Nutrition, no fuss > PCOS
Polycystic ovarian syndrome
What is PCOS?
Polycystic Ovary Syndrome (PCOS) is a hormone or endocrine syndrome
or group of clinical symptoms and was first described by doctors in the
1930s.
In PCOS characteristically there is an excess of androgens (male-like
hormones) and lack of regular ovulation (release of an egg from the
ovary). It is sometimes also referred to as “hyperandrogen anovulation
syndrome” or “Stein Leventhal Syndrome”.
How Common is PCOS?
PCOS (with clinical symptoms) affects between 5-10% of all women of
childbearing age. However around 20-25% of premenopausal women have
polycystic ovaries mostly with no symptoms and therefore do not have the
“syndrome”.
What causes PCOS?
The exact cause is unknown but there appears to be a hereditary and a
lifestyle component e.g. sisters of PCOS sufferers have up to a 50% chance of
having the disorder and 70% of women with PCOS are overweight and not physically
active.
The ovary produces excessive androgens (eg testosterone), which may be caused by
the body not producing and/or processing the hormone insulin normally.
The “cysts” seen in the ovary in PCOS are follicles or eggs which have matured
but not released, so giving a “space-craft like” appearance. On pelvic
ultrasound the diagnosis of polycystic ovaries is confirmed if there are more
than 15 follicles visible in an ovary.
In a normal ovary only one egg matures and is released (ovulation) each
menstrual cycle.
Symptoms explored
There are many symptoms but each woman will be quite individual in her
presentation. Symptoms may present from puberty but may begin in the twenties.
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Period problems |
Weight problems or obesity |
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Some women have normal regular periods whereas most will have some changes
to their cycle. Sometimes bleeding is heavy but it can also be lighter. The
periods may be or become irregular and may stop altogether.
In the teenage years this maybe normal and
can delay diagnosis of PCOS. When chronic
anovulation (lack of egg being released
regularly) occurs the lining of the uterus
(endometrium) may thicken and may lead to
abnormal cell changes and an increased risk
of uterine and endometrial cancer as women
age. |
Two thirds of PCOS sufferers are affected by weight problems. The weight gain is usually in the
abdominal region giving an “apple” shape. This shape carries a higher risk
of cardiovascular disease including high blood pressure and heart disease.
The weight gain is associated with the body not processing insulin normally.
Insulin resistance is caused by weight gain and in itself does
not necessarily cause weight gain. The remainder of PCOS sufferers are
either normal or underweight.
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Reduced fertility or infertility |
Hirsutism |
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This is usually related to the lack of egg release or ovulation and can be
complicated by being overweight.
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Excess of hair on the face and body due to
the excess in androgens. The hair can
increase of the sideburn area, chin, upper
lip, around nipples, lower abdomen, chest
and thighs. |
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Alopecia |
Acne |
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Loss or thinning of scalp hair in a
“male-like” pattern.
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Can increase on face and body with the
increase in androgens. |
Risks
With the increase in androgens, menstrual problems and changes
in insulin there is an increased risk of:
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lipid abnormalities including high cholesterol, low HDL &
high LDL cholesterol (the different forms of cholesterol)
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diabetes, insulin resistance or elevated insulin levels
Potential risks
There may be an increased risk of cardiovascular disease
including high blood pressure and heart disease, this has yet to be clarified.
Endometrial or uterine cancer may be increased as oestrogens
produced by the ovaries can overstimulate and thicken the endometrium or
womb lining and is associated with chronic anovulation
Psychological Effects
Self-esteem and a sense of one’s body image may be affected by
the symptoms of hirsutism, acne, hair loss, obesity and fertility problems.
Other psychological reactions may occur relating to issues of femaleness,
femininity and sexuality and can contribute to depression, social isolation and
other mood changes.
Investigations
A range of investigations may be undertaken however not all tests are necessary in every woman. Other conditions of the adrenal glands, ovaries or pituitary
gland will also be ruled out by other tests if necessary.
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Investigations |
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A thorough medical history and examination
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A transvaginal ultrasound of the uterus, ovaries and the
pelvis |
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Blood tests for androgens (testosterone, DHEAS,
androstenedione), sex hormone binding globulin (SHBG) and free androgen
index (FAI)
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Blood tests for oestradiol, FSH (Follicular Stimulating
Hormone) and LH (Luteinizing Hormone) |
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Blood tests for thyroid TSH and Prolactin levels which can
mimic PCOS symptoms |
Blood tests for fasting glucose, insulin and cholesterol
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Management
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Lifestyle changes |
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1. Loss of weight (even a 5% loss of weight will reduce insulin
resistance and result in symptom improvement).
- It will restore ovulation
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reduce symptoms
- reduce risk of diabetes & insulin resistance and
cardiovascular disease (CVD)
- dietary plan similar for diabetics with low GI (Glycaemic
Index) foods
- high protein/ low carbohydrate diets good in initial weight loss
phase
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2. Exercise (even without wt loss, this effectively reduces
insulin resistance, 10,000 steps per day with a simple pedometer is very
effective cheap and achievable for most women).
- regular low fat burning
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improves self esteem
- reduces CVD risk
reduces weight
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3. Support Groups
Polycystic Ovary Syndrome Association of Australia (www.posaa.asn.au)
PCOS Support (www.pcosupport.org (USA)) |
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Medications |
Period Problems:
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oral contraceptives (Diane/Brenda/Juliet or low dose pills)
“the pill” will regulate the period, eliminate a troublesome period or and
may reduce risks of endometrial cancer. Because of the lack of ovulation
oestrogen levels may be normal or high and therefore increase the risk of
abnormal cell changes in the lining of the uterus (endometrium).
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Hirsutism – Anti-androgen therapies:
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oral contraceptives (Diane/Brenda/Juliet) contain small
amount of anti-androgen, cyproterone acetate, but concerns of possible side
effects of weight gain, ovarian cysts and change in glucose tolerance.
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Cyproterone acetate is an effective anti-androgen often used
with “the pill”. Side effects may include weight gain, depression, reduced
libido and tiredness.
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Spironolactone is a diuretic (fluid tablet) which also is an
effective anti-androgen and should be used only in women who are not trying
to conceive because of the possibility of foetal abnormalities (birth
defects)
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Metformin, a drug for diabetes, reduces the insulin level
and insulin resistance leading to a reduction in testosterone and therefore
an effect on hair growth.
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Acne:
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the pill effectively reduces acne
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the anti-androgens, cyproterone acetate; “the pill” or
spironolactone reduce acne by reducing testosterone.
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Roacutane for acne.
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Metformin by reducing testosterone.
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Alopecia:
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Reduced fertility
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ovulation needs to be monitored and sexual intercourse timed to coincide
with ovulation. There are over-the-counter kits available to measure LH,
which goes up at ovulation. Temperature charting can show ovulation change
but is not a reliable indicator. A progesterone level taken about seven days
after expected ovulation will determine if ovulation has occurred (day 21
progesterone in a 28 day cycle). If ovulation is not regular, even modest
lifestyle change and weight loss can effectively improve ovulation. Also
medications to induce ovulation maybe required.
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Referral to a fertility specialist is necessary for further treatment.
Ovulation may be induced by oral Clomiphene,. Metformin (comment” based on
recent Cochrane review) or FSH injections. It may be necessary to proceed to
assisted reproduction techniques including IVF although these are more
effective in those women who have instituted lifestyle change effectively
first.
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Alternative therapies
Natural remedies should only be prescribed by an experienced
qualified practitioner with an interest in women’s health including fertility.
There are no clinical trials at present that have been completed on alternative
therapies in this area.
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Summary
Polycystic Ovary Syndrome is present in 5-10% of all childbearing
aged women. It is characterised by an excess of androgens and problems
of insulin activity.
Management and treatment will depend on a woman’s individual symptoms.
Lifestyle changes remain the most important aspect of management.
Medications used to treat symptoms include oral contraceptives, anti-androgens, metformin
and alternative therapies.
Infertility may require the expertise of a fertility specialist for ovulation
induction and/or assisted reproductive techniques.
Future
Our understanding of PCOS has come a long way in recent times, but there is a
lot more we need to know. Active research continues into the causes, mechanisms,
prevention and treatments and we should all look forward to increasing our
knowledge on this common condition in the not too distant future.
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For more information
The Jean Hailes Foundation for Women's Health
- Managing PCOS Website
http://www.managingpcos.org.au/
Phone: 1800 151 441 or (03) 9562 6771
Understand your health Features
Content updated February 16, 2007
Page updated
April 29, 2008
