PCOS - Polycystic Ovary Syndrome

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Polycystic ovary syndrome is a common hormonal problem usually, found in women of childbearing age. Women may complain of some or all or the following; infrequent or irregular menstrual periods, excessive body hair, difficulty with conceiving (from infrequent egg release form the ovary), excessive body weight and acne. If an ultrasound scan is performed of the ovaries, many tiny cysts/follicles (fluid filled spaces) are found arranged on the edge of the ovary. Women with PCOS commonly have slightly higher levels of male type hormones, however the levels are not as high as those usually found in men.  PCOS is thought to be present in about 5-8% of women in the childbearing age group. However the ultrasound scan findings may be present in up to 33% of women in the general population many of whom may not have any obvious problems. PCOS may also be commoner in the Asian population.


The exact cause of PCOS is not certain, however some of the following factors have been suggested. These include an alteration in the levels of hormones secreted by the hypothalamus (part of the brain), the pituitary gland (a small gland in the brain) and the ovaries at puberty, excessive resistance of the tissues to the effects of a hormone called insulin (insulin resistance), genetic inheritance and an interaction between excessive body weight and an underlying genetic tendency

Ultrasound Image of a Polycystic Ovary


Women with PCOS are at increased risk of Diabetes in later life especially if they are of excessive body weight. They may also be more likely to develop heart disease and cancer of the womb, however the exact risks of these latter two conditions have not been fully clarified.


The current diagnosis of PCOS is one of exclusion of other androgenic-based diseases following clinical identification of at least two of the following three criteria: chronic oligo-/anovulation (infrequent menstrual periods); clinical and/or biochemical signs of hyperandrogenism (excessive body hair and acne) and ultrasound evidence of polycystic ovaries.

In day to day clinical practice weight loss and weight maintenance are central to the care of women with PCOS.  This usually involves a combination of lifestyle advice on diet and exercise provided by a healthcare professional (Dietician, Nurse or Doctor), the use of anti-obesity drugs and in extreme cases anti-obesity surgery.  However, although some women with PCOS will successfully lose weight, weight maintenance is a real challenge in women with obesity with most women putting back the weight within a few years of losing the weight.

Infertility is best managed by a recognised PCOS specialist and the options include Clomiphene, Metformin, Gonadotrophins, Laparoscopic Ovarian Drilling or assisted conception.

Menstrual disorders can be managed using the combined oral contraceptive, cyclical progestogens or the Mirena Intrauterine System.

Hirsutism may be managed using mechanical methods (shaving, laser treatment, depilatory creams e.t.c), the combined oral contraceptive, cyproterone acetate, spironolactone, finansteride or flutamide.

Women have to be monitored for potential long term complications such as diabetes and womb cancer and advised to maintain a healthy lifestyle and avoid weight gain to prevent the risks of these occuring.



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