Polycystic ovary syndrome (PCOS)
This is the commonest hormonal condition in young women. It affects up to 10% of women and presents with a variety of symptoms. These include acne, irregular, usually less frequent periods, increased levels of body hair (hirsutism) and a tendency to be overweight. Between 35 – 60% of women with PCOS are overweight. There may be problems with subfertility.
Random ultrasound scanning of women will reveal that as many as 20% may show polycystic changes in their ovaries. This alone, however is not sufficient to make the diagnosis. One or more symptoms must also be present. It is not yet clear whether those women showing polycystic change in their ovaries on routine scan will go on to develop the full syndrome. Blood tests can be helpful in making the diagnosis.
The symptoms are caused by a hormonal imbalance. An increase in the levels of circulating male hormones (androgens) causes acne and hirsutism. Other hormonal disturbances cause the menstrual irregularities and problems with fertility. It seems that women with this syndrome are unable to develop eggs in a regular fashion and it may be difficult for the ovary to develop any single egg to the point where it is mature enough for ovulation to occur. This results in irregular and often infrequent periods.
Whether treatment is warranted depends on the severity of symptoms, in which there is wide variation. Taking the combined oral contraceptive pill will help women who present with troublesome acne and irregular periods. This reduces the amount of circulating androgens (male hormones) and regulates the periods. One pill in particular helps with acne and hirsutism. It contains a drug called cyproterone acetate which it is a particularly potent anti-androgen.
Drug therapies may take six to nine months or longer before any improvement of hirsutism is perceived. Physical treatments including electrolysis, waxing and bleaching may be helpful whilst waiting for medical treatments to work. Regrowth is not uncommon and there is no really permanent cosmetic treatment but the last few years have seen much development in the use of laser techniques.
Women suffering from the most severe form of PCOS who are obese are at increased risk of developing diabetes, heart disease and cancer of the lining ot the womb (endometrial cancer) and may need additional treatment. The increased risks caused by their weight may mean that they may not be able take the combined oral contraceptive pill. Endocrinologists have been using a drug called metformin, which is an anti-diabetic agent, to good effect. Taking the contraceptive pill may help to protect the lining of the womb.
Reduction of weight helps all the symptoms of PCOS and is an important objective in treatment, but weight loss may be more difficult for women suffering from the severest form.
Problems with fertility will need to be treated by a gynaecologist. Treatments vary from simple ovulation induction by hormones to complex specialist regimes.
Relevant Web Sites http://www.verity-pcos.org.uk/
Women's Health Information
This article published on
12 December 2005
Next review date 01/12/2013