
• Spironolactone
• Flutamide
• Finasteride

These medications work by blocking the effects of testosterone and other ‘male hormones’. Some also work by suppressing the production of these hormones by the ovaries.

If you are overweight, losing excess weight will help reduce the risk of developing long-term health problems from PCOS. A healthy, balanced diet and regular exercise can help you to lose weight.

Although the majority of treatments for PCOS are non-surgical, there is a procedure called laparoscopic ovarian drilling (LOD) to help with fertility problems associated with the condition.

During the procedure, the ovaries are treated with a laser. This is to destroy the tissue that produces the androgens (male hormones), which raises the levels of follicle-stimulating hormones. This can restore the normal function of the ovaries by correcting the hormone imbalance.

Fertility and polycystic ovarian syndrome

Most women with polycystic ovary syndrome will be able to become pregnant with the right treatment. A short course of medication, for example clomifene, will be sufficient for the majority of women with PCOS to improve their fertility enough to conceive. (Clomifene helps with ovulation by encouraging the release of an egg from the ovaries.)

If this is not successful, injections or IVF treatments will be offered.

Polycystic ovary syndrome is associated with a higher risk of pregnancy complications, such as high blood pressure (hypertension), gestational diabetes and miscarriage. If you have been diagnosed with polycystic ovary syndrome, it is important to seek medical advice if you are planning on starting a family.

Get help for polycystic ovarian syndrome

A consultation with an experienced gynaecologist is often the quickest and simplest way to resolve your problem. They will be able to diagnose the cause of your pain and talk with you about the best treatment options for your specific situation. To arrange an initial consultation with one of our specialists, give us a call or use our online booking system.

To find out more about polycystic ovary syndrome, download our Women's Health Matters report.