Polycystic Ovary Syndrome
What is it?Polycystic ovary syndrome (PCOS) is recognised by the presence of large pearly-white ovaries that have partially grown eggs arranged in circular patterns under their surface. It may develop eventually in any woman who does not ovulate for a prolonged period. It is thus associated with anovulation (absence of ovulation), absent or irregular menstrual periods and abnormal female hormone levels. Some affected women may also be overweight. Blood levels of male-type hormones may be raised in some women leading to excessive growth of facial and body hair, oily skin and acne.What causes it?The cause of this condition was an enigma to doctors for many years. It is now recognised that polycystic ovaries usually results from an inappropriate release of hormones from a gland in the brain (pituitary). The condition frequently follows a prolonged period of anovulation resulting from any cause. Such causes include excessive blood levels of prolactin and thyroid hormone, as well as low levels of thyroid hormone. They also include stress, anxiety, extreme physical exertion (as with athletes), profound weight loss or gain (greater than 15% of body weight), anorexia, and serious illness. The condition appears to run in some families and may thus be inheritable.Is it harmful?Polycystic ovary syndrome is the commonest cause of absence of ovulation and can lead to infertility. Even when a pregnancy takes place, there is a higher risk of miscarriage. One of the typical features of this condition is a persistently raised blood level of the female hormone oestrogen that over a prolonged period can induce pre-cancers of the lining of the womb and breasts.How is it investigated?The first step is a detailed history and examination. The examination particularly focuses on the woman's weight for height ratio (body mass index) and body hair distribution, as well as a search for possible causes. Any abnormalities of the vagina, womb and ovaries are also noted. Blood tests are done to measure hormone levels and these may confirm absence of ovulation, as well as problems with the ovaries, adrenals and pituitary glands. Ultrasound of the abdomen and pelvis are usually also performed to search for swellings of these glands.How is it treated?The treatment of PCOS depends on the most prominent features and the woman's wishes. Excessive weight gain is often associated with this condition and losing the appropriate amount of weight may be enough treatment. Treatment may not be required if the condition is neither causing menstrual disruption, cosmetic problems nor preventing pregnancy.• Hormone treatment - absent or irregular periods may be corrected by using an appropriate combined oral contraceptive pill or simply progesterone tablets. It is important that women with PCOS have at least four menstrual periods every year to prevent the development of pre-cancers of the lining of the womb. Women who have fewer periods than these need to be on medicines that will induce periods in them every 1-3 months. Oily skin, acne and excessive growth of facial and body hair may be treated with hormone (anti-androgen) tablets and/or cosmetic procedures like electrolysis. • Ovulation induction - this is the appropriate form of treatment when fertility is an issue and it may be achieved using tablets or injections. The tablets are normally given daily for five days during the menstrual period and the doctor may confirm that ovulation has indeed occurred by doing a blood test and/or ultrasound scan. The injections are given daily for anything from 7 to up to 28 days and the woman's response is monitored by regular blood tests and/or ultrasound scans. The tablets are usually available at both local health centers and hospitals but the injections need to be given in hospital. About three-quarters of treated women would ovulate successfully but only a third of them become pregnant. Ovulation induction can result in the birth of twins or triplets (up to 1 in 4 women), as well as in a condition of the ovaries called 'ovarian hyperstimulation syndrome' (up to 1 in 10 women). • Surgery - this involves placing a few holes in one or both ovaries during laparoscopy. It results in ovulation and pregnancy rates that are similar to the ones obtained following use of medicines. Useful contacts: VERITY Polycystic Ovary Syndrome Support Group Tindle Manor 52-54 Featherstone Street London EC1Y 8RT Back top top > |
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