# Polycystic Ovarian Syndrome (PCOS)



## Anthony Reid (Jan 1, 2002)

*Polycystic Ovarian Syndrome (PCOS)*

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries are not working correctly. The number of women affected by PCOS is not clear. In the UK, it is estimated that "approximately one in ten British women have PCOS to some degree, and of those referred for an ultrasound examination, about 25% are found to have polycystic ovaries."

*PCOS Diagnosis*

The exact cause of PCOS is not known. If a woman is diagnosed with PCOS, she will usually have two out of three of the following conditions: "High levels of the male hormone testosterone, which is produced by the ovaries, and/or signs of having high levels of testosterone, (such as excess body hair or thinning of the hair on your head) irregular or no ovulation, which usually means irregular or no periods, and many cysts on the ovaries which are called polycystic ovaries."

There is evidence indicating "that the risk factors in PCOS women are elevated at an earlier age than among women without PCOS and therefore the risks of developing atherosclerotic conditions, hypertension and myocardial infarction are greater."

*Symptoms of PCOS*

Women with PCOS may begin to become aware of problems when they are in their late teens or in their twenty's. Conditions can include: "absent, infrequent or irregular periods, infertility - you need to ovulate to become pregnant and you may not be ovulating regularly or at all, obesity or being overweight, especially with excess fat around your waist excess hair (hirsutism) on your face, around your nipples or on your lower tummy, thinning of your hair on the top of your head, and acne which lasts longer than your teenage years."

*Causes of PCOS*

Although, the exact cause of PCOS is not known, there are several indicators that appear to be significant. There may be a genetic predisposition as PCOS has occurred in some families. PCOS may be caused by higher than normal levels of certain hormones. "One of the hormones involved is insulin, which controls your blood sugar level. Many women with PCOS have insulin resistance. This means the level of insulin in the blood needs to be higher than normal to control your blood sugar level. The high level of insulin causes the ovaries to make too much testosterone, which results in the symptoms such as excess hair and acne."

*Treatment*

In obese women, weight loss can improve the symptoms of PCOS. However, because of the insulin resistance and excess testosterone, losing weight can be quite challenging for women with PCOS, they truly have a metabolic cause for their additional weight.

A decrease in weight will decrease the quantity of insulin that the body needs to produce. Insulin reduction will then decrease testosterone and may increase the prospect of ovulation. As a result, menstrual and fertility difficulties may improve. Irregular or missing periods can also be managed with hormone treatment. "The contraceptive pill or progestogen-only pill may be recommended to induce regular periods (and reduce the long-term risk of cancer of the endometrium in women with absent periods). If you are trying to conceive but not ovulating, your ovaries can be stimulated with a medicine called clomiphene. Other medicine or surgical treatments are also available to induce ovulation."

*Reducing the Risk*

Lifestyle changes may help reduce PCOS symptoms. Eating a healthy and balanced diet while adopting a daily exercise routine can help reduce insulin resistance, resume ovulation, and help reduce extra weight. Excess hair can be managed using hair removing creams, bleaching, shaving, waxing, or plucking. Laser treatment and electrolysis can give longer lasting results but needs to be carried out by trained professionals. Obesity worsens the hormone imbalance that causes excess hair growth, so overweight women should lose excess weight. Other treatments include normal acne treatments and techniques to remove excess facial and body hair. PCOS is commonly diagnosed by gynaecologists so it is essential that gynaecologists have a comprehensive understanding of the long-term effects of PCOS.

*References*
NHS Direct
BUPA Healthcare
Royal College of Obstetricians and Gynaecologists


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