Polycystic Ovarian Syndrome (PCOS) is a common syndrome which is a hormone disorder and affects approximately 10% of women. It is a collection of problems that are found together and doesn’t affect everyone equally.
What is PCOS?
To be diagnosed with PCOS a woman has 2 out of three issues – lack of ovulation (anovulation), chronic high testosterone hormone levels (hyper-androgenism) and ovaries that have multiple follicles (over 20)
PCOS is diagnosed by a combination of history taking, examination, pelvic ultrasound and blood tests.
SYMPTOMS OF PCOS
- Irregular or missed menstrual periods
- Difficulty with weight (50% of women with PCOS are overweight)
- Increased hair growth (hirsutism)
- Thick endometrial lining as the lining is not shed regularly which can lead to episodes of abnormal bleeding and can be a precursor to endometrial hyperplasia (stage pre cancer) and then endometrial cancer
- Metabolic syndrome – which leads to elevated blood pressure, diabetes, increased risk of heart disease, obesity with weight increasing around the abdomen mainly
- Hormone evaluation including male hormones (often elevated)
- Full blood examination with LFT (there is a increased risk of fatty liver)
- Lipid profile (often abnormal lipid profile is detected)
- Glucose testing
- If pregnancy is not desired the oral contraceptive pill with an antiandrogen the best form of treatment and prevention
- If pregnancy is desired the oral therapies such as clomid or letrozole can be used (increased risk of multiple pregnancy of 10%)
- Lifestyle changes are important and a low carbohydrate diet should be followed
- Metabolic issues should be treated with metformin
- Resistance to clomid – ovarian drilling may be considered – a surgical procedure to burn the follicles – this comes with risk of scarring and damage to ovary and its function
- Low dose Gonadotropins if oral agents do not induce ovulation (there is an increased of multiple pregnancies between 20-30 %)
- IVF is generally considered if ovulation therapy fails or if the patients wish to avoid multiple pregnancy.