Polycystic Ovary Syndrome (PCOS) 1 June 2013 PCOS is the most common hormonal condition likely to affect women of child-bearing age. Women of childbearing age generally produce an ovum (egg from the ovaries) 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 the ovaries rather than being released each month. They build up in the ovaries and are known as cysts. The hormone testosterone can cause insulin resistance (high insulin levels) or it can be the other way around, where high insulin levels can increase the amount of testosterone produced in the body. Insulin resistance is a condition where the body produces more insulin in order to keep blood glucose levels within the normal range. Sometimes, the body cannot produce enough insulin to keep glucose levels within the normal range and the woman develops pre-diabetes or type 2 diabetes. What causes PCOS? Experts do not know what causes PCOS but, in some cases, it seems to be genetic because it often runs in families. Who gets PCOS? PCOS can begin at puberty or even in early to mid 20s. Approximately 12â€“21 per cent of Australian women of reproductive age are affected by this condition but about 70 per cent of women with PCOS don’t know they have it. Although not all women with PCOS are overweight, it is more common in overweight women and women of indigenous backgrounds. What are the signs and symptoms of PCOS? Signs and symptoms can be very different from woman to woman. Some women may have only a few signs and symptoms while others may have many of the features of PCOS. These can include: Irregular periods (more or less often) or no periods (amenorrhea) Pelvic pain Many cysts on one or both ovaries seen on ultrasound (but not all women have cysts) Infertility or decreased fertility (although some women have no problem with fertility because it also depends on how severe the condition is) Excessive hair growth to face, upper arms and upper legs Male pattern balding or thinning hair Acne Skin tags to neck and armpits Obesity and difficulty losing weight (usually around the abdomen) Depression and low mood Darkened skin patches (called Acanthosis nigricans) behind the neck, armpits and behind knees Metabolic syndrome (high blood pressure, high cholesterol, abdominal overweight) Sleep apnoea (condition where the upper airway blocks during sleep and decreases the amount of oxygen breathed in). How is PCOS diagnosed? PCOS is a complex condition and there is no single test to diagnose it. It is diagnosed when two of the following three are present: Irregular periods (>35 or Signs of increased male type hormones e.g. acne, body hair, or increased male hormones in blood test Presence of polycystic ovaries detected on ultrasound. If any of the signs and symptoms discussed above seem familiar to you talk to your GP about being assessed for PCOS. It could change your life. Why is PCOS a problem in the long term? PCOS can lead to heart and vessel disease because of high insulin levels. Some women can develop a poor body image because of the way they look due to PCOS. Features such as acne, excessive hair growth, male pattern balding, difficulty losing weight and low moods can cause women to feel negatively about themselves. The longer that PCOS goes undiagnosed the higher the risk of problems such as infertility. Will PCOS affect the chance of becoming pregnant? Some women with PCOS may experience a degree of infertility and it may take them longer to conceive. However, 60 per cent will become pregnant naturally. To increase your chances of fertility, plan your pregnancy if you can at an age when you are most fertile, ideally between 28-35 years old. You should also avoid smoking and reduce stress levels, caffeine and alcohol intake. A BMI of >30 significantly reduces your fertility so if you are overweight try to engage in regular exercise and healthy eating to lose a few kilos. Can PCOS be cured? There is no cure for PCOS but it can be managed. Early detection of PCOS and lifestyle factors are key to improving signs, symptoms and fertility. Factors which can improve PCOS include: Losing weight if overweight – just 5-10 per cent weight loss can improve symptom Exercise Good nutrition Certain medications can assist PCOS these include: diabetes medication such as Metformin to help reduce insulin resistance the oral contraceptive pill – to regulate periods fertility medications medicine to stop unwanted hair growth and excessive male hormones. In some cases, surgery may be offered to remove the cysts from the ovaries. In many cases psychological support for women experiencing PCOS talking to a psychologist or counsellor or participating in a support group is of great value. The Royal Women’s hospital has a support group for women with PCOS. For more PCOS information on see the Jean Hailes or POSAA websites.