Polycystic ovary syndrome (PCOS) Tirohanga whānui ki te rarunga ruawahinetanga
Polycystic ovary syndrome (PCOS) is a common condition that affects the way your ovaries work. It can make it difficult to get pregnant and cause physical symptoms. There is no cure but there are treatments and lifestyle changes that can help.
Causes of PCOS
PCOS affects 5 to 10% of women. When you have PCOS you have:
- higher than usual levels of the male-type hormone testosterone — your ovaries usually make testosterone, but with PCOS they make more than usual
- bigger than normal ovaries
- irregular ovulation — the follicles (small fluid-filled sacs that surround the eggs) in your ovaries fail to release eggs (ovulate) on a regular cycle.
It is not fully understood what causes PCOS, but it seems to involve a mix of factors.
- Your genetics may be a factor. PCOS tends to run in families.
- Your body might make too much insulin — a hormone that controls the level of glucose (sugar) in your blood. If your body is not very sensitive to insulin (insulin resistant) it has to make much more to keep your blood glucose level normal. This makes your ovaries produce more male-type hormones. If you have PCOS, you may also have a higher risk of diabetes and heart disease later in life, especially if you are over a healthy weight.
- It might be related to being an unhealthy weight, which increases the amount of insulin your body produces. But slim women can also get PCOS.
Symptoms of PCOS
Signs and symptoms of PCOS usually start around the time of puberty through to your early 20s. The main symptoms include:
- irregular periods or no periods
- difficulty getting pregnant (infertility)
- acne
- excessive hair growth (hirsutism) — extra hair often grows on your top lip, chin, chest and in a line down from your tummy button (navel)
- thinning hair on your head and hair loss.
You might also have depression, anxiety or low self-esteem because of the physical symptoms of PCOS.
It is common for women with PCOS to be an unhealthy weight, but this is not caused by the PCOS.
Sometimes you can have PCOS with no symptoms.
Complications of PCOS
If you have PCOS you might have a higher risk of:
- developing type 2 diabetes
- high blood pressure
- heart attacks
- endometrial cancer.
Diagnosing PCOS
Your healthcare provider will ask you about your:
- symptoms
- periods
- medical history.
They may suggest some tests such as:
- blood tests to measure your hormone levels and check your lipids (cholesterol and other blood fats) and glucose levels
- an ultrasound examination of your ovaries to look for cysts.
To diagnose PCOS, your healthcare provider will need to find 2 out of 3 of the following:
- classic symptoms of PCOS (listed in Symptoms above)
- high levels of testosterone and other imbalances in your hormones shown on blood tests
- polycystic ovaries on an ultrasound scan.
Despite the name, you can also have PCOS without any cysts on your ovaries. You can also have lots of cysts on your ovaries without having PCOS.
Treating PCOS
Having PCOS means you may have a higher risk of being an unhealthy weight, mental health issues, diabetes and heart disease. So regular check-ups with your healthcare provider are important.
The aim of your treatment will depend on your situation. If you want to get pregnant, the treatment will focus on your fertility. If you do not, the treatment will focus on managing your symptoms. The treatment will need to be lifelong.
Lifestyle management
To improve your symptoms, you can try:
If you are an unhealthy weight, losing just 5 to 10% of your weight can improve irregular periods and infertility. It can also improve other problems caused by PCOS, such as insulin resistance.
The physical symptoms of PCOS may make you feel anxious or depressed or give you low self-esteem. If so, a combination of self-care and medical or psychological treatments may help. Talk to your healthcare provider about treatment options.
Excessive hair growth and acne
If you wish to control your facial and body hair, you can use cosmetic methods such as plucking, waxing or using depilatory creams that dissolve the hair. All these methods are temporary. Electrolysis and laser therapy are more permanent but can be expensive. You may need more than one treatment.
If these treatments do not work for you, you might need medication. There are several types of medication that can help both excessive hair growth and acne.
The combined oral contraceptive pill reduces androgen (male hormone) levels including testosterone and provides you with contraception.
Other medicines include anti-androgen drugs such as spironolactone or cyproterone acetate. They slow down hair growth and make the hair finer. They may take up to 6 months to work, and the effect gradually wears off if you stop taking them. They are not recommended if you are pregnant or planning to become pregnant.
Cyproterone acetate — My Medicines
Risk of other health conditions
PCOS can increase your risk of having insulin resistance. Insulin resistance means your cells do not react as well to insulin. Insulin is a hormone associated with controlling glucose in your system.
Insulin resistance means that your body needs to produce more insulin to have the same effect. This in turn can lead to a higher production of other hormones.
Some of the effects of insulin resistance are:
- weight gain and increased body fat
- risk of developing diabetes and heart disease.
These are sometimes called metabolic symptoms.
Lifestyle changes can help with losing weight.
But if losing weight is not enough to control your insulin levels, you may need to take a medication called metformin. Metformin has been used for many years to treat diabetes.
Fertility
Some but not all people with PCOS have difficulty with fertility (getting pregnant). It is still important to use contraception if you do not want to become pregnant.
If you have PCOS and are having difficulty getting pregnant, there are treatments that you can discuss with your healthcare provider. If you are more than a healthy weight, losing weight and keeping more physically active will also improve fertility.
There are also drugs that can stimulate ovulation (releasing an egg), such as clomifene. If you do not become pregnant using clomifene, your healthcare provider may also suggest you take metformin. It may help make your periods more regular and increase the chances clomifene will lead to ovulation.
If these treatments do not work, your healthcare provider may suggest other medications or refer you to a fertility specialist.
Useful resources
The AskPCOS website has more information about PCOS and provides a forum for discussion with other women, researchers and health professionals. AskPCOS is also available as an app.
Being a healthy weight is important for managing PCOS. Find out if you are a healthy weight using the body mass index (BMI) calculator.