Polycystic ovarian syndrome (PCOS) is a complex hormonal condition. It affects 12 to 21 % of Australian women of reproductive age. PCOS is relatively common, especially in infertile women. But almost 70 per cent of these cases remain undiagnosed. ‘Polycystic’ literally translates as ‘many cysts’. This really refers to there being many partially formed follicles on the ovaries, which each contain an egg. These rarely grow to maturity or produce eggs that can be fertilised.
Up to a third of women may have polycystic ovaries seen on an ultrasound, but they do not all have PCOS. Diagnosis of PCOS is made if at least 2 of the 3 Rotterdam criteria are present. Women with PCOS commonly have elevated levels of insulin or androgens, or both. While the cause of PCOS is unknown there do appear to be connections with family history, insulin resistance, lifestyle and environment. Insulin resistance is thought to be the key problem driving this syndrome.
Immediate female relatives (i.e. daughters or sisters) of women with PCOS have up to a 50% chance of having PCOS. Type 2 diabetes is also common in families of those with PCOS. There is no clear genetic contributor to PCOS currently identified and the link is likely to be complex and involve multiple genes. In some women, PCOS can run in the family, but for others, the condition only occurs when they are overweight. Such women may also have varying degrees of insulin resistance and an increased incidence of Type II diabetes, unfavourable lipid patterns (usually high triglycerides), and a low bone density. Laboratory tests often show higher than normal circulating androgens, especially testosterone.
PCOS affects women differently, with some having only mild symptoms, and others being affected quite severely. In younger women, reproductive symptoms predominate. The prevalence of metabolic features increases with age but can also occur in younger women who are overweight. Hyperandrogenaemia and insulin resistance are the pathophysiological features of PCOS. Symptoms can include hirsutism, acne, weight gain, hair loss, difficulties with fertility, increased anxiety, depression, and symptoms associated with periods.
Depending on the symptoms experienced, management of PCOS can include:
- lifestyle modifications – increasing physical activity levels and eating a healthy diet can both help to manage PCOS.
- weight reduction – If overweight, even a small reduction in weight (eg. 5-10%) can help significantly with improving regular menstrual cycles and fertility.
- medical treatment – with hormones, mainly progesterone.
It is important that all the symptoms of PCOS are addressed and managed long term, to avoid associated health problems. PCOS is a long-term condition and long-term management is needed. The focus should be on accurate diagnosis, prevention and management of excess weight gain, as well as long term support and management of psychological, metabolic and reproductive health.