Polycystic ovary syndrome (PCOS)

Published by Bupa's Health Information Team, March 2010.

This factsheet is for women who have polycystic ovary syndrome, or people who would like information about it.

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries aren't working properly. PCOS can affect hormone levels, periods (menstrual cycle), fertility, appearance and long-term health.

About polycystic ovary syndrome

If you have PCOS, you will usually have two out of three of the following.

• High levels of the male hormone testosterone, which is produced by your ovaries, and/or signs of having high levels of testosterone (such as excess body hair or thinning of the hair on your head).
  
• Irregular or no release of eggs from your ovaries (ovulation), which usually means irregular or no periods.
  
• Many small cysts on your ovaries called polycystic ovaries.

In the UK, it's estimated that between five and 26 of every 100 women may have PCOS.

Ovaries

Women have two ovaries, which are small organs inside the body where eggs (ova) mature and are then released. This happens about once a month. The ovaries produce the hormones oestrogen, progesterone and testosterone.

Cysts

Cysts are fluid-filled sacs. Before ovulation, the egg develops in a small swelling on the ovary called a follicle. Cysts form when follicles stop growing too early. Instead of bursting to release the egg, they form swollen egg chambers (cysts).

What is a polycystic ovary?

Polycystic means 'many cysts'. A polycystic ovary generally has 12 or more cysts. These cysts are usually benign, which means they are not cancerous.

Symptoms of polycystic ovary syndrome

You may start to notice symptoms of PCOS in your late teens or 20s, such as:

• absent or irregular periods
  
• infertility - you need to ovulate to become pregnant and you may not be ovulating regularly or at all
  
• obesity or being overweight
  
• excess hair (hirsutism) on your face, around your nipples or on your lower abdomen
  
• thinning of the hair on top of your head
  
• acne

Causes of polycystic ovary syndrome

The exact reasons why you may develop PCOS aren't fully understood at present. Several factors seem to be important.

PCOS runs in some families, so there may be a genetic link.

High levels of certain hormones may also cause PCOS. For example, you may have resistance to insulin, the hormone that controls your blood sugar level. This means the level of insulin in your blood needs to be higher than normal to control your blood sugar level. The extra insulin may cause your ovaries to make too much testosterone, which can lead to excess hair and acne. Increase in testosterone can also stop ovulation.

If you have excess body fat, this can make insulin resistance - and the symptoms of PCOS - worse.

Diagnosis of polycystic ovary syndrome

If your GP thinks you may have PCOS, he or she may refer you to a specialist doctor such as a gynaecologist, who specialises in women's reproductive health. Your doctor will look for the signs of PCOS and rule out other problems that cause similar symptoms. Common tests include:

• blood tests - to check thyroid function, and measure your level of glucose and hormones such as testosterone
  
• an ultrasound scan - to see if your ovaries are enlarged and/or polycystic

Having cysts on your ovaries doesn't necessarily mean you have PCOS. It's also possible that you will be diagnosed with PCOS even if you don't have any cysts on your ovaries.

Treatment of polycystic ovary syndrome

Self-help treatments

Your doctor is likely to suggest lifestyle changes, such as eating a healthy, balanced diet and exercising regularly, to help control your symptoms, reduce insulin resistance and improve your fertility.

Stress can make your PCOS symptoms worse so managing your stress levels and finding time to relax can also help control your symptoms.

If you have excess hair, you can control this with hair removing creams or by bleaching, shaving or waxing. Laser treatment and electrolysis can give longer-lasting results but should be done by qualified professionals.

Medicines

A number of medicines are available that can help you deal with the different symptoms of PCOS.

• Over-the-counter treatments containing benzoyl peroxide (eg Oxy 10 lotion) can help reduce acne. If over-the-counter treatments don't help, speak to your GP. He or she may prescribe antibiotic tablets or creams to treat your acne.
  
• Oral contraceptive (eg Dianette). Oral contraceptives stop ovaries from producing too much testosterone, so improve both acne and excess hair.
  
• Metformin. This medicine increases the sensitivity of muscle cells to insulin (reduces insulin resistance). This means your body needs less insulin to control your blood sugar levels. Reduced insulin levels in the blood means your ovaries will produce less testosterone. As the testosterone levels drop symptoms such as excess hair and irregular periods will improve, and your ovaries will start to release eggs (improve fertility).
  
• Fertility medicines including clomifene citrate and tamoxifen can stimulate your ovaries to release eggs. You can take these for up to a year. If clomifene makes you ovulate but you don't become pregnant after six months, your doctor might suggest intra-uterine insemination (this is when sperm is placed directly into your womb). If fertility medicines don't help improve your fertility, your doctor may offer hormone therapy or surgical treatment. You can also consider assisted conception, such as IVF (in vitro fertilisation), egg donation or surrogacy.

Surgery

Rarely, your doctor may suggest surgery to control PCOS symptoms and improve fertility, for example laparoscopic ovarian drilling. This is a type of keyhole procedure used to destroy the testosterone-producing tissue on your ovaries. As levels of testosterone fall, your PCOS symptoms improve and ovaries start to release eggs again.

Living with polycystic ovary syndrome

If you have PCOS, you may have a higher risk of developing diabetes and heart disease later in life.

If you have periods less than every three months, you might also be at higher risk of womb cancer.

Try to follow the recommended lifestyle advice (see Self-help treatments) to reduce your risk of developing these conditions.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.