Polycystic Ovarian Syndrome
PCOS is formerly known as Stein-Levanthal syndrome. Approximately 5 – 10% women of child bearing age have PCOS. Women with this condition, have a higher level of male hormones and insulin circulating in their body. Due to this hormonal imbalance, it may affect the women’s menstrual cycle, ovulation, fertility, glucose metabolism, cholesterol level and appearance. Unfortunately, the actual cause of PCOS is still unknown. There may be an underlying genetic factor.
What symptoms do women with PCOS have?
- Infrequent, irregular menses which could be heavy. Sometimes, there are no menses at all. This is due to prolonged lack of ovulation.
- Overweight.
- Problems with ovulation which may cause infertility.
- Type II Diabetes.
- High cholesterol.
- Oily skin and acne.
- Excessive hair growth (hirsutism) which is similar to the male distribution pattern.
- Depression or mood swings.
How is the diagnosis of PCOS made?
Your doctor with make the diagnosis of PCOS if you have at least two out of the three Rotterdam’s criteria as listed below and other possible causes have been excluded:
- Irregular or absent menses.
- Blood investigation and / or clinical symptoms showing imbalanced hormones where there is an increased level of male hormones.
- Polycystic ovaries on the ultrasound.
What do you mean by polycystic ovary?
This term describes the appearance of the ovaries when they are seen on the ultrasound scan. In women with polycystic ovary they have multiple small cysts (fluid containing sac) 12 or more of them which are between 2 – 8 mm in diameter at the edge of their ovaries. This gives the appearance of ‘strings of pearls’ sign on the ultrasound. About 1 in 5 women have polycystic ovary but not all of them have the other symptoms associated with PCOS. Hence, not all women with polycystic ovary has polycystic ovarian syndrome and not all women with PCOS have polycystic ovary. Only about 6 – 7% of women with polycystic ovaries have PCOS.
Why do women with PCOS may have problems getting pregnant?
This is mainly caused by lack of ovulation. Every month prior to ovulation whereby an egg is released by the ovary, several small swellings will develop in the ovary (follicles). Only one of the follicles will fully grow and mature to be released as an egg. However, an increased level of insulin and male hormones (testosterone) in the blood will disturb the normal development of the follicles in the ovary. Hence, as a result many follicles will develop but often not fully leading to lack of ovulation, disturbed menses and reduced chance of pregnancy.
How could PCOS affect pregnancy?
There is an increased risk of miscarriage, hypertension and diabetes in pregnancy.
What are the possible long term health implications in women with PCOS?
Several researches have shown that women with PCOS may be at increased risk of:
- Diabetes in about 10 – 20% of women with PCOS. The risk is increased if you are obese, have a family history of diabetes, above the age of 40 years old or had diabetes during pregnancy (gestational diabetes)
- High cholesterol
- High blood pressure which is related to insulin resistance and being overweight.
- Heart disease especially if you have high blood pressure and diabetes. However, if you do not have high blood pressure or diabetes, there is no clear evidence that you will develop heart disease just because you have PCOS.
- Cancer of the womb (endometrial cancer) especially in women who have infrequent or no menses at all. PCOS does not increase your risk of developing breast, ovarian and cervical cancer.
- Sleeping problems i.e sleep apnoea which could lead to sleepiness and tiredness.
- Depression and mood swings.
What is the treatment for women with PCOS?
This depends on the symptoms, the women’s wishes and fertility requirement.
- In general, practicing a healthy lifestyle great improves the symptoms associated with PCOS. In addition, it reduces the long-term health risks. This includes maintaining an optimal weight, healthy eating, exercise and cessation of alcohol and smoking.
- Combined oral contraceptive pill could regulate menses, making it lighter and less painful. In addition, it improves the skin condition and reduces hair growth.
- Diabetes medication e.g Metformin (insulin-sensitizing drug). In some women with PCOS, they have a resistance to the hormone insulin. This hormone regulates the glucose metabolism in your body. Metformin could reduce the insulin resistance and reduced its level therefore counteracting some the effects of PCOS. It will not cause you to have diabetes. However, more studies are needed to validate the actual role of metformin in PCOS treatment.
- Fertility medications to induce ovulation.
- Surgery i.e laparoscopic ovarian drilling. This is usually not the first line fertility treatment for PCOS women. It is usually reserved for those with resistance to ovulation induction medication. In this key-hole surgery, small tiny holes are made in the ovaries which will reduce the level of male hormones and hopefully improve ovulation. However, it will not help with the skin condition or excessive hair growth.
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REFERENCE:
ESHRE/ASRM – Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81:19 – 25.
Long-term consequences of Polycystic Ovary Syndrome. Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 33 Dec 2007.
