“I am 25 years old, a newlywed and recently got diagnosed
with PCOS. Every time I see baby things, watch baby stories on tv and in movies
I get very emotional. I am very excited to start a family soon and now I hit
this road block. I get a lot of positive talk that it is something that can be
fixed and there still is hope, but to me it is devastating. I was also told
that a lot of worrying can effect things too, that isn't good because I worry
about everything under the sun. I am trying to lose weight, I just lost 18kg in
a year for myself, so losing more sounds hard to do right now, I am not
morbidly obese just a little extra here and there. Although I here PCOS is
highly hereditary and my mother tried for 8 years to have me although she had
normal menstrual cycles. If anyone could share with me their positive stories
that have PCOS that would do me a world of good”
This was a genuine concern from one among many women who was
diagnosed with polycystic ovary syndrome. Let us have a look about this
condition.
What is polycystic ovary syndrome?
Polycystic ovary syndrome (PCOS) is a condition which can
affect a woman’s menstrual cycle, fertility, hormones and aspects of
appearance. It can also affect long-term health.
What are polycystic ovaries?
Polycystic ovaries are slightly larger than normal ovaries
and have twice the number of follicles (small cysts). Polycystic ovaries are very
common affecting 20 in 100 (20%) of women. Having polycystic ovaries does not
mean you have polycystic ovary syndrome. Around 6 or 7 in 100 (6-7%) of women
with polycystic ovaries have PCOS.
What are the symptoms of PCOS?
Irregular periods or no periods at all
Difficulty becoming pregnant (reduced fertility)
Having more facial or body hair than is usual for you
(hirsutism)
Being overweight, rapid increase in weight, difficulty
losing weight
Oily skin, acne
Depression and mood swings
The symptoms may vary from woman to woman. Being overweight
increases the risk of developing symptoms.
What causes PCOS?
The cause of PCOS is not yet known. PCOS sometimes runs in
families
The symptoms of PCOS are related to abnormal hormone levels.
Testosterone is a hormone which is produced by the ovaries. Women with PCOS
have slightly higher than normal levels of testosterone and this is associated
with many of the symptoms of the condition.
Hormone Insulin also has a role. If you have PCOS, your body
may not respond to the hormone insulin (known as insulin resistance), so the
level of glucose is higher. To prevent the glucose levels becoming higher, your
body produces more insulin. High levels of insulin can lead to weight gain,
irregular periods, infertility and higher levels of testosterone.
This disorder affects the function of the ovaries, which
produce eggs and the hormones oestrogen and progesterone. Other imbalances
affect hormones produced by the brain and include elevated levels of
luteinising hormone (LH) and a relative deficiency of follicle-stimulating
hormone (FSH), both of which control the release of eggs from the ovaries. As
the ovaries aren’t working properly, eggs may not be released in a regular
monthly cycle.
How is PCOS diagnosed?
PCOS is a syndrome where at least two of the following
occur:
At least 12 follicles (tiny cysts measuring 2 to 9 mm)
develop in your ovaries. (Polycystic means 'many cysts'.)
Ovulation may not occur regularly. Some women with PCOS do
not ovulate at all. If you do not ovulate then you may not have a period.
The balance of hormones that are made in the ovaries is
altered. In particular, the ovaries make more testosterone than normal.
How is it treated?
Unfortunately there is no cure for PCOS. However, symptoms
can be treated, and the health risks can be reduced.
The cysts in polycystic ovaries are not harmful and do not
need surgical removal.
If overweight, losing a few pounds may be enough to get the
ovaries working properly again, as the more fat is carried, the higher the
insulin levels are likely to be. Unfortunately, a lot of women with PCOS
struggle for years to lose weight and have little success, so hormone treatment
may be needed to restore the hormonal balance.
Some women, who have no periods, or infrequent periods, do
not want any treatment for this. However, the risk of developing cancer of the
uterus (womb) may be increased if you have no periods for a long time or have
less than four periods a year. Regular periods will prevent this increased risk
to the uterus.
Possible treatments include the oral contraceptive pill ,
progestogen tablets taken to induce regular withdrawal bleeds or a progestogen
releasing coil.
An oral contraceptive Pill called Dianette is often used as
it helps suppress testosterone levels and control acne and body hair growth
A promising new treatment currently being researched is a
drug called Metformin, which makes tissues in the body more sensitive to
insulin, helping bring insulin levels back to normal. However the current
evidence is not enough to suggest that Metformin can improve fertility as well
as the metabolic function in PCOS.
Finally, physical treatments such as electrolysis and laser
hair removal are also helpful.
Is infertility inevitable?
Not at all. Regular periods usually mean there isn’t a
problem. Irregular periods indicate
irregular ovulation and about half of those with symptoms suffer from
infertility as a result of not ovulating. The first treatment that’s usually
tried is stimulation of the ovary with the tablet Clomiphene. This induces
ovulation in about 70 per cent of women, and about half of these women will
become pregnant within six months. If this fails, injections of FSH may be
tried and this triggers ovulation in around 80 per cent of women treated, of which about 60 per cent
will conceive within six months. It’s vital, however, that ovarian stimulation
is monitored by ultrasound in a fertility unit as women with PCOS have a
tendency to develop a high number of eggs. This not only raises their risk of a
multiple birth, but also of a potentially serious condition known as ovarian
hyperstimulation syndrome (OHSS).
Is laparoscopy has any role?
If drug treatment doesn’t work, laparoscopic surgery that
involves cauterising the ovary(making few punctures) is very successful in triggering ovulation
without the risk of hyperstimulation. Laparoscopy can also can identify and
treat the other causes of infertility if present.
Remember, you are much less likely to become pregnant if you
are obese. If you are obese or overweight then losing weight is advised in
addition to other fertility treatments.
What are the long term health risks?
Diabetes – 10-20% women with PCOS go on to develop diabetes
High blood pressure
Heart disease
Cancer of the uterus
What can be done to reduce long-term health risks?
Healthy life style:
Healthy diet, regular exercise and weight reduction should
help to reduce the long-term health risks.
You should aim to keep your weight to a level which is normal
(a BMI between 19 and 25)
Regular health checks:
Women with PCOS over the age of 40 should be offered a blood
sugar test once a year to check for signs of diabetes.
After the menopause it would be wise to have regular
cholesterol and blood pressure checks so early signs of disease can be treated.
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