PCOS or polycystic ovary syndrome is a common condition affecting the way that a woman’s ovaries work. It can cause increased hair growth on the face and body, irregular periods, and fertility problems.
The name can be a little confusing, as the condition is actually under-developed follicles (fluid filled sacs in which eggs develop), and not cysts as the name suggests. PCOS affects up to 5-10% of women in the UK, with the figure at 8-20% worldwide.
What happens with polycystic ovaries?
There are 3 main features of PCOS:
- Oligomenorrhea: This is when women have prolonged period of no menstruation for 36 days or more, and lack of ovulation.
- Increased male hormone: An increase in androgens in the body, which can be diagnosed through blood tests, or from clinical symptoms of acne and increased hair growth on the face and body.
- Polycystic ovaries: Appearance of multiple (more than 12 in each ovary), very small follicles in the ovaries which can be identified with an ultrasound scan.
What are the signs and symptoms of PCOS?
- Infertility is the most common symptom of PCOS.
- An irregular menstrual cycle.
- Increased hair growth on the face and body
- Weight gain
- Symptoms of metabolic syndrome can appear later. This includes possible type 2 diabetes, and cardiovascular disease.
- If the symptoms proceed for a long time, the condition can lead to endometrial cancer (cancer of the womb lining).
- Patients with PCOS are more likely to see their GP for anxiety and depression (usually caused through concerns with self-image and infertility).
Is PCOS hereditary?
PCOS does run in families, and there is theoretical evidence that it is genetic, but the condition is not purely hereditary. However, the genetic condition can also be influenced by environmental factors and lifestyle.
What are the treatment options?
As little is known about the cause, only the symptoms can be treated by the doctor. Changes to lifestyle and dietary improvements can have beneficial effects on the condition.
Certain treatments can be provided for the symptoms of the condition:
- Increased hair and acne: the oral contraceptive pill, and referral to a dermatologist. Anti-androgen drugs can also be prescribed.
- Oligomennorhea: the oral contraceptive pill is the first line of treatment. In patients who do not want to take the pill, cyclical progestogen drugs can be prescribed.
- Fertility treatment: The prominent reason that women see their consultant gynaecologist or obstetrician is for fertility treatment.
Possible fertility treatments for women with PCOS
70% of Women with PCOS have issues with fertility at some point in their life. Some of the treatment options that are available to them include:
- Ovulation induction with clomifene or letrozole tablets: This gives patients a 50-60% chance of live birth after 6 cycles. It requires ultrasound monitoring and carries a 5% multiple pregnancy risk.
- Gonadotrophin injection: This is given in cases resistant to ovulation tablets. Management of the treatment requires a high level of expertise, and there is a significantly increased risk of multiple pregnancy and hyperstimulation.
- Laparoscopic ovarian diathermy (Laparoscopic ovarian drilling): An operative procedure that can trigger ovulation in women. Less used due to risk of ovarian damage and peritoneal adhesions unless performed by a skilled specialist.
- The final option can be IVF treatment.