Polycystic ovaries

What is polycystic ovary syndrome?


Polycystic Ovary Syndrome (PCOS) is a condition that can affect a woman's menstrual cycle, her fertility, her hormones or aspects of her appearance.


It can also affect her long-term health.


This information is about potential long-term health effects and does not cover specific treatment options for PCOS.



What are polycystic ovaries?


Polycystic ovaries are slightly larger than normal ovaries and have twice the number of follicles in one ovary (small cysts).


Polycystic ovaries are very common, affecting around 20 in 100 women (20%).


Having polycystic ovaries does not mean you have polycystic ovary syndrome.


About 6 or 7 in 100 women with polycystic ovaries (6-7%) have polycystic ovary syndrome.



What are the symptoms of the syndrome?


Symptoms of the syndrome may include:


  • irregular period or no period
  • difficulty achieving pregnancy (reduced fertility)
  • an increased amount of facial or body hair compared to what is normal for you (hypertrichosis)
  • loss of hair from the head
  • increased weight, rapid weight gain, difficulty losing it
  • oily skin, acne
  • depression and mood swings.


Symptoms can vary from woman to woman.


Some women have mild symptoms, while others are more severely affected by a wider range of symptoms.


PCOS is a cause of fertility problems in women, but we won't cover them in this article.


You can get pregnant even if you don't have a period.


If you do not want to become pregnant, you should ask your doctor for advice about contraception.




What causes polycystic ovary syndrome?


The cause of the syndrome is not yet known.


PCOS sometimes occurs more often in certain families.


If any of your relatives (mother, aunt, sister) have been diagnosed with PCOS, you may have a higher chance of developing it as well.


The symptoms of the syndrome are related to disturbed hormone levels.


Hormones are chemical messengers that control body functions.


Testosterone is a hormone produced by the ovaries.


Women with PCOS have slightly higher than normal levels of testosterone and this is linked to many of the symptoms of the condition.


Insulin is a hormone that regulates the level of glucose (a type of sugar) in the blood.


If you have polycystic ovary syndrome, your body cannot respond to the hormone insulin (also known as insulin resistance), so your glucose level is higher.


To avoid rising glucose levels, your body produces more insulin.


Higher than normal insulin levels can lead to weight gain, irregular periods, infertility and higher testosterone levels.




How is PCOS diagnosed?


Women with PCOS often have different signs and symptoms and sometimes these come and go.


This can make diagnosing PCOS a very difficult situation.


Because of this, it may, in some ladies, delay the diagnosis.


  • irregular, infrequent periods or no periods
  • more facial and/or body hair and/or blood tests showing higher than normal levels of testosterone
  • an ultrasound showing polycystic ovaries.



What could PCOS mean for my long-term health?


You are at greater risk of developing any of the following long-term health problems if you have been diagnosed with PCOS:



Insulin Resistance and Diabetes Mellitus


If your blood glucose does not stay at normal levels, this can lead to diabetes.


For every ten women with PCOS, 1 in 2 (10-20%) will go on to develop diabetes mellitus at some point in their lifetime.


Without treatment, diabetes causes damage to your body's organs. If you have polycystic ovary syndrome, your risk of developing diabetes increases further if you:


  • You are over 40 years old
  • You have relatives suffering from diabetes
  • You developed diabetes during pregnancy (also known as gestational diabetes)
  • You are obese (body mass index or BMI over 30).


If you are diagnosed with diabetes, you will be given proper nutrition advice and depending on your sugar levels, you may need insulin tablets or injections.



Increased blood pressure


Women with PCOS tend to have high blood pressure, which is likely related to insulin resistance and being overweight, rather than PCOS per se.


High blood pressure can lead to heart problems and should therefore be treated.



Heart disease later in life


The development of heart disease is linked to health conditions such as diabetes and high blood pressure.


If you don't have these predisposing factors, then there's no clear evidence that just because you have PCOS, you're more likely to die from heart disease than women who don't have PCOS.


If you have a high cholesterol level you may be advised to take medicines (statins) to reduce the risk of heart problems.


If you are trying to get pregnant, then you should ask a specialist about taking statins.





With fewer periods (less than three a year), the endometrium (the inner lining of the uterus) can thicken and this can lead to endometrial cancer in a small number of women.


There are several ways to protect the lining of the uterus using the hormone progestogen.


Your doctor will explain your options.


These may include a five-day course of progesterone tablets every three or four months, taking the birth control pill or using the intrauterine contraceptive system (Mirena).


Your options will depend on whether you are trying to get pregnant.


PCOS does not increase the chance of breast, cervical, or ovarian cancer.



Depression and mood swings


Symptoms of the syndrome can affect how you see yourself and how you think others see you. They can lower your self-confidence.



Snoring and sleepiness


PCOS can lead to daytime fatigue or sleepiness. It is also associated with snoring.





What can I do to reduce my long-term health risks?


Maintaining a healthy lifestyle


The main ways to reduce your overall risk for potential health problems over time are as follows:


  • Have a healthy, balanced diet. This should include fruits and vegetables and whole foods (such as whole-grain bread, whole-grain cereals, brown rice, whole-grain pasta), lean meat, fish and chicken. You should cut down on sugar, salt, caffeine and alcohol (14 units is the recommended maximum units per week for women).
  • Eat meals regularly, including breakfast irregularly.
  • Exercise regularly (30 minutes, at least three times a week).



Your goal should be to maintain your weight at a level that is normal (BMI between 19 and 25).


BMI is the measurement of weight in relation to height.


If you are overweight, it would be helpful to lose weight and maintain your weight at this new level.


If you are obese (BMI greater than 30), discuss weight loss strategies, including weight loss medications, with your doctor.



Weight loss benefits include:


  • lower risk of insulin resistance and developing diabetes
  • lower risk of developing heart problems
  • lower risk of uterine cancer
  • more regular periods
  • increased chance of getting pregnant
  • reducing acne and reducing excessive hair growth over time
  • improved mood and self-esteem.



Regular (check-up) health checks


Once you are diagnosed with the syndrome, you should be monitored to check for any early signs of the aforementioned health disorders.


Women with PCOS over 40 should be recommended a blood sugar test once a year to check for signs of diabetes.


If you are obese (BMI over 30) or have a family history of diabetes, you may be advised to check your blood sugar earlier than age 40.


If you haven't had a period for a long time (more than 4 months), it's a good idea to see your gynecologist.


He may recommend further tests, including an ultrasound.


Talk to your doctor about how often you should check your blood pressure and when you should have blood tests for your cholesterol levels.




Is there a cure?


There is no cure for polycystic ovary syndrome.


Medical treatments are aimed at the best possible management to reduce the symptoms or consequences of the Syndrome.


Medication alone has not been shown to be better than healthy lifestyle changes (weight loss and exercise).


Many women with PCOS successfully manage their symptoms, as well as the long-term health risks, without medical intervention (medication).


They achieve this by eating a healthy diet, exercising regularly and generally maintaining a healthy lifestyle.



This information is based on the Royal College of Obstetricians and Gynecologists (RCOG) www.rcog.org.uk


These specific clinical guidelines aim to inform and improve the health care of our female patients.


Any comment, observation or question from you is welcome for the correct information of all our women.