Polycystic ovarian syndrome or PCOS as it’s commonly called is something I see very frequently at my Endocrine clinic. It’s one of the commonest causes of difficulty getting pregnant. The other symptoms that are associated with it can also be upsetting.

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How do you know if you have PCOS?

Women that have PCOS often have excessive hair in areas that they find really embarrassing, for instance the chin, upper lip, and side-burn areas but also elsewhere on the body. The medical term for this is hirsuitism. They can spend a huge amount of time and money on hair removal. To make matters worse at the same time some women with PCOS notice that the hair on their head is thinning over the temples, commonly known as “male pattern baldness”. They may also have problems with acne.

They may find that their periods are much less frequent than they should be as their ovaries are not regularly releasing eggs.

Most, but not all girls and women with PCOS have significant problems with their weight.

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If an ultrasound scan in performed to look at the ovaries lots of cysts are seen, hence the name – polycystic ovarian syndrome. They are not really cysts, however, they’re actually little egg sacs from which the egg has not been released and in themselves don’t cause problems.

If you attend the doctor with these symptoms, you’ll find there’s no blood test that will give you a diagnosis of PCOS. Diagnosis is made by having a combination of the symptoms described and blood tests with the typical hormone abnormalities. Your doctor may want to do some blood tests to rule out other rare conditions that can cause similar symptoms. They may arrange a scan, but that’s not always necessary if everything is in keeping with PCOS and nothing else shows up.

Why do some girls and women develop PCOS?

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PCOS runs in families. Women with PCOS will often have an affected sister or mother. Women with a increased genetic risk of PCOS often begin to show signs of it at times when the body is more insulin resistant. For example if they gain weight, or during puberty when all children are naturally a bit more insulin resistant.

We don’t know exactly why PCOS occurs but as mentioned above, it is strongly associated with being resistant to insulin, meaning the body doesn’t respond as well to the hormone insulin. The main job of insulin is to control blood sugar levels in the body so conditions such as Pre-diabetes and Type 2 diabetes are much commoner in women with PCOS than they are in women of the same weight without it. We’ve also recently become more aware that a condition called sleep apnoea is strongly connected with PCOS. It causes poor sleep which can also lead to worsening insulin resistance.

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So why is insulin resistance such an issue? If you have insulin resistance your body needs to produce higher levels of insulin in an attempt to control your sugar levels. But sugar control is only one of the things that insulin does. There is also a second insulin system that isn’t affected by being insulin resistant which has an effect on other hormones.

The high levels of insulin produced may be enough to overcome insulin resistance and keep blood sugar controlled but they are super potent for this second system and this is what cause a lot of the symptoms of PCOS. Insulin acts on the ovaries and adrenal glands to cause increased production the male hormones which cause hirsuitism, acne and male pattern baldness. It acts on the ovary to stops monthly egg-containing follicles fully developing which then stops ovulation, resulting in absence or reduced frequency of periods.

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The mainstay of management of PCOS is improving lifestyle in order to lose weight. Women who lose weight, even 5% of their body weight can have substantial improvements in both their blood tests and their symptoms. This amount of weight loss is often enough to regulate the menstrual cycle and increase chance of pregnancy.

There is a ongoing debate in scientific circles as to whether PCOS makes it harder for a woman to lose weight. There are a number of reasons it may do. We know that some people are genetically more likely to be overweight and it may be this. There may be psychological factors relating to PCOS eg. depression and stress. Poor sleep quality may have an impact on both appetite and weight.

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What is less certain is if insulin resistance itself has an impact on ability to lose weight. It looks unlikely from studies but not enough research has been done specifically on PCOS to say this is definitely the case. The same applies to having a “fast” or “slow” metabolism. We know that your metabolic rate (or the speed you burn calories) is mainly influenced by your lean body weight ie. muscles, bones, organs etc but not fat.

At present there is not great evidence that one particular diet is better than any other, and again it seems to boil down to what fits with your life and is easiest for you can stick to.

Other treatment

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Although a healthy lifestyle is by far the most important aspect of PCOS management there are a number of medications used to help with symptoms. The decision about what medication is appropriate for an individual will depend on what symptoms are having the greatest impact. It will also depend on whether they are wanting a pregnancy or not.

Metformin is a tablet used to reduce insulin resistance and improve blood sugar levels in people with Type 2 diabetes. In PCOS it has been shown to help regulate periods which can be useful if you are thinking of trying for a baby.

If you have PCOS and are having problems with getting pregnant despite taking Metformin you may need referred on to a fertility specialist. They will also emphasize the importance of healthy eating, physical activity, good sleep habits to maximise fertility. There are other more specialist treatments that can be offered to help with ovulation and fertility.

Studies in people with prediabetes have also shown that Metformin reduces the development of Type 2 diabetes. There are not many studies looking specifically at PCOS but logic would dictate that it would also reduce prediabetes and Type 2 diabetes in this group. Metformin is sometimes used for this reason.

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If you are not planning a pregnancy the contraceptive pill can be used to regulate periods and to keep the womb healthy by causing a regular bleed. It can also help to reduce the high levels of male hormone and over time can have some impact on hair growth and acne. If the contraceptive pill is not suitable, treatment with hormone tablets every few months can cause a bleed and is another option for keeping the womb healthy.

Laser treatment is thought to be the most effective way of treating facial hair. It works best on people with paler skin and dark hair. In some parts of the country it is available on the NHS for women with a diagnosis of PCOS.

Acne symptoms can be helped by the same treatments that would be used in people who don’t have PCOS and can be discussed with your family doctor.

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Women and girls with PCOS should be checked for prediabetes and type 2 diabetes at the time of diagnosis and also periodically thereafter. They should also have their cholesterol and blood pressure checked. As they are increased risk of sleep apnoea, depression and eating disorders they should be asked about symptoms of these as well.

If you think you may have PCOS go and have a chat with your doctor.


©AYOSC 2019

    2 replies to "Polycystic Ovarian Syndrome"

    • clutter savannah

      Hey! Do you use Twitter? I’d like to follow you if that
      would be ok. I’m undoubtedly enjoying your blog
      and look forward to new posts.

      • isabelhowat

        Hi, thanks, we’re not great on twitter but you can follow us on Instagram or Facebook at Ayearofsmallchanges

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