Polycystic Ovary Syndrome (PCOS) is a common hormonal and metabolic condition that affects how a woman’s ovaries work. It is a “syndrome,” meaning it is a collection of symptoms rather than a single disease.
The three main features are:
- Irregular or absent periods (due to lack of ovulation).
- High levels of “male hormones” (androgens), which may cause excess facial/body hair or acne.
- Polycystic ovaries on ultrasound (ovaries containing many small, harmless follicles that have not matured properly).
PCOS is a lifelong condition, but its symptoms can be effectively managed. It is also a leading cause of fertility problems and can increase long-term health risks if unmanaged.
Common Symptoms
Symptoms vary greatly and often start in the late teens or early 20s.
- Menstrual: Irregular periods (cycles longer than 35 days), very heavy periods, or no periods at all.
- Skin & Hair:
- Excess facial or body hair (hirsutism).
- Severe acne or oily skin.
- Thinning of scalp hair (female pattern hair loss).
- Fertility: Difficulty getting pregnant due to irregular ovulation.
- Metabolic:
- Weight gain or difficulty losing weight.
- Darkening of skin in body folds (acanthosis nigricans), often linked to insulin resistance.
- Mental Health: Increased risk of low mood, anxiety, and poor self-esteem.
- Other: Sleep problems, fatigue.
Causes & Risk Factors
The exact cause is unknown, but it involves a combination of:
- Insulin Resistance: The body doesn’t use insulin effectively, leading to high insulin levels. This can increase androgen production and worsen ovulation problems.
- Hormonal Imbalance: High levels of luteinizing hormone (LH) and androgens (like testosterone).
- Genetics: PCOS often runs in families.
- Risk Factors: Family history of PCOS or type 2 diabetes.
Diagnosis
There is no single test. Diagnosis is based on the “Rotterdam Criteria” – you must have at least twoof the above mentioned three features, including irregular or absent ovulation, clinical or biochemical signs of high androgens and polycystic ovaries on ultrasound. Blood tests (hormones, glucose, cholesterol) and Pelvic ultrasound scan is performed for diagnosis.
Management & Treatment Options
Treatment focuses on managing your specific symptoms and reducing long-term health risks (like type 2 diabetes and heart disease).
Lifestyle Changes (First-Line Treatment for Everyone):
- Healthy Diet & Exercise: Even a 5-10% reduction in body weight can significantly improve symptoms, regulate cycles, and improve insulin sensitivity.
Medication for Symptoms:
- For Irregular Periods: The contraceptive pill or cyclical progestogen tablets to regulate cycles and protect the womb lining.
- For Fertility: Medications like Clomiphene or Letrozole to induce ovulation.
- For Insulin Resistance: Metformin can help improve insulin sensitivity, regulate cycles, and aid weight management.
- For Excess Hair & Acne: The contraceptive pill, anti-androgen medications (e.g., spironolactone), or skin treatments.
Managing Long-Term Health:
- Regular checks of blood pressure, blood sugar (glucose), and cholesterol.
- Mental Health Support: Access to counselling or support groups is important.
Possible Long-Term Health Considerations
With good management, risks are significantly reduced. Unmanaged PCOS can increase the risk of:
- Type 2 Diabetes & Insulin Resistance.
- High Cholesterol & Cardiovascular Disease.
- Endometrial Hyperplasia (thickening of the womb lining due to infrequent periods).
- Depression and Anxiety.
- Sleep Apnoea.
Frequently Asked Questions (FAQ)
Q: Does PCOS mean I have cysts on my ovaries?
A: The “cysts” are actually immature follicles. They are harmless and not the same as ovarian cysts that need removal. Many women with PCOS have normal-looking ovaries on scan.
Q: Will I be able to have children?
A: Yes. PCOS is a common cause of ovulation problems, but not infertility. Most women with PCOS can conceive, often with the help of lifestyle changes and ovulation-inducing medications. A reproductive specialist can help.
Q: Is there a cure for PCOS?
A: There is no cure, but symptoms can be very effectively managed. It is a lifelong condition that requires long-term health strategies.
Q: Does PCOS mean I will definitely get diabetes?
A: No, but your risk is higher. Regular exercise, a healthy diet, maintaining a healthy weight, and monitoring with your doctor greatly reduce this risk.
Q: Is the weight gain my fault?
A: No. Weight gain and difficulty losing weight are core symptoms of the hormonal and metabolic imbalance in PCOS. It is not a lack of willpower. Focus on sustainable health changes, not just the scale.
eGynaecologist Advice
- You should seek gynaecological consultation if you have irregular periods, concerns about excess hair or acne, or are having difficulty conceiving. Early diagnosis and management are key to preventing complications.
- You must adopt sustainable lifestyle changes including a balanced diet and regular physical activity are the most important treatments for PCOS, regardless of your weight or fertility goals.
You should have regular annual health check-ups with your gynaecologist to monitor blood sugar, cholesterol, and blood pressure to protect your long-term health.
