Polycystic ovary syndrome

Polycystic Ovarian Syndrome (PCOS), is a condition where your hormones are out of balance. It is a very common problem for women of reproductive age, affecting between 8 and 13% of women and can affect them in different ways.

You may have been told you have PCOS because you are experiencing issues with any of the symptoms below:

  • Facial hair or excess body hair

  • Hair falling out or male pattern baldness

  • Weight issues

  • Insulin resistance

  • Problems conceiving

  • Irregular or absent periods

  • Heavy periods

  • Severe acne

PCOS simply describes a set of symptoms.  To be diagnosed with PCOS you need to have at least two out of three of:

  1. Polycystic ovaries on ultrasound (more than 20 follicles per ovary on ultrasound)

  2. Excess hair, acne or high testosterone in the blood

  3. Infrequent periods

80% of the time PCOS is due to high insulin which causes the follicles in the ovaries to make too much testosterone which interferes ovulation.  This means women with PCOS don’t usually ovulate every month so it can be hard to fall pregnant.  The excess testosterone made in the ovary can cause the facial and body hair growth, acne and sometimes, male pattern baldness.

PCOS may present with different symptoms in different ethnic groups. Ethnic differences appear to relate primarily to skin manifestations and metabolic features of PCOS.

Treatment for the majority of women with PCOS starts with diet and lifestyle.  Reducing insulin, and body weight can correct many of the issues for most women.  Stress plays a big factor too, as stress increases the hormones that can raise insulin, as well as increasing inflammation in the body.

Hormonal treatments such as the oral contraceptive pill can help with symptoms such as hair growth and acne. These can also help with heavy and irregular or infrequent periods. Medications such as Metformin, which increase insulin sensitivity may be appropriate however this has to be balanced against side effects and also for other anti-testosterone medications such as Spironolactone can help with excessive hair symptoms.

If you are trying to fall pregnant and lifestyle changes such as diet, exercise and stress reduction have not normalised your cycles, medication to help you ovulate such as Letrozole may be appropriate.