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Polycystic Ovarian Syndrome

Background:

Polycystic ovary syndrome (PCOS) affects up to 1 in every 10 women in the UK. (1) Over 50% of women do not have symptoms, and even when women do it can take years to diagnose and treat due to the missing gaps in knowledge.

Frustratingly, the name is misleading – as research advanced it’s now known the cysts that may be found are not cysts but follicles (eggs) and can be seen in non-PCOS women too. 

PCOS is a hormonal disorder, forming a collection of symptoms from having high levels of the male sex hormone testosterone (hyperandrogenism). Hopefully, this article will give you a foundation of what we know about PCOS so far, and how it should be treated.

What causes it?

Multiple systems (the brain, ovaries, adrenal glands) in the body are affected, but the origin is unknown and still being researched. What we do know is that high levels of testosterone can prevent ovulation (egg released from ovaries) during each cycle and the symptoms mentioned below. (2) It also appears that PCOS may be inherited, however, no specific genes have been found (3)

Who is more likely to get it?

PCOS is strongly associated with:

    • Family history – you have a 20-40% chance of having PCOS if your 1st-degree relatives do (3)
    • Obesity (4) – 30-80% of women may be obese (5) 
    • Early adrenarche – this involves the adrenal gland making hormones such as testosterone, responsible for pubic hair, oily skin and sweat gland activation.  It’s considered early if it happens before the age of 8 in girls.

 

How will I know I have PCOS?

There are many symptoms in PCOS, however, it is important to know that:

      1. You may not have any, have 1 or have all of them
      2. You may have some symptoms different to others with PCOS
      3. It may be masked if you take oral contraceptive medication from a young age 

 

The hormonal imbalance can lead to the following symptoms:

    • Irregular periods occur in 75% of patients (6)
    • Struggling to conceive 
    • Hirsutism – excessive thick hair growth in unexpected places e.g., face, chest, back etc. Present in approximately 60% of women (7)
    • Acne/oily skin – present in 15-25% of women (7)
    • Scalp hair loss – quite uncommon – can be as low as 5% (7)
    • Weight gain

 

How will the doctors know?

The doctors will usually run hormonal blood tests and you may need an ultrasound scan. The Rotterdam criteria is used to rule in when all other conditions present like PCOS have been ruled out. Diagnosis of PCOS is made when you have at least 2 of the following (1):

      1. Irregular periods
      2. High levels of testosterone in the blood OR symptoms pointing towards high levels 
      3. An ultrasound scan shows many cysts in the ovaries 

 

Can I still have kids?

Yes. Although PCOS is a common cause of reduced fertility in women of reproductive age, as eggs may not be able to be released from the ovaries – there are many treatments and natural ways to help support women to get pregnant – and many do successfully. (8)

Is there a cure?

Unfortunately, there is no cure and treatments are based on managing symptoms. 

The general treatments based on NHS guidelines:

    • Lose weight + Eat a healthy diet 
    • Start the contraceptive pill to regular periods
    • Fertility treatments – if can’t conceive naturally, such as follicle-stimulating drugs and IVF
    • Medication for unwanted hair growth e.g., combined pill or spironolactone

 

Telling a woman to lose weight can lead to patients feeling blame for having PCOS. Women with PCOS have it harder than other women when trying to lose weight due to the hormonal imbalance, and insulin resistance, therefore they need more tailored tools to help them.

It is important to have regular health checks and talk to your doctor or nutritionist before starting any medication.

References:

        1. NHS Choices. Polycystic ovary syndrome [Internet]. NHS. 2019. Available from: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
        2. Polycystic ovary syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice [Internet]. bestpractice.bmj.com. Available from: https://bestpractice.bmj.com/topics/en-gb/141?q=Polycystic%20ovary%20syndrome&c=recentlyviewed
        3.  ‌Kahsar-Miller MD, Nixon C, Boots LR, Go RC, Azziz R. Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS. Fertility and Sterility [Internet]. 2001 Jan 1 [cited 2020 Oct 17];75(1):53–8. Available from: https://pubmed.ncbi.nlm.nih.gov/11163816/
        4. Day F, Karaderi T, Jones MR, Meun C, He C, Drong A, et al. Large-scale genome-wide meta-analysis of polycystic ovary syndrome suggests shared genetic architecture for different diagnosis criteria. PLOS Genetics. 2019 Dec 5;15(12):e1008517.
        5. Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, et al. Assessment of Cardiovascular Risk and Prevention of Cardiovascular Disease in Women with the Polycystic Ovary Syndrome: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. The Journal of Clinical Endocrinology & Metabolism. 2010 May;95(5):2038–49.
        6. Harris HR, Titus LJ, Cramer DW, Terry KL. Long and irregular menstrual cycles, polycystic ovary syndrome, and ovarian cancer risk in a population-based case-control study. International Journal of Cancer [Internet]. 2016 Oct 6;140(2):285–91. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542050/
        7. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism [Internet]. 2006 Nov [cited 2019 Aug 16];91(11):4237–45. Available from: https://academic.oup.com/jcem/article/91/11/4237/2656314
        8. Dennett CC, Simon J. The Role of Polycystic Ovary Syndrome in Reproductive and Metabolic Health: Overview and Approaches for Treatment: TABLE 1. Diabetes Spectrum [Internet]. 2015 May;28(2):116–20. Available from: https://spectrum.diabetesjournals.org/content/28/2/116


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