Polycystic ovary syndrome
- Dr Madhavi Vellayan, Consultant Gynaecologist
Polycystic ovary syndrome (PCOS) is a common condition affecting your ovaries. It can cause irregular periods, unwanted facial and body hair, and acne. It can also make it more difficult for you to get pregnant. PCOS treatment can help to ease symptoms, prevent complications, and improve your chances of pregnancy.
PCOS treatment can help to ease symptoms, prevent complications, and improve your chances of pregnancy.
About polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) affects up to 1 in 10 women. There are two ovaries that are part of a woman’s reproductive system. They store and release eggs, and produce sex hormones. About once a month, one ovary should release an egg, ready to be fertilised.
Eggs develop in small fluid-filled swellings, called follicles. Each month, more than one follicle starts to develop. But usually only one becomes a fully mature egg. In polycystic ovary syndrome (PCOS), 12 or more follicles start to grow. But often none develop into an egg that can be fertilised and you don’t have a period that month. The follicles range in size from 2mm to 9mm, and stay on your ovaries containing undeveloped eggs. Despite the name, it’s actually follicles that are on your ovaries, not cysts.
You can have lots of follicles on your ovary without having PCOS. You can also have PCOS without having any follicles on your ovaries.
Causes of polycystic ovary syndrome
Doctors don’t know exactly why women get polycystic ovary syndrome (PCOS). But there are likely to be a few causes working together.
PCOS can run in families. So you may have a higher risk of developing PCOS if your mother or sister has the condition. Researchers have found several genes that are linked to an increased risk of PCOS. But it’s complicated because these genes are also common in women who don’t have PCOS. So they haven’t yet found genes that definitely cause the condition.
Many different hormones work together during a woman’s reproductive and menstrual cycle. In PCOS, some of these are out of balance. Your body may produce too much luteinising hormone (LH). This hormone helps to control the menstrual cycle.
Women naturally produce small amounts of the sex hormone testosterone. But in PCOS, your body may be making too much. This may be because your cells are resistant to insulin. This hormone helps your body to control the level of sugar in your blood. If your cells are resistant to insulin, your body makes more than it should. The extra insulin causes your ovaries to make too much testosterone.
All these hormone changes can stop your ovaries from releasing an egg each month.
Symptoms of polycystic ovary syndrome
PCOS symptoms usually start around puberty, but can be as late as your early 20s. Sometimes, symptoms only become noticeable if you stop taking the oral contraceptive pill. Or you might find out that you have PCOS if you see your doctor because you’re having trouble getting pregnant.
The main symptoms include:
- irregular periods – fewer than nine a year and sometimes none at all
- difficulty getting pregnant (infertility)
- being overweight or finding it hard to lose weight
- having more hair than usual, often on your top lip, chin, around your nipples, and in a line down from your tummy button
- thinning hair and losing hair on your head
- acne
- patches of dark thick skin in your armpit or around your groin or neck
PCOS is also linked with anxiety, depression, mood swings and low self-esteem.
If you have any of these symptoms, see your GP.
Diagnosis of polycystic ovary syndrome
Your GP will ask about your symptoms, your periods, and your medical history. They will look for signs of polycystic ovary syndrome (PCOS). They’ll also try to rule out conditions that can cause similar symptoms. You may need to have some tests, including:
- blood tests to measure your hormone levels and to check for other conditions
- an ultrasound scan to see if your ovaries look like you have PCOS
An ultrasound uses sound waves to build up a picture of the inside of your body. The scan may be external or internal. An external ultrasound uses a probe that the doctor moves back and forth across your tummy. An internal ultrasound uses a probe that the doctor puts into your vagina. Both will check your womb and ovaries.
Your GP will refer you to a specialist if they think you may have severe PCOS or problems with infertility.
Struggling with PCOS symptoms, or know about someone who is?
Our Period Plan offers fast access to women's health experts to support conditions like PCOS.
Self-help for polycystic ovary syndrome
Lifestyle changes can help to control polycystic ovary syndrome (PCOS) symptoms. They may also improve your fertility, and can reduce your risk of long-term health problems.
Your doctor may suggest that you lose weight if you’re overweight. You may start ovulating again and having more regular periods if you lose even a small amount of weight.
You can improve your health and help to control your weight by eating a healthy, balanced diet, and exercising regularly. Changes to your diet may also help to ease symptoms. Your doctor may suggest a low GI (glycaemic index) diet. This means eating foods that cause your blood sugar levels to rise slowly.
If treatment doesn’t help with excess hair growth, you could try hair removal techniques. These include hair-removing creams, waxing, shaving, electrolysis, or laser hair removal. Or you could try bleaching products.
Treatment of polycystic ovary syndrome
There’s no cure for polycystic ovary syndrome (PCOS). But treatments can help to ease symptoms. They can also prevent complications and improve your chances of getting pregnant.
The aim of PCOS treatment will depend on your situation, and the symptoms you have.
- If you want to get pregnant, your treatment will focus on giving you the best chance of having a baby.
- If you don’t wish to become pregnant, your treatment will focus on managing your symptoms.
PCOS can increase your risk of developing long-term health problems. These include heart disease, womb cancer, and type 2 diabetes. So, part of your PCOS treatment will aim to reduce your risk of developing these conditions.
To manage your symptoms, you’ll probably need to take some of these treatments long term. But once you reach the menopause, your symptoms may improve enough for you to stop treatment. Ask your doctor for more information.
Medicines
If you are trying to have a baby, medicines used to treat infertility may help.
- Metformin may regulate your periods and help you to start ovulating again. Your doctor may suggest this if losing weight hasn’t helped.
- Fertility medicines can help your ovaries to release eggs. These include clomifene citrate or injections of female sex hormones (gonadotrophins).
If these medicines don’t work, your doctor may suggest fertility treatment such as IVF (in vitro fertilisation).
If you’re not trying to get pregnant, your doctor may suggest other treatments to manage symptoms.
- Going on the pill (oral contraceptive) can stop your ovaries producing too much testosterone. This can help to make your periods more regular. It may also help with acne.
- Your doctor may prescribe a cream called eflornithine to reduce extra hair growth.
- Co-cyprindiol is a treatment for acne and extra hair growth. It can also make your periods more regular.
- Weight loss medicines may help if lifestyle changes aren’t working.
Always read the patient information leaflet that comes with your medicines. If you have any questions, ask your pharmacist or doctor for advice.
Surgery
If medicines don’t work, your doctor may suggest you have an operation to improve your fertility. They will usually only suggest surgery if other treatments haven’t helped and will refer you to a fertility specialist.
If you’re trying for a baby, one option is keyhole surgery. This procedure is called laparoscopic ovarian drilling. The surgeon makes a small cut in your abdomen. They then put a heated probe or laser through the cut and into the ovary. They use this to destroy the ovarian tissue that produces testosterone. This changes the balance of hormones in your body, and can cause your ovaries to release eggs again.
Complications of polycystic ovary syndrome
One of the main complications of polycystic ovary syndrome (PCOS) is infertility. Your ovaries don't produce a mature egg each month, so it's more difficult to get pregnant. But if you get treatment for PCOS, you may still be able to have a baby. Losing weight may also help.
If you do get pregnant, you may be more likely to develop complications. These can include diabetes and high blood pressure. Your baby is also more likely to be born early. Your antenatal team will take extra care by giving you regular health checks.
The high insulin levels linked to PCOS increase your risk of type 2 diabetes and obesity. This can also mean that you’re more likely to develop:
- heart disease
- womb cancer
- mental health conditions such as depression and anxiety
- sleep apnoea – breathing problems during sleep that can make you extremely tired during the day
- non-alcoholic fatty liver disease
A healthy diet and exercise can significantly lower your risk of obesity and diabetes, and in turn, the chance of developing these other conditions. So, it’s important to be active and to eat well. Talk to your doctor if you’re worried about complications or getting pregnant.
PCOS: your questions answered
Transcript
Who are you and what is your background?
Hi, my name's Dr.
Rebecca Rohrer.
I'm a doctor, working clinically,
a medical director at Bupa,
and I've got a real passion for women's health.
What is Polycystic Ovary Syndrome (PCOS)?
Polycystic ovary syndrome is sometimes called PCOS,
and it's a condition that affects the ovaries.
It means that in the body there are higher levels
of circulating hormones called androgens,
and that can affect the way
that the ovaries develop follicles. Now,
every month, follicles develop in the ovary,
and it's those that release an egg ready to be fertilised.
In PCOS, what happens is you have more of these follicles
that develop, and
because you have more follicles, they're less likely
to be able to mature an egg ready enough to release,
and that means that it can be harder for people with PCOS
to get pregnant.
What causes Polycystic Ovary Syndrome (PCOS)?
The exact cause of polycystic ovary syndrome
or PCOS isn't known,
but it's felt to be related to higher levels than normal
of some circulating hormones, particularly testosterone.
It's also being linked to conditions such
as hormone imbalance and resistance to insulin
and to genetics.
Who gets Polycystic Ovary Syndrome (PCOS)?
Polycystic ovary syndrome
or PCOS is a condition that affects the ovaries,
so only people born with ovaries can be affected by it.
It's really common,
but not everybody with the condition will develop symptoms.
What are the symptoms of Polycystic Ovary Syndrome (PCOS)?
Polycystic ovary syndrome
or PCOS has lots of different symptoms
and not everybody with the condition will be affected by all
of them, but some of the common symptoms include
irregular or even completely absent periods,
and that can make it difficult for people
with PCOS to get pregnant.
It can also be associated
with either problems gaining weight
or difficulty losing weight
in addition to issues like acne.
These symptoms often become apparent in people's late teens
or early twenties, but it can
become apparent later on as well.
How is Polycystic Ovary Syndrome (PCOS) diagnosed?
Polycystic Ovary syndrome
or PCOS is usually diagnosed when people first make a trip
to their GP with concerns about the condition.
GPs can do a blood test to look for any hormone imbalances,
including high levels of hormones like testosterone
to see whether the symptoms are due to that
or another hormone condition.
Often that'll be followed up with an ultrasound scan
to look at whether there are follicles in your ovaries
and the size and number of those.
After that, follow-up
blood tests might include additional tests to screen
for things like other hormone imbalances or diabetes
or high cholesterol.
We typically make a diagnosis
of PCOS if there are at least two
of the following criteria met.
So if periods are either really irregular
or absent, if blood tests do show high levels
of hormones like testosterone,
and if ultrasound scans show a high number
of follicles in the ovaries.
I think I have Polycystic Ovary Syndrome (PCOS) - what should I do?
If you think you have polycystic ovary syndrome
or PCOS, your first port of call should be your
doctor or GP.
They're in the best position to be able
to advise you about any tests that they might want
to do in order to get a diagnosis and any onward treatment.
What are the treatments for Polycystic Ovary Syndrome (PCOS)?
Whilst polycystic ovary syndrome
or PCOS can't be cured, there are loads
of treatment options available for it.
That includes something as simple
as lifestyle measures to lose weight.
Even a 5% weight loss can really improve the symptoms
of PCOS.
There are also lots of medications available.
The oral contraceptive pill can help to regulate cycles,
for example, and there are options available to those
who want to get pregnant in order to improve those chances.
Also, medications available to treat some of the symptoms
of PCOS, including acne
and excessive hair growth that people might find
really burdensome.
Finally, there are surgical options to burn off some
of the excessive areas around the ovary to help to correct
that long-term hormone balance.
Really important that people
with a PCOS diagnosis feel happy
to discuss these treatment options with their GP
or doctor so that they feel enabled to be able
to make the best decision for them.
What are the side effects of different treatments for Polycystic Ovary Syndrome (PCOS)?
Every treatment comes with side effects.
So it's really important when you are considering treatment
options for polycystic ovary syndrome
or PCOS to be able to talk to your doctor or GP about them.
How does the contraceptive pill help treat Polycystic Ovary Syndrome (PCOS)?
Whilst the contraceptive pill can't cure polycystic ovary
syndrome or PCOS,
it can be really effective at managing the symptoms
of it such as irregular periods.
Does losing weight help Polycystic Ovary Syndrome (PCOS)?
Losing as little as 5%
of your weight can be really effective,
not just at relieving some of the symptoms
of polycystic ovary syndrome or PCOS,
but also in terms of reducing the risk
of developing some longer term health problems.
Will Polycystic Ovary Syndrome (PCOS) get better on its own?
Symptoms of polycystic ovary syndrome
or PCOS won't get better by themselves,
which is why it's really important to speak to your doctor
or GP about what treatments might be available to you.
Does Polycystic Ovary Syndrome (PCOS) change as you age?
Polycystic ovary syndrome
or PCOS does change as you age.
Obviously, when you are younger,
some of the concerns might be around fertility.
However, in older people, some
of the concerns might be on the metabolic risks associated
with PCOS,
and that includes things like type two diabetes,
high blood pressure, and high cholesterol.
That's why it's really important to speak to your doctor
or GP around potential treatments.
Can Polycystic Ovary Syndrome (PCOS) affect my fertility?
Unfortunately, for some people
with polycystic ovary syndrome
or PCOS, the high number of follicles in the ovaries means
that the eggs are less likely to mature
and you are less likely to ovulate,
and that means that it can be harder to get pregnant.
It doesn't apply for everybody, but it can apply for some.
That's why it's really important that if you do know
that you have PCOS
and you're trying to get pregnant, that you go to your GP
or doctor as soon as possible
because there are lots of treatments and options available.
And likewise, if you are trying to get pregnant
and it's taking a little bit longer
and you think you might have PCOS,
it's also a really good idea to speak to your doctor or GP.
Can Polycystic Ovary Syndrome (PCOS) affect my periods?
Polycystic ovary syndrome or PCOS can affect your periods.
For some people, they may have irregular periods
or even no periods at all.
Now there are treatments available for that, so
the contraceptive pill, for example, can help
to regulate your periods.
Also, really important to bear in mind
that if you are trying to conceive, if you're trying
to get pregnant, then irregular periods
or absent periods might indicate that that's going
to be a bit more challenging.
So I'd really urge people to go
and speak to their doctor or GP if that's the case, so
that there can be any investigations
and treatments offered as soon as possible.
Does Polycystic Ovary Syndrome (PCOS) run in families?
There is some evidence that polycystic ovary syndrome
or PCOS can run in families,
and that there may be a genetic element to it.
The exact genes haven't been identified yet,
but if an immediate family member has been diagnosed
with PCOS and you have concerns, then I'd really recommend
that you go and speak to your doctor or GP about that.
Can you get Polycystic Ovary Syndrome (PCOS) post-menopause?
Polycystic Ovary syndrome
or PCOS is usually diagnosed when people are in their late
teens or early twenties once their cycles have
started to become established.
Therefore, it's really unlikely that you would be diagnosed
with PCOS after the menopause.
Can I protect myself against Polycystic Ovary Syndrome (PCOS)?
So in polycystic ovary syndrome
or PCOS, unfortunately, we know that it can't be cured,
but it can be treated.
So there are lots of treatment options available
to help you manage the symptoms of PCOS.
We also know that polycystic ovary syndrome
or PCOS can't be prevented.
But likewise, if you think
that you have polycystic ovary syndrome,
it's really important that you speak to your doctor
or GP to talk about some
of the many treatment options available to you.
Can children get Polycystic Ovary Syndrome (PCOS)?
Polycystic ovary syndrome
or PCOS is usually diagnosed in people's late teens
or twenties, and that's
because it is usually diagnosed when people's cycles are
really well established, and we know
that it can take a couple of years for people's periods
to become regular after they start,
and that's why it's not usually diagnosed in children.
How is Polycystic Ovary Syndrome (PCOS) managed?
There are lots of ways to manage polycystic ovary syndrome
or PCOS,
and that can broadly be divided into lifestyle changes,
so something as simple as losing 5%
of weight can really improve the symptoms of PCOS.
There are also treatments available,
and they include things like the pill,
to regulate your periods, medication
that can specifically treat some of the symptoms of PCOS,
like acne, and then other treatments including surgical
options and treatments to help improve chances
of conceiving, for example.
Does what I eat impact the symptoms of Polycystic Ovary Syndrome (PCOS)?
Diet can be a really good way to help address some
of the symptoms of polycystic Ovary syndrome or PCOS.
That means following some of the principles
that we all know about,
but that can be really hard to follow.
But I'd really recommend that people try to eat a diet
that is as varied as possible in terms of amounts of fruit
and vegetables, beans, legumes that you can eat,
reducing your consumption of red meat,
minimising your consumption of any processed food,
including processed meat like sausages.
Also, really valuable if you can eat two portions
of oily fish a week, that's really rich in omega oils,
and also do most
of your cooking in olive oil rather
than butter, for example.
All of that can help
to reduce your symptoms in the short term
and optimise your risk in the long term.
Does Polycystic Ovary Syndrome (PCOS) cause pain during sex?
Some people can experience discomfort during or
after sex. Pain during sex is
not normal and is definitely a reason to go
and see your GP or doctor
because there are lots of things
that can be done to improve it.
Some people with polycystic ovary syndrome
or PCOS can find
that their are impacts on their sexual confidence,
on their sex drive and even on their lubrication.
Again, really important to speak to your partner
or GP about that
because there are lots of options out there to be able
to support you with this.
Does having Polycystic Ovary Syndrome (PCOS) make me more likely to get cancers?
People with polycystic ovary syndrome
or PCOS can have infrequent
or even absent periods.
The challenge there is that there is some evidence
that people with really infrequent periods,
so fewer than three or four a year for a really long period
of time, can be at an increased risk of developing cancer
of the womb or endometrial cancer.
It's therefore really important to speak to your GP
or doctor because there are lots
of treatment options available that can help
to regulate your periods.
Now, options there include the oral contraceptive pill,
but also the intrauterine system, which some
of you might know as the Mirena.
My Polycystic Ovary Syndrome (PCOS) is affecting my quality of life, what should I do?
If you think that you are having symptoms
of polycystic ovary syndrome or PCOS,
or if you've got a new diagnosis
and you're finding those symptoms really bothersome,
it's really important that you speak to your GP or doctor,
because there are lots of treatment options available
and there's no need for you to suffer in silence.
What is the link between Polycystic Ovary Syndrome (PCOS) and diabetes?
We know that people with polycystic ovary syndrome
or PCOS can also be at increased risk
of developing something called insulin resistance.
That's when the body produces a normal amount of insulin,
but the body just doesn't react
to it in the way that it normally would.
The challenge there is that it can increase the risk
of developing type two diabetes,
and that has lots of long-term health consequences.
So it's really important that people with PCOS
keep on chatting to their GP, who might want
to keep an eye on it with some tests.
But there's also lots of things that they can do in terms of
maintaining an active lifestyle
and particularly focusing on maintaining their weight
or losing weight if necessary,
because we all know that that can minimise the chances
of developing type two diabetes later on.
Is Polycystic Ovary Syndrome (PCOS) associated with any other conditions?
Polycystic ovary syndrome or PCOS has been associated
with an increased risk of developing certain conditions.
They include: type two diabetes, high cholesterol,
and high blood pressure,
and all of those can increase a person's risk of developing
more worrisome conditions like heart
attacks or strokes.
PCOS has also been associated with some mood disorders
and depression. And finally, people who are overweight
with PCOS,
it's also been associated with an increased risk
of sleep apnea, which is disruptive breathing during sleep.
If you're worried about any of these conditions
or if you want to talk to anybody about it,
it's really important to reach out to your GP or doctor.
Health checks for peace of mind
A Bupa health check can help rule things out, so you can stop asking “but what if?”. No insurance required.
PCOS can have several different symptoms caused by hormone imbalances. As well as irregular periods, you may gain weight, have excess body hair or acne. It can also affect your mood and increase the risk of depression. For more information, see the symptoms section.
Polycystic ovary syndrome is likely to be caused by a combination of lifestyle factors and the genes you’ve inherited. Although it’s not possible to cure it, changes to your lifestyle may help to reduce symptoms. See our section on self-help for more information.
If you have polycystic ovary syndrome (PCOS) you might have difficulty getting pregnant. Irregular periods, fewer periods, or none at all can make it more difficult to conceive. If you’re having difficulty conceiving, treatment for PCOS may help you to have a baby. See our section on complications for more information.
Polycystic ovary syndrome (PCOS) is likely to be caused by a combination of things. But your risk may be higher if your mother or sister has the condition. We now know of some genes that are linked to PCOS. See the section on causes of PCOS for more information.
Benefits of exercise
Not only does regular exercise help you manage your weight and reduce your risk of developing diseases, it can help prevent and treat mental health problems
Tips for a healthy and well-balanced diet
A healthy, well-balanced diet involves eating foods from a variety of food groups to get the nutrients that your body needs to function.
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- Liz Woolf, Freelance Health Editor
