Polycystic ovary syndrome (PCOS)

Also known as polycystic ovarian syndrome (PCOS)

PCOS is a hormonal condition in which your ovaries become larger and develop cysts (small sacs filled with fluid).

Key points

  1. PCOS is the most common hormonal condition for women of childbearing age.
  2. Symptoms range from mild to severe. They can include obesity, irregular or heavy periods, acne and too much hair growth.
  3. The cause is not yet known but it often runs in families.
  4. If you have PCOS, you are at greater risk of developing type 2 diabetes, high blood pressure, depression, mood swings and infertility.
  5. There is no cure for PCOS, but lifestyle changes make a difference and there are also treatments available.
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What is PCOS?

Women of childbearing age generally produce an egg from each ovary every month. Women with PCOS produce too much testosterone and/or too much insulin, which stop the ovaries from producing and releasing eggs.

These eggs do not mature properly and can stay in your ovaries rather than being released each month. They build up in your ovaries and are known as cysts.

Women may have polycystic ovaries (many cysts in your ovaries) but may not have symptoms of PCOS.

PCOS is called a syndrome because it is a complex condition.

Who gets PCOS?

PCOS can begin at puberty or even in early to mid-20s. It is the most common hormonal condition affecting women of childbearing age.

PCOS affects about 5–10 out of 100 women of childbearing age. Many women with PCOS don't know they have it.

What causes PCOS?

The cause of PCOS is not yet known but it often runs in families. If any of your relatives (mother, aunts, sisters) are affected with PCOS, your risk of developing it may be increased.

The symptoms are related to increased hormone levels, mainly testosterone and insulin.

  • Testosterone is a hormone produced in small amounts by the ovaries in all women. Women with PCOS have slightly higher than normal levels of testosterone and this is associated with many of the symptoms of the condition.
  • Insulin is a hormone that controls the level of glucose (a type of sugar) in your blood. If you have PCOS, your body may not respond to insulin (this is known as insulin resistance), so the level of glucose is higher. To try to prevent the glucose levels becoming higher, your body produces even more insulin. High levels of insulin can lead to weight gain, irregular periods, fertility problems and higher levels of testosterone.

What are the symptoms of PCOS?

The symptoms vary from woman to woman. Some women have very few mild symptoms, while others are affected more severely by a wider range of symptoms.

Common symptoms of PCOS
  • oily skin, acne
  • excessive hair growth on your face, chest or abdomen (hirsuitism)
  • irregular or absent periods
  • hair loss or thinning of hair on your head (in a classic 'male baldness' pattern)
  • being overweight, experiencing a rapid increase in weight or having difficulty losing weight.

In addition, women with PCOS may also have symptoms of PCOS complications (see complications below):

  • depression and mood problems
  • high blood pressure
  • infertility and problems getting pregnant
  • symptoms of diabetes, such as thirst, going to the toilet more than normal, skin infections or vaginal thrush (candidiasis).
  • sleep apnoea.

How is PCOS diagnosed?

There is no easy test for PCOS, so your doctor will need to assess your symptoms, medical history and physical appearance.

If your doctor suspects you have PCOS, they will send you for tests to confirm it and rule out other medical conditions. These tests may include:

  • an ultrasound scan to give a view of your ovaries
  • blood tests to check your levels of male hormones, insulin, glucose, cholesterol or luteinising hormone (which stimulates ovulation).

About 20% of women (pre-menopause) are shown to have polycystic ovaries on ultrasound yet may have no symptoms of PCOS itself.

How is PCOS treated?

PCOS is treatable, but not curable. The key is learning what you can do to help yourself. Exercise and weight loss (if overweight as most people with PCOS are) are the best treatments for managing PCOS. 

Exercise and weight loss

If you are overweight, weight loss and maintaining this loss can help relieve PCOS-related symptoms and lead to more regular periods, less acne, a decrease in excess hair growth and improved mood and self-esteem. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, help your hormones reach normal levels and increase your chance of becoming pregnant. Learn more about healthy weight loss.

Medications

There are a number of medications used to manage the different symptoms of PCOS, including for acne, excess hair growth, problems with your periods and fertility issues. Some medicines may help more than one symptom.

Progestogen – you may be prescribed progestogen (a synthetic version of the female hormone progesterone) so you have regular periods. An example of progestogen is norethisterone (also called Primolut N).

Contraceptive pill – some low-dose contraceptive pills contain oestrogen and a small amount of the anti-androgen (a substance that blocks the effects of male hormones) cyproterone acetate. This is very effective in keeping excess hair growth under control and improving acne.

Cyproterone acetate is also available by itself and your doctor may suggest you try this or another anti-androgen, spironolactone, which works in a similar way. Sometimes excessive hair growth is best managed with both medical treatment and electrolysis or laser therapy. Your doctor can advise what’s best for you.

Isotretinoin is used for severe acne that hasn’t been helped by other treatments. It works by reducing the amount of oil the skin produces and shrinking the oil glands in your skin. It is usually prescribed by a specialist doctor as it has numerous side effects. It should not be used in pregnancy or if you might become pregnant as there is a high risk of permanent damage to the unborn baby. Read more about isotretinoin and acne treatments.  

Metformin helps your body make better use of the insulin it produces. It can help with weight loss, blood pressure and can often restore your menstrual cycle, as well as helping control excess body hair caused by high testosterone levels.  

All these medicines may take some time to work. Also, you will need to manage any existing hair growth manually by bleaching, waxing or electrolysis, as the medicines do not do this.

Fertility treatment can include the use of drugs such as clomiphene citrate (which stimulates the ovary to grow follicles so that an egg is released mid-cycle) or injections of synthetic hormones similar to the naturally produced hormones.

Surgery

As a treatment for infertility, your doctor may suggest surgery called laparoscopic ovarian drilling, which uses either a hot needle or laser to cauterise the ovary in several places. This procedure can stimulate ovulation and increase the chances of conceiving. However, surgery is generally considered a last option because scar tissue can form on your ovaries as a result, which may in fact further reduce your ability to get pregnant in the future.

What are the complications of PCOS?

PCOS can increase your chances of developing health problems later in life, so you need to have regular medical check-ups. Even though some PCOS symptoms may lessen after menopause, this is likely to be the time many of the long-term associated conditions appear.

Type 2 diabetes (and insulin resistance) 
The difficulty most women with PCOS have in processing insulin tends to get worse with age. By the time of menopause, about 50% of women with PCOS are diagnosed with type 2 diabetes. Because of this, it is important to follow a healthy diet and maintain an exercise programme long before menopause. Read more about prediabetes and diabetes

High blood pressure 
Women with PCOS tend to have high blood pressure, which can lead to heart problems and should be treated. Ask your doctor at what age you should start having cardiovascular risk assessments and getting your blood pressure checked regularly.

Depression and mood swings
The symptoms of PCOS may affect how you see yourself and how you think others see you. It can lower your self-esteem. Read about depression.

Snoring and daytime drowsiness
PCOS can lead to fatigue or sleepiness during the day. It is also associated with snoring.

Endometrial cancer
Because women with PCOS do not ovulate often, they have infrequent periods, which results in a build-up of the lining of the uterus (endometrium). This may increase the risk of the uterine lining producing abnormal cells that can turn into cancer, although this is not known for certain.

What can I do to improve my PCOS symptoms?

Making a few lifestyle changes can help reduce your PCOS symptoms and the risk of long-term complications.

Lose weight if you are overweight

If you are overweight, weight loss and maintaining this loss can help relieve PCOS-related symptoms and lead to more regular periods, less acne, a decrease in excess hair growth and improved mood and self-esteem. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, help your hormones reach normal levels and increase your chance of becoming pregnant. Learn more about healthy weight loss.

Get regular health checks

Getting regular health checks such as blood sugar testing and blood pressure testing can reduce your risk of heart disease. Read more about heart risk assessment.

Is there a cure for PCOS?

There is no cure for PCOS. Medical treatments aim to manage and reduce the symptoms or consequences of having PCOS. Medication alone has not been shown to be any better than healthy lifestyle changes (weight loss and exercise). Many women with PCOS successfully manage their symptoms and long-term health risks without medical intervention.

Learn more

Polycystic ovary syndrome – what it means for your long-term health Royal College of Obstetricians and Gynaecologists
Ask PCOS Monash University, Australia

References

  1. Understanding polycystic ovary syndrome BPAC, 2008
  2. Long-term consequences of polycystic ovary syndrome Royal College of Obstetricians and Gynaecologists, 2014  
Credits: Health Navigator Editorial Team.