What every woman should know about Polycystic Ovary Syndrome
Polycystic Ovary Syndrome, also known as PCOS, is a common hormone condition which affects about 1 in 5 women in the UK but do you know the signs and symptoms?
Polycystic Ovary Syndrome, also known as PCOS, is a common hormone condition which affects about 1 in 5 women in the UK (1).
PCOS affects a woman’s ovaries, the reproductive organs that are responsible for protecting all the eggs that a woman is born with, and for releasing them into the fallopian tube for fertilisation.Your ovaries are also responsible for producing oestrogen and progesterone, the hormones that regulate the menstrual cycle.
Normally, a woman’s ovaries produce an egg each month, but with polycystic ovaries, an imbalance in the reproductive hormones that govern ovulation, this process can be disrupted. During the monthly cycle FSH stimulates the ovary to produce a follicle – a sac to contain an egg, and then LH triggers the ovary to release a mature egg.
In a woman with PCOS, the ovaries and ovulation process are affected. Its three main features are:
- Irregular periods
- High levels of male hormones - androgens
- Cysts in the ovaries
In polycystic ovaries, several small, fluid-filled sacs grow inside of the ovaries. These small sacs contain a number of harmless follicles that are up to 8mm in size. Each one of the follicles contains an immature egg which never matures enough to activate ovulation. The absence of ovulation changes the levels of oestrogen, progesterone, FSH and LH, making them lower than usual, while male hormone levels are higher than usual.
What causes PCOS?
The exact cause of PCOS remains a mystery, however it often runs in families (2). It is also believed that an increase of male hormones prevents the ovaries from producing hormones and releasing eggs normally.
Factors which are thought to play a role in PCOS include:
- Inflammation – women with PCOS often have increased levels of inflammation in their bodies which has been linked to higher levels of androgens (3). Being overweight can also impact a woman’s inflammation levels.
- Insulin resistance – it has been identified that 70% of women with PCOS have insulin resistance which means their cells can’t use insulin properly (4). This means that more and more insulin is produced to try to move glucose from the blood into the body’s cells. This elevated insulin is thought to be one of that factors that causes polycystic ovaries to develop.
The symptoms of PCOS can vary from person to person, with many women having very few signs, which can lead to some being unaware that they have PCOS. A study found that up to 70% of women with PCOS haven’t been diagnosed (5).
If symptoms are visible, women usually start to notice them around their first period, whilst others may only uncover they have PCOS after they have gained a lot of weight or have had trouble trying to get pregnant.
Common symptoms include:
- Irregular periods or no periods at all
- Excessive hair growth – usually on the face, chest or back
- Weight gain
- Difficulty getting pregnant due to irregular ovulation or failure to ovulate
- Oily skin or acne
- Hair loss or thinning on the head
PCOS has also been found to increase a woman’s risk of developing health problems in later life, such as type 2 diabetes and high cholesterol levels.
How PCOS can affect your body
Higher levels of androgen can impact your overall health in a variety of ways:
As women with PCOS do not ovulate regularly or not at all, the eggs that are needed to become pregnant are not released making it difficult to become pregnant.
A study found that women who are obese with PCOS are 5 to 10 times more likely to develop sleep apnoea than those who don’t have PCOS (6). The condition causes repeated pauses in breathing during the night, which can affect sleep.
Due to the hormonal changes and the difficulties PCOS presents such as unwanted hair and infertility, women can experience high levels of depression and anxiety (7).
How is PCOS diagnosed?
Many women express that getting a diagnosis for PCOS can be a struggle as there is no single test to identify whether you have it.
Under the NHS guidelines, doctors should confirm that a woman has two or more of the following factors;
- high androgen levels
- irregular menstrual cycles
- cysts in the ovaries
Usually your doctor will send you to have an ultrasound scan and a blood test. The ultrasound scan uses sound waves to look for abnormal follicles and other problems with your ovaries and uterus.The blood test will check whether your male hormone levels are high than normal.
How is PCOS treated?
According to the NHS there is no cure for PCOS, yet the symptoms can be managed by making lifestyle changes or taking medication (8).
- Diet and lifestyle changes – treatment for PCOS often starts with making lifestyle changes such as weight loss, diet and exercise. Studies have found losing just 5 to 10 percent of your body weight can help regulate your menstrual cycle and improve PCOS symptoms (9, 10).
- Medications – several medications can assist in regulating the menstrual cycle and treat PCOS symptoms such as hair growth and acne. For example; Metformin can help to restore the menstrual cycle and Clomiphene, a fertility drug can help women with PCOS get pregnant.
- Surgery – if taking Clomiphene is not successful, a surgical procedure called laparoscopic ovarian drilling (LOD) can be performed. This involves using heat or a laser to destroy the tissue in the ovaries that is producing androgens.
If you are experiencing symptoms such as irregular periods, acne, excess hair or are having difficulty getting pregnant and want to check whether this could be due to polycystic ovary syndrome, a simple blood test is a good place to start. Our simple Polycystic Ovary Syndrome Check provides a comprehensive check of your hormones including key male hormones such as testosterone, which can be raised in women with PCOS.
Our Polycystic Ovary Syndrome Check Advanced also checks your cholesterol and diabetes status to assess whether you are at higher risk of conditions such as heart disease and diabetes.
- NHS (2019). Polycystic ovary syndrome. [online] nhs.uk. Available at: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/ [Accessed 23 Oct. 2019].
- Diamanti-Kandarakis, E., Kandarakis, H. and Legro, R. (2006). The Role of Genes and Environment in the Etiology of PCOS. Endocrine, 30(1), pp.19-26.
- González, F. (2012). Inflammation in Polycystic Ovary Syndrome: Underpinning of insulin resistance and ovarian dysfunction. Steroids, 77(4), pp.300-305.
- Marshall, J. and Dunaif, A. (2012). Should all women with PCOS be treated for insulin resistance?. Fertility and Sterility, 97(1), pp.18-22.
- March, W., Moore, V., Willson, K., Phillips, D., Norman, R. and Davies, M. (2009). The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction, 25(2), pp.544-551.
- Ehrmann, D. (2012). Metabolic dysfunction in PCOS: Relationship to obstructive sleep apnea. Steroids, 77(4), pp.290-294.
- Cooney, L. and Dokras, A. (2017). Depression and Anxiety in Polycystic Ovary Syndrome: Etiology and Treatment. Current Psychiatry Reports, 19(11).
- The American College of Obstetricians and Gynaecologists (2017). Polycystic Ovary Syndrome (PCOS) - ACOG. [online] Acog.org. Available at: https://www.acog.org/Patients/FAQs/Polycystic-Ovary-Syndrome-PCOS [Accessed 23 Oct. 2019].
- Teede, H., Deeks, A. and Moran, L. (2010). Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Medicine, 8(1).