Polycystic Ovary Syndrome


The ovaries are a pair of glands that lie on either side of the uterus (womb). Each ovary is about the size of a large marble. The ovaries make ova (eggs) and various hormones. Hormones are chemicals that are made in one part of the body, pass into the bloodstream, and have an effect on other parts of the body.

Ovulation normally occurs once a month when you release an ovum (egg) into a Fallopian tube which lead into the uterus (womb). Before an ovum is released at ovulation, it develops within a little swelling of the ovary called a follicle (like a tiny cyst). Each month several follicles start to develop, but normally just one fully develops and goes on to ovulate.

Polycystic ovary syndrome (PCOS), formerly known as the Stein-Leventhal syndrome, is a condition where at least two of the following occur, and often all three:

  • At least 12 follicles (tiny cysts) develop in your ovaries. (Polycystic means many cysts.)
  • The balance of hormones that you make in the ovaries is altered.
  • You do not ovulate each month. Some women do not ovulate at all.
What causes polycystic ovary syndrome?

The exact cause is not totally clear. Several factors probably play a part. These include:

  • Insulin
  • Women with PCOS have what is called insulin resistance. This means that cells in the body are resistant to the effect of a normal level of insulin. Increased insulin also contributes towards weight gain.
  • Luteinising hormone (LH)
  • This hormone is made in the pituitary gland. It stimulates the ovaries to ovulate and works alongside insulin to promote testosterone production. A high level of LH is found in about 4 in 10 women with PCOS.
  • Hereditary factors
  • PCOS is not strictly inherited from parents to children, but it may run in some families.
  • Weight
  • Being overweight or obese is not the underlying cause of PCOS. However, if you are overweight or obese, excess fat can make insulin resistance worse. This may then cause the level of insulin to rise even further. High levels of insulin can contribute to further weight gain producing a 'vicious cycle'. Losing weight, although difficult, can help break this cycle.
What are the symptoms and problems of polycystic ovary syndrome?

Symptoms that occur if you do not ovulate

  • You may have irregular or light periods, or no periods at all.
  • Fertility problems

Symptoms that can occur if you make too much testosterone (male hormone)

  • Excess hair growth.
  • Acne.
  • Thinning of scalp hair.

Other symptoms

  • Weight gain.
  • Depression or poor self-esteem.

Possible long-term problems of polycystic ovary syndrome

If you have PCOS, over time you have an increased risk of developing type 2 diabetes, diabetes in pregnancy, a high cholesterol level, and possibly high blood pressure.

If you have no periods, or very infrequent periods, you may have a higher than average risk of developing cancer of the uterus (womb).

Are any tests needed?
  • Blood tests may be taken to measure certain hormones. For example, a test to measure testosterone and LH which tend to be high in women with PCOS.
  • An ultrasound scan of the ovaries may be advised.
  • An annual screening test for diabetes or prediabetes (impaired glucose tolerance).
What is the treatment for polycystic ovary syndrome?
  1. There is no cure for PCOS.
  2. You should aim to lose weight if you are overweight
  3. Treating hair growth
  4. A cream called eflornithine may be prescribed to rub on affected areas of skin. It works by counteracting an enzyme (chemical) involved in making hair in the skin. Some research trials suggest that it can reduce unwanted hair growth, although this effect quickly wears off after stopping treatment.
  5. Cyproterone acetate is an antitestosterone drug.
  6. The combined contraceptive pill YasminŽ (a combination of ethinylestradiol and drospirenone) has been shown to help.
Treating acne

The treatments used for acne in women with PCOS are no different to the usual treatments for acne.

Treating period problems

Therefore, some women with PCOS are advised to take the contraceptive pill as it causes regular withdrawal bleeds similar to periods. If this is not suitable, another option is to take progestogen hormone for several days every month which will cause a monthly bleed like a period. Sometimes, an intrauterine system (IUS), which releases small amounts of progesterone into the womb preventing a build-up of the lining, can be used.

Fertility issues

If you do not ovulate but want to become pregnant, then fertility treatments may be recommended by a specialist and have a good chance of success. If you are obese or overweight then losing weight is advised in addition to other fertility treatments.

Metformin and other insulin-sensitising drugs

Metformin is a drug that is commonly used to treat people with type 2 diabetes. It makes the body's cells more sensitive to insulin. This may result in a decrease in the blood level of insulin which may help to counteract the underlying cause of PCOS.

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