Polycystic Ovary Syndrome (PCOS)

This is an extremely common condition which affects about 5-10% of women of childbearing age, producing three groups of symptoms:

1. Anovulation: In ‘normal’ women, the pituitary gland at the base of the brain, directs one egg in an ovary to develop per month through a complex sequence of hormone changes. In PCOS,however, either no eggs develop at all or many eggs develop together, but fail to reach maturity turning into ‘cysts’ within the ovary.

The consequences of this abnormality may be:

a)Long Cycles (85% of women with cycle length > 35 days have PCOS), sometimes amounting to 'oligomenorrha (infrequent, irregular cycles) or even amenorrhea (no periods at all).

b) Menorrhagia (heavy periods)

c)Delayed menarche (i.e.’periods don’t begin until age 14 –17)

d)Infertility

e) Increased likelihood of developing diabetes during pregnancy.

f) Increased risk of miscarriage (recurrent).

2. Excess Androgen (male hormone) production by the ovary; this may lead to acne and/or increased amounts of facial or bodily hair and/or deepening of the voice.

3. Insulin resistance. This means that the pancreas has to produce more insulin than normal to maintain normal blood sugar levels. This worsens blood fats and make diabetes more likely in the long term.

The severity of the condition in any person is worsened by the excess weight she carries.

The starting point of all treatment is therefore to lose weight; this by itself will dramatically improve Insulin Resistance and help reverse the condition. At the moment of writing, only one drug which clinically improves insulin resistance is available in the UK (others are pending); this is called metformin and as this improves appetite control it is the writers' view that all women with PCOS should be offered this medication. Exercise also improves Insulin Resistance and regular daily exercise is mandatory. This combined approach (metformin, exercise and weight reduction) not only improves the symptoms of the disease but dramatically reverses the increased risks of diabetes, high blood fats and heart disease to which these patients are hostage.

What else can be done?

1. For acne/hirsuites, androgen blocking medications are available (spironolactone or cyproterone).

2. Cycle control with 'the pill' - especially if contraception is required. Remember that pregnancy can occur in PCOS, but even if no contraception is required, a regular period is needed to prevent build-up of the womb lining and possible cancerous change there.

Making the Diagnosis.

Although the diagnosis can be confidently made from the history of the symptoms, it is often necessary to exclude a few related conditions and firmly establish the diagnosis by:

1.Ultrasound Scan of the ovaries will usually reveal the tell-tale cysts on the ovaries.

2.Blood Tests. The female sex hormone - oestrogen - is normal, but the male hormone is raised. Other hormone changes may include raised Luteinising Hormone (LH - from the pituitary).

Remember: Weight reduction will improve all aspects of this condition and remains the single most important means of helping yourself

Professor Nancy Bohannon, San Francisco /Doctor Bernard Shevlin, Old Rd., Tean Staffs.