Polycystic Ovarian Syndrome (PCOS) is a common hormonal disorder in woman of reproductive age. The condition is caused by an imbalance of the female hormones (oestrogen and progesterone) which leads to the development of the multiple, small ovarian cysts from which the disease gets its name. Higher than normal levels of testosterone also contribute. It is thought that higher than normal levels of insulin contribute to the sex hormone imbalance.
It is estimated that between 10 and 20% of women are affected by the PCOS, and it can cause significant symptoms, including irregular menstrual cycles, decreased fertility and insulin resistance. PCOS is a risk factor for developing type 2 Diabetes.
Symptoms of Polycystic Ovarian Syndrome
Symptoms vary from woman to woman, but most often start with the onset of menstruation. Sometimes the disease develops later in the reproductive years. It can go undiagnosed for years, often only being discovered when a woman wants to get pregnant and finds she has fertility issues.
Most women won’t have all of the below symptoms, but have a combination including:
- Irregular periods. Menstruation may be more of less frequent, due to less frequent ovulation. Some women cease ovulating altogether and do not menstruate for many months or even years.
- Acne, probably due to increased testosterone levels
- Excess hair growth, particularly male pattern hair growth (facial hair, chest hair, back hair)
- Head hair loss
- Fertility problems – inability to become pregnant due to irregular or absent ovulation
- Mood problems – anxiety, depression, rage, mood swings that can be very severe, particularly in the luteal phase (the weeks between ovulation and menstruation)
- Weight gain/Obesity
- Heavy periods, and long lasting periods
- Insulin resistance/Prediabetes. The body becomes less sensitized to insulin, and isn’t able to process glucose efficiently, which can lead to elevated blood sugar and type 2 diabetes.
Women who have Polycystic Ovarian Syndrome tend to gain weight very easily and have a very hard time losing weight. This is thought to be because of the hormone imbalances, caused by insulin resistance.
It is thought that PCOS can be triggered by excess weight gain, and this can set up a vicious cycle. A woman gains weight, this triggers the hormonal imbalances that contribute to insulin resistance, which in turn makes it extremely difficult to lose weight. For some women, if they are able to lose weight, they can reverse symptoms. Others require medication.
Women with PCOS often find it difficult to conceive, and in many cases this is what leads to diagnosis of the condition.
Complications of Polycystic Ovarian syndrome
Women with PCOS are also at much higher risk of developing:
- Metabolic Syndrome (obesity, high blood pressure, cardiovascular disease (heart disease or stroke)).
- Endometrial cancer thought to be due to prolonged elevated oestrogen levels, and its effect on the lining of the uterus (endometrium).
- Diabetes
- High blood pressure
- High cholesterol
- Sleep apnea
- Depression/anxiety/mood disorders
- Abnormal uterine bleeding
- Gestational diabetes
Polycystic Ovarian Syndrome Diagnosis
While there is no single definitive test for PCOS, diagnosis relies on at least two of the following three being present:
- Irregular periods
- Excess male hormones – elevated levels of testosterone and other androgens seen on bloodwork.
- Polycystic Ovaries – the presence of numerous fluid filled cysts on the ovaries, seen on ultrasound.
Treatment of Polycystic Ovarian Syndrome
Polycystic Ovarian system is not curable so the aim is management. Depending on which symptoms a woman is experiencing, treatment involves lifestyle modification (healthy diet and exercise) and medication.
Weight loss is recommended, as research shows that even a 10% loss of bodyweight can result in hormones normalizing and symptoms remitting. As previously stated, however, the hormonal make up of a woman with PCOS makes weight loss very difficult.
It is important to undertake lifestyle changes, such as eating a healthy diet, and doing regular cardiovascular exercise. This can help with weight loss, but exercise can dramatically reduce insulin resistance, and decrease the chance of developing diabetes.
Birth control pills may be prescribed to regulate the menstrual cycle if the woman is not wishing to get pregnant.
Metformin, a drug prescribed for diabetes, is also often prescribed for PCOS as it improves insulin resistance and lowers insulin levels. Metformin may also help with ovulation, and regulating the menstrual cycle, and combined with diet and exercise, many women lose weight while taking it.
If a woman is trying to get pregnant, there are medications to induce ovulation, e.g. Clomiphene. These medications may also be taken with metformin to increase fertility. Ovarian drilling is a minor surgical procedure that can promote ovulation, and reduce androgen production in the short term.
If excessive hair loss is a problem birth control pills can be effective, as can spironolactone. Both of these block the production of androgens (male hormones).
I have always found this use of metformin interesting. Metformin acts in diabetes because it suppresses production of glucagon by the liver. For years we felt it only worked for type 1’s. Today we think it is helpful for many people with insulin resistance including those of us with type 1 (autoimmune diabetes). Thank you for giving me some more information about this medication.