Polycystic ovary syndrome (PCOS)
What is PCOS?
Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman’s ovaries work.
The three main features of PCOS are:
irregular periods – which means your ovaries don't regularly release eggs (ovulation)
excess androgen – high levels of "male hormones" in your body, which may cause physical signs such as acne and excess facial or body hair (see signs and symptoms below)
polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (follicles) which surround the eggs (it's important to note that, despite the name, if you have PCOS you don't actually have cysts)
What causes PCOS?
Resistance to insulin
The exact cause of PCOS is unknown, but it often runs in families. It's related to abnormal hormone levels in the body, including high levels of insulin.
Insulin is a hormone that controls sugar levels in the body. Many women with PCOS are resistant to the action of insulin in their body and produce higher levels of insulin to overcome this.
This contributes to the increased production and activity of hormones such as testosterone. Being overweight or obese also increases the amount of insulin your body produces.
Many women with PCOS are found to have an imbalance in certain hormones, including:
raised levels of testosterone – a hormone often thought of as a male hormone, although all women produce small amounts of it.
raised levels of luteinising hormone (LH) – this stimulates ovulation, but may have an abnormal effect on the ovaries if levels are too high
low levels of sex hormone-binding globulin (SHBG) – a protein in the blood, which binds to testosterone and reduces the effect of testosterone.
raised levels of prolactin (only in some women with PCOS) – hormone that stimulates the breast glands to produce milk in pregnancy
The exact reason why these hormonal changes occur isn't known. It's been suggested that the problem may start in the ovary itself, in other glands that produce these hormones, or in the part of the brain that controls their production. The changes may also be caused by the resistance to insulin.
PCOS sometimes runs in families. If any relatives, such as your mother, sister or aunt, have PCOS, then the risk of you developing it is often increased.
This suggests there may be a genetic link to PCOS, although specific genes associated with the condition haven't yet been identified.
Do I have PCOS?
A diagnosis of PCOS can usually be made if other rare causes of the same symptoms have been ruled out and you meet at least two of the following three criteria:
you have irregular periods or infrequent periods – this indicates that your ovaries don't regularly release eggs (ovulate)
blood tests showing you have high levels of testosterone (or sometimes just the signs of excess male hormones, even if the blood test is normal)
scans showing you have polycystic ovaries
As only two of these need to be present to diagnose PCOS, you won't necessarily need to have an ultrasound scan before the condition can be confirmed.
What are the treatment options?
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.
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.
You can find out whether you're a healthy weight by calculating your body mass index (BMI), which is a measurement of your weight in relation to your height. A normal BMI is 18.5-24.9.
You can lose weight by exercising regularly and having a healthy, balanced diet. Your diet should include plenty of fruit and vegetables, (at least five portions a day), whole foods (such as wholemeal bread, wholegrain cereals and brown rice), lean meats, fish and chicken. Your GP may be able to refer you to a dietitian if you need specific dietary advice.
A number of medications are available to treat different symptoms associated with PCOS. These are described below.
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.
With treatment, most women with PCOS are able to get pregnant. We work alongside several IVF treatment units and we will more than happy to refer you for further information.
Unwanted hair growth and hair loss
Medications to control excessive hair growth (hirsutism) and hair loss (alopecia) include:
particular types of combined oral contraceptive tablets (such as co-cyprindiol, Dianette, Marvelon and Yasmin)
These medications work by blocking the effects of "male hormones", such as testosterone, and some also suppress production of these hormones by the ovaries.
A cream called eflornithine can also be used to slow down the growth of unwanted facial hair. This cream doesn't remove hair or cure unwanted facial hair, so you may wish to use it alongside a hair-removal product. Improvement may be seen four to eight weeks after treatment with this medication. However, eflornithine cream isn't always available on the NHS, because some local NHS authorities have decided it's not effective enough to justify NHS prescription.
If you have unwanted hair growth, you may also want to remove the excess hair (by methods such as plucking, shaving, threading, creams or laser removal). Laser removal of facial hair may be available on the NHS in some parts of the UK.
A minor surgical procedure called laparoscopic ovarian drilling (LOD) may be a treatment option for fertility problems associated with PCOS.
Under general anaesthetic, a small cut is made in your lower abdomen (tummy) and pass a long, thin camera called a laparoscope through into your abdomen. The ovaries will then be surgically treated using heat or a laser to destroy the tissue that's producing androgens (male hormones).
LOD has been found to lower levels of testosterone and luteinising hormone (LH) and raise levels of follicle-stimulating hormone (FSH). This corrects your hormone imbalance and can restore the normal function of your ovaries.