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Polycystic ovary syndrome (PCOS)Published by Bupa's health information team, February 2008. This factsheet is for women who have polycystic ovary syndrome, or people who would like information about it. Polycystic ovary syndrome (PCOS) is a condition in which the ovaries aren't working properly. The exact number of women affected by PCOS isn't clear. In the UK, it's estimated that between five and 26 of every 100 women may have PCOS.
About PCOSIf you have PCOS you will usually have two out of three of the following.
If you have cysts on your ovaries it doesn't necessarily mean you have PCOS. It may be another condition or they may be harmless. An ovaryWomen have two ovaries, which are small organs inside the body where eggs (ova) mature and are then released (ovulation). This happens about once a month. The ovaries produce the hormones oestrogen and progesterone. A cystA cyst is a fluid-filled sac. Before ovulation, the egg develops in a small swelling on the ovary called a follicle. Cysts form when follicles stop growing too early. Instead of bursting to release the egg, they gradually build up on the ovaries to form lots of small cysts. These cysts are swollen egg chambers. They are benign which means they are not cancerous. What is a polycystic ovary?Polycystic means 'many cysts'. A polycystic ovary is generally an ovary with 12 or more cysts that are two to nine millimetres in size. Sometimes the cysts are only found on one ovary. It's possible to be diagnosed with PCOS without having cysts on your ovaries.
Symptoms of PCOSWomen with PCOS may start to notice problems in their late teens or 20s. Symptoms can include:
Causes of PCOSThe exact cause of PCOS isn't known. Several factors seem to be important. PCOS runs in some families, so there may be a genetic link. PCOS may be caused by higher than normal levels of certain hormones. One of the hormones involved is insulin, which controls your blood sugar level. Many women with PCOS have insulin resistance. This means the level of insulin in the blood needs to be higher than normal to control your blood sugar level. The high level of insulin causes the ovaries to make too much testosterone, which results in the symptoms such as excess hair and acne. Excess body fat can make insulin resistance worse, increasing your insulin level. The level of another hormone called luteinising hormone (LH) is also important. This is raised in some women with PCOS. LH acts together with insulin to increase levels of testosterone in the body. Diagnosis of PCOSIf your GP thinks that you have PCOS, he or she may refer you to an endocrinologist, a doctor who specialises in hormones, or a gynaecologist who specialises in women's reproductive systems and hormones. There is no single test to diagnose PCOS. Your doctor looks for the signs of it and rules out other problems that may cause similar symptoms. You might have the following tests.
Treatment of PCOSSelf-helpLifestyle changes may help to control the symptoms of PCOS. Eating a healthy, balanced diet and exercising regularly can help to reduce insulin resistance, improve fertility and help ensure you are a healthy weight. If you have excess hair, you can control this with hair removing creams or by bleaching, shaving, waxing or plucking. Laser treatment and electrolysis can give longer lasting results but need to be performed by qualified professionals. Being overweight worsens the hormone imbalance that causes excess hair growth, so try to lose excess weight if you need to. MedicinesSeveral medicines can help deal with individual symptoms of PCOS. Topical (applied to the affected skin) treatments can be used to treat acne. Benzoyl peroxide is included in many non-prescription acne treatments (eg Oxy lotion) which you can purchase. Your GP may prescribe antibiotic tablets or cream if over-the-counter treatments don't help. Isotretinoin (eg Roaccutane) is available on prescription from a dermatologist, a doctor who specialises in skin conditions, to help you to control acne. You should not take isotretinoin if you're pregnant and you shouldn't become pregnant for one month after taking it because it can harm an unborn baby. Oral contraceptives (the pill) can improve acne and excess hair because they reduce the production of testosterone by your ovaries. The pill also means that you have regular periods, which lowers the risk of womb cancer. A combination of the usual pill hormone (which is called ethinylestradiol), along with cyproterone acetate (eg Dianette) suppresses testosterone activity so is often used for women with PCOS. Ask your GP for advice. InfertilityIf your BMI is more than 29 and you're not ovulating, you may need to make lifestyle changes, such as eating a healthy diet and exercising, will help you lose excess weight. This can increase your chances of getting pregnant. If you are still having difficulty getting pregnant there are several treatments available. You should see an infertility specialist to discuss which is best for you. Fertility medicines such as clomifene stimulate your ovaries to release eggs. You can take this for up to a year. If you have been ovulating with clomifene but haven't become pregnant after six months, your doctor might suggest intrauterine insemination, where sperm is placed directly into your womb. Metformin is a medicine that reduces insulin resistance and may improve fertility (as well as reduce excess hair). You may have it along with clomifene if you don't ovulate with clomifene alone. Metformin is only licensed for the treatment of diabetes in the UK. Ask your doctor for advice. Hormone injections with human gonadotrophin hormone (a mixture of luteinising hormone and follicle stimulating hormone) may be offered if clomifene has not worked for you. You can have keyhole surgery to make tiny holes in the surface of your ovary to stimulate it. This is known as laparoscopic ovarian drilling. It's as effective as hormone injections, and it might be an option for you if clomifene doesn't make you ovulate. Assisted conception, such as IVF (in vitro fertilisation) is another possibility. You could also consider other forms of assisted conception such as egg donation or surrogacy. Living with PCOSWomen with PCOS tend to have a higher risk of developing diabetes and heart disease later in life, but there doesn't seem to be an increased risk of dying before the age of 75 compared to women without PCOS. A healthy lifestyle can help prevent long-term health problems. For example you should:
You might be at an increased risk of womb cancer if you have periods less often than every three or four months. Further information
Related topics
Sources
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: February 2008.
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