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Suite 15, 117A Harley Street, London, W1G 6AT, UK
Suite 15, 117A Harley Street, London, W1G 6AT, UK
Polycystic ovarian syndrome (PCOS) is a metabolic disorder occurring due to hormonal imbalance. It primarily affects your fertility and menstrual cycle along with other symptoms like weight gain or excess hair growth.
While the exact reason for PCOS is not yet known, it is assumed to occur from an imbalance of reproductive hormones. These can lead to ovarian problems such as underdevelopment of eggs, or no release of eggs during ovulation.
Early intervention can help reduce the long-term impacts of PCOS, including high blood pressure or type 2 diabetes. It is quite common for most women to have PCOS. Let’s explore with this blog how you can know if you have PCOS and how to manage it.
Polycystic ovarian syndrome, also called PCOS, is a hormonal disorder, causing the formation of cysts on the ovaries of a woman. These cysts are actually the eggs which have not been able to mature, and they appear as black dots on the ovaries on an ultrasound.
PCOS is a complex condition that was previously thought to be a gynaecological issue, interfering with the reproductive health of a woman. Later on it was understood that PCOS is primarily a metabolic problem, associated with the ability of the body to handle insulin and other hormones.
Obesity and genetic factors often lead to insulin resistance, a change in the way how the body’s organs respond to the insulin hormone. This phenomenon increases the insulin levels in the body which bring about several changes in female hormones.
Overproduction of the luteinising hormone (LH) hinders the increase of LH in the middle of the menstrual cycle, which is essential for ovulation. As an egg is not made every month, it reduces the fertility in the woman.On the other hand, the rise in the LH stimulates the ovaries to make testosterone – a male hormone; instead of the female hormone – oestrogen. Such hormonal changes prevent eggs from completely maturing the ovary, thereby reducing ovulation.
PCOS is a common hormonal disorder. Although it is not easy to figure out how exactly common PCOS is, as this varies across different locations.
Research studies show that every 1 in 3 women have been tested and diagnosed with a polycystic ovary, that is ovaries with multiple small cysts. However, there are many women who are healthy, do not produce high levels of male hormones, and ovulate normally even with PCOS. In short, having polycystic ovary does not necessarily mean you have PCOS.
As PCOS is common, around 8 to 13 % of women aged between 15 and 44 years are affected by this syndrome.
Some common signs occurring during PCOS include:
Symptoms of PCOS usually start around the late teens or in early 20s. However, not every symptom is found to occur in every woman with PCOS. For instance, some women with PCOS have normal periods and fertility but excessive hair growth. On the contrary, some other women show irregularity or complete absence in periods, but do not exhibit other symptoms.
Besides, these PCOS symptoms range from mild to severe. While mild unwanted hair loss is normal at some point, it can become abnormal for women with mild PCOS. On the other hand, women having severe PCOS can show remarkable hair growth, obesity, and infertility.
These symptoms also tend to change over the years. For example, acne might not be a huge problem for middle aged women, but hair growth becomes more noticeable at that point.
PCOS is a complex hormonal condition which is not yet understood completely. It is not yet evident if PCOS is inherited like other conditions, but it may run in a similar pattern in several families. While some women with PCOS have obesity, some other women may show insulin resistance. As the cause is uncertain, symptoms vary from one woman to another.
Your healthcare provider may recommend certain tests for diagnosing and ruling out other hormone conditions, such as:
This condition PCOS can only be diagnosed when a woman has at least any two of the following criteria:
PCOS does not have any specific cure. However, the symptoms can be treated by reducing your health risks.
Giving up weight can be beneficial in reducing the high insulin level which occurs in PCOS. It works by reversing certain hormonal changes associated with PCOS, thereby improving your chances of ovulation. This will improve the fertility and regularity of periods in the woman. Acne and hair growth issues might also be resolved, along with reducing the risks of long term complications like high blood pressure and diabetes.
Losing weight is not easy. While ‘eat less and move more’ seems an easy line for weight loss, obesity is way more complex beyond that. This causes long term changes in hormones regulating hunger and satiety. Exercise has been proved to be helpful for managing PCOS symptoms, usually by enhancing the sensitivity to insulin.
You can also work on losing weight by consulting a dietician, or considering a reference weight for good health. Even a loss of around 10% of your body weight can improve your ovulation and fertility.
PCOS patients must consider having foods which are gradually absorbed in the body, allowing the blood sugar levels to remain steady. These items are known to have a low glycaemic index (GI). This includes avoiding or completely cutting down on rice, white bread, pasta, and opting for wholemeal alternatives instead. It is also recommended to avoid sugary foods and drinks and potatoes. Most vegetables, fruits, wholegrain foods, and pulses have a low GI and are healthy.
Excess hair growth occurs due to the increased testosterone level – the male hormone. However, you can remove unwanted hair by waxing, shaving, electrolysis, using hair removing creams, or through laser treatments. While waxing, shaving, or using creams need to be repeated frequently, laser treatments and electrolysis are usually more long lasting but expensive.
Certain medicines are also available which can remove unwanted facial hair. By counteracting with an enzyme which is responsible for making hair on the skin, these medicines limit unnecessary hair growth. However, this effect rapidly disappears after the treatment is stopped.
Oral medications taken for treating hair growth work by minimising your testosterone levels or blocking their effects. Such medicines usually require about 3 to 9 months to function completely. But you require continuing these medicines; otherwise the hair growth will recur.
Treating acne in women with PCOS is no different from the usual treatments for acne. Certain oral contraceptive pills are helpful in improving acne. Besides antibiotic tablets, topical treatments are also available for acne management.
Some women with absent or infrequent periods may not feel the need for treatment. However, going without periods for a long time can increase the risk of developing endometrial (womb or uterus) cancer. Having regular periods helps reduce this risk by preventing a thickening of the uterine lining.
For this reason, some women with PCOS are recommended to take the contraceptive pill. It triggers regular withdrawal bleeds that resemble natural periods and help protect the uterus. If the pill is not suitable, another option is to take a progestogen hormone drug for a few days every few months. This will also cause a bleed similar to a period and help regulate the lining of the womb.
Another alternative is an intrauterine device (IUD) that releases small amounts of progestogen directly into the uterus, preventing the lining from building up. If none of these options are appropriate, your specialist might suggest regular ultrasound scans to monitor the uterus for any early signs of abnormal changes – though such complications are rare.
Although fertility may be reduced with PCOS, contraception is still needed if you want to avoid pregnancy, as some women ovulate occasionally. The likelihood of pregnancy depends on how often you ovulate – some ovulate irregularly, others not at all. If you are not ovulating but wish to conceive, a specialist may recommend fertility treatments, which are often successful. However, having obesity can significantly lower your chances of becoming pregnant. If you are overweight or have obesity, losing weight is strongly advised alongside any fertility treatment, as it can improve ovulation and overall fertility outcomes.
If you are having PCOS, you are probably susceptible to risks of developing:
Women with PCOS may face increased long term health risks, mainly due to ongoing insulin resistance. This can raise the likelihood of developing stroke and heart disease later in life. Sleep apnoea, a condition that affects breathing during sleep, is also more common in women with PCOS. During pregnancy, there may be a higher risk of complications, such as premature birth, high blood pressure (pre-eclampsia), and gestational diabetes. In fact, the risk of developing diabetes in pregnancy may be up to twice as high, so regular screening is recommended. Additionally, women who have very few or no periods may have a greater risk of developing uterine (womb) cancer, due to the build-up of the uterine lining.
A healthy lifestyle is integral to the management of PCOS. A healthy diet along with regular exercise can alleviate some of your physical and mental problems related to PCOS. Regular exercise also brings down the risks of diabetes and improves your chances of becoming pregnant. The following healthcare specialist can offer your further help and guidance:
Living with PCOS can be challenging, but with the right approach, it is manageable. Understanding the condition, recognising symptoms early, and making healthy lifestyle changes are the key to reducing both immediate discomfort and long term health risks. While there is no cure, treatments are available for managing symptoms such as irregular periods, excess hair growth, acne, and fertility issues. Addressing insulin resistance through diet, exercise, and, when necessary, medication can significantly improve overall health and wellbeing. PCOS affects each woman differently, so finding the right combination of treatments and support is essential. With proper care, women with PCOS can lead healthy, fulfilling lives. Contact our private gynaecologists at London GP Clinic for better healthcare guidance on your PCOS.
