What is it?
Polycystic ovary syndrome (PCOS) is an endocrine disorder in women of reproductive age. It occurs when follicles on the ovaries don’t produce eggs for fertilisation, and consequently develop into cysts that make imbalanced amounts of female and male hormones. This is a problem because the absence of certain female hormones or an overproduction of male hormones can suppress menstruation and ovulation, and cause infertility.
Even when fertility isn't affected by PCOS, there may be separate complications or side effects that can impair future ovulation and general health if they are left untreated, such as:
- insulin resistance and Type-2 diabetes
- metabolic syndrome
- high blood pressure during pregnancy
- sleep apnoea
- cardiovascular issues.
According to a fact sheet published by the Royal Australian College of General Practitioners, PCOS affects 12–21 per cent of women of reproductive age, but the vast majority remain undiagnosed.
What are the symptoms?
Symptoms can include any of the following things, and can vary between women:
• menstruating erratically or not at all
• abnormal bleeding when menstruating, such as having very heavy bleeding or only spotting
• weight gain
• high cholesterol
• hair growth in places such as the face, chest, stomach and back
• abdominal pain
• skin pigmentation
• thinning hair
• not conceiving after 12 months of unprotected sex when under age 35, and not conceiving after 6 months of unprotected sex when over age 35.
Some studies have found that genetics can play a role in PCOS, with some women from the same family all suffering from it.
How is it diagnosed?
PCOS can be difficult to diagnose when the women is unaware that she is not ovulating, especially if she is still menstruating, so women will need to look out for other symptoms and speak to their doctors if they are concerned.
GPs will initially need to ask several questions about a woman’s medical history, check her BMI, and may also run blood tests to check hormone levels, which will rule out other possible conditions such as thyroid problems. Women with PCOS may be asked to track their periods to determine how often they are menstruating.
A final diagnosis is usually made through a pelvic or vaginal ultrasound, which may find polycystic ovaries, which are incidentally found in 20% of healthy women. A woman may need to be reviewed by a gynaecologist or an endocrinologist, depending on the health issues that are related to the symptoms.
What's the treatment?
Treatment can be based around three issues, which can be related to one another but not always, such as:
- lowering insulin levels
- treating the hormonal component that leads to acne and hair growth
- stimulating regular menstruation and the shedding of the endometrial layer (which needs to happen at least once every three months to prevent endometrial abnormalities that have been linked to endometrial cancer) for fertility reasons.
Treatment for PCOS depends largely whether or not a woman is trying to get pregnant. Lifestyle measures such as exercise, a low GI diet, weight management and addressing insulin resistance can help improve the health of women with PCOS, regardless of whether or not they want to become pregnant.
For women who are trying to fall pregnant, medication (such as clomid), can be prescribed; this will encourage ovulation and make the menstrual cycle regular. Insulin resistance will also need to be managed to optimise the outcomes of pregnancy.
From time to time, keyhole surgery is recommended, and a procedure called laparoscopic ovarian drilling can be performed. Some women with PCOS will need medically assisted reproduction (such as IVF) to have a baby.
Does it affect the baby?
PCOS can affect unborn babies because there are certain pregnancy complications that are correlated to the uneven hormone levels and elevated blood glucose many PCOS sufferers have. These pregnancy complications include a higher chance of miscarriage, gestational diabetes, high blood pressure and premature labour.
Most women with PCOS, however, have healthy pregnancies - it may just be that they need to be monitored more closely in prenatal check-ups.
Facts verified by Dr Andrew Zuschmann. Dr Andrew Zuschmann is a Miranda-based fertility specialist, obstetrician and gynaecologist.