Home
Bupa members

Support and offers for individual members and customers

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 PCOS

If you have PCOS you will usually have two out of three of the following.

  • High levels of the male hormone testosterone, which is produced by the ovaries, and/or signs of having high levels of testosterone (such as excess body hair or thinning of the hair on your head).
  • Irregular or no ovulation, which usually means irregular or no periods.
  • Many small cysts on your ovaries which are called polycystic ovaries.

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 ovary

Women 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 cyst

A 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.

Illustration showing an ovary affected by polycystic ovary syndrome
An ovary affected by polycystic ovary syndrome

Symptoms of PCOS

Women with PCOS may start to notice problems in their late teens or 20s. Symptoms can include:

  • absent, infrequent or irregular periods
  • infertility - you need to ovulate to become pregnant and you may not be ovulating regularly or at all
  • obesity or being overweight, especially with excess fat around your waist
  • excess hair (hirsutism) on your face, around your nipples or on your lower tummy
  • thinning of your hair on the top of your head
  • acne which lasts longer than your teenage years

Causes of PCOS

The 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 PCOS

If 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.

  • Blood tests are used to measure the levels of certain hormones, such as testosterone and luteinising hormone, to rule out other reasons for having no periods.
  • An ultrasound scan can be used to look at your ovaries to see if they appear enlarged and/or polycystic.

Treatment of PCOS

Self-help

Lifestyle 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.

Medicines

Several 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.

Infertility

If 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 PCOS

Women 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:

  • not smoke
  • do regular physical activity
  • eat a healthy, well-balanced diet

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

  • British National Formulary (BNF) March 2006. BMJ Publishing Group, 2006 51
  • Fertility: assessment and treatment for people with fertility problems. NICE. 2004 Clinical Guideline No 11.
    www.nice.org.uk
  • Polycystic ovary syndrome. GP Notebook.
    www.gpnotebook.co.uk
    accessed 17 April 2007
  • Long-term Consequences of Polycystic Ovary Syndrome. Royal College of Obstetricians and Gynaecologists. 2003. Care Guideline No 33.
    www.rcog.org.uk
  • Polycystic ovary syndrome. BMJ Clinical Evidence.
    http://clinicalevidence.bmj.com
    1 July 2006
  • Polycystic ovary syndrome. NHS National Library for Health Clinical Knowledge Summaries, 2007.
    www.cks.library.nhs.uk
    accessed on 16 April 2007
  • Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Human Reproduction 2004; 19(1):41-47

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.

 

Rate this page

Up to £100 off a Bupa Health assessment

Bupa health insurance

Free online health check

Bupa Care Homes

Bupa travel cover