Do you have polycystic ovary syndrome?
Panicked about Polycystic ovary syndrome? PCOS is an incredibly common condition that affects how a woman's ovaries work, but still comes with its fair share of confusion.
We speak to Consultant Obstetrician and Gynaecologist Dr Amma Kyei-Mensah, Director of IVI Fertility Dr Manuel Fernandez and fertility expert Dr Geetha Venkat about PCOS symptoms, treatment and fertility tips:
What is polycystic ovary syndrome?
Up to 10 per cent of women of reproductive age are thought to have PCOS, a condition which affects how a woman's ovaries work.
So what exactly is PCOS? Often the outer surface of the ovary has several small cysts. These cysts can prevent the eggs from fully maturing and being released, so a woman with PCOS may ovulate less frequently and have irregular (or absent) periods. If this happens, she might find it more difficult to get pregnant.
PCOS is also associated with a number of other symptoms including:
Difficulty losing weight
Irregular periods
Fertility
What if you only have some symptoms?
One of the biggest misconceptions about PCOS is that it's a single entity, rather than a collection of signs and symptoms. In fact, it's a condition that can end up being diagnosed by a range of healthcare professionals: from dermatologists to metabolic physicians.
'One of the features could be multiple small cysts on your ovaries on a scan. Another feature might be acne or unwanted hair on your face, breast, lips or tummy,' says Dr Kyei-Mensah. 'Alternatively there could be irregularities in your menstrual cycle. You need two out of three of these features to be considered as having polycystic ovarian syndrome.'
There is no typical PCOS patient. If you have many small cysts on your ovaries and irregular periods, even if you have clear skin and no problems with body hair, you could have the syndrome. Likewise, you could have serious acne and absent periods but your ovaries look fine on a scan, and you could still have PCOS.
Is there a PCOS and testosterone link?
Some women, particularly those with excess body hair and acne, may find they have raised male hormones (called androgens), usually testosterone. But other women with much higher androgens may have flawless skin and hairless thighs.
It's not just about the amount of androgens, but also about how your body (usually your skin or hair follicles) responds to the hormone that's important. Some women just have more sensitivity to androgens so even normal testosterone levels may be associated with acne and unwanted hair in some cases.
Will you have problems conceiving?
If you don't have any other symptoms of PCOS, you will most likely not struggle to conceive. A lot of women who have an ultrasound scan for reasons unrelated to their fertility (such as abdominal pain) find out they have cysts on their ovaries and worry needlessly.
'A polycystic ovary on scan without any of the other symptoms is a very common finding,' says Dr Kyei-Mensah. 'Women become very upset when they go and look it up online, but they're usually fine.'
⚠️ If you are concerned that you might have PCOS or have any questions about your fertility, visit your GP or a fertility specialist.
Can the contraceptive pill control PCOS?
If you're not looking to get pregnant, birth control pills will likely help a lot of PCOS symptoms – particularly those associated with male hormones like excess body hair and acne. Certain brands of the pill such as Dianette and Yasmin are ideal for these symptoms because they contain an anti-androgen to reduce the effect of male hormones.
But whatever brand you go for, the pill will regulate your periods by giving you a light withdrawal bleed every month when you stop the pill for a week so you'll be able to be sure you're not pregnant. Dr Kyei-Mensah recommends that women with PCOS who aren't having periods and are not on the pill should bleed at least a few times a year, so that the lining of the womb is definitely shed.
'If you have PCOS, your ovaries still make plenty of oestrogen and there's a small risk that you could make a thickened womb lining that could develop abnormal cells,' says Dr Kyei-Mensah. 'That's why we recommend at least 3 – 4 periods a year for women with PCOS who don't normally have periods.'
Will weight loss help PCOS?
Weight loss can make a positive impact and might restore your periods, but only if you're already overweight to begin with. 'Losing weight is one of the main lines of treatment and it can be as efficient as some treatments with hormones,' says Dr Fernandez.
If you're slim however, dieting is not a good idea, but eating healthily and taking regular exercise is still important.
Can you get pregnant if you have PCOS?
Can you still get pregnant if you have polycystic ovary syndrome? If you're hoping to get pregnant and think you have PCOS, seek fertility help before the normal one year recommendation, says Dr Fernandez. If you've been trying for six months with no joy, it's worth chatting to a fertility specialist.
Dr Venkat says around 60 per cent of her patients have PCOS. And before IVF is considered, a medicine called clomifene is used to help a woman's eggs grow to maturation and be released in ovulation.
'Clomiphene is the basic underpinning of traditional fertility help, but some women won't respond. For these patients, we have to make the eggs grow directly by giving them hormones like FSH,' says Dr Venkat. 'Of course, if this doesn't work after trying for a few months, the woman might need to try IVF.'
Is there a link between PCOS and diabetes?
In recent years, PCOS has been linked to the way women's bodies use insulin – the hormone that controls sugar levels in your blood and determines how much is stored in fat cells for future use. Overweight women with PCOS are far more likely to develop type 2 diabetes than the average woman, but even if you're slim with PCOS, your risk is increased. So it's important to eat a diet that's low in sugar and exercise regularly, even if you're slim.
The diabetes drug metformin may be prescribed to women to reduce their insulin resistance, improve the regularity of their periods and may even reduce testosterone-associated symptoms like excess body hair and acne.
Does PCOS impact bone density?
Another common misconception is that women with PCOS aren't producing enough of the female hormone oestrogen, but this is rarely the case. In fact they often produce higher amounts. Oestrogen is needed to build a strong skeleton. Despite not having periods, women with PCOS still make plenty of oestrogen so they are not at risk of thin, brittle bones.
Last updated: 10-12-19
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