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Polycystic ovary syndrome

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Polycystic ovary syndrome is a term which covers a spectrum of problems caused by an imbalance in the level of the body’s sex hormones (oestrogen and testosterone).
MRI scan of a patient with polycystic ovaries.

MRI scan of a female patient with polycystic ovary syndrome. Multiple cysts (white) have formed in the ovaries (centre left and right).

Alternative names for polycystic ovary syndrome

Polycystic ovaries; Stein-Leventhal syndrome; PCOS; polycystic ovarian syndrome.

What is polycystic ovary syndrome?

Polycystic ovary syndrome covers a variety of symptoms caused by problems with the balance of female reproductive hormones.  Confusingly, women do not need to have cysts on their ovaries to be diagnosed with the condition.  The signs and symptoms vary greatly among women.

What causes polycystic ovary syndrome?

Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, and it is this which is responsible for many of the symptoms experienced.  The exact cause is not known, but it is thought that genetic and environmental factors play a part.  Polycystic ovary syndrome tends to run in families and can in some circumstances be related to being overweight.  There are also strong associations with diabetes and insulin resistance.

What are the signs and symptoms of polycystic ovary syndrome?

Polycystic ovary syndrome commonly causes problems relating to menstrual periods.  They can become erratic, infrequent, or even stop altogether and this can cause reduced fertility.  Other symptoms can include greasy skin or acne and there is often an increase in hair growth (hirsutism) in a male pattern (on the face, back and chest) which some women may find distressing.  Symptoms get worse with weight gain.

How common is polycystic ovary syndrome?

Polycystic ovary syndrome is actually quite common in women of reproductive age.  It is estimated to affect 5-10% of women in this group.  Not all women will have symptoms.

Is polycystic ovary syndrome inherited?

Polycystic ovary syndrome tends to run in families in about 50% of cases.

How is polycystic ovary syndrome diagnosed?

Polycystic ovary syndrome can be present at any age during the reproductive years and, because of its often vague symptoms, it can take time to diagnose.

Women with polycystic ovary syndrome can have a variety of symptoms including:

  • Irregular periods
     
  • Evidence of increase in male hormones showing either excess body hair or an increase in hormone levels in the blood
     
  • Multiple cysts in the ovaries

For diagnosing polycystic ovary syndrome, at least two out of the three criteria listed above should be present.

The diagnosis is made by taking a history of the symptoms, an examination and hormonal blood tests which can be done as an outpatient.  Women may or may not need to have an ultrasound scan of their ovaries.

How is polycystic ovary syndrome treated?

Weight loss, although difficult, is recommended as this often helps reduce the symptoms of polycystic ovary syndrome.  If becoming pregnant is not the most important objective, periods can usually be regulated with the oral contraceptive pill.  Other medication used includes metformin (which is also often used in diabetes), spironolactone and cyproterone.  These work by overcoming the hormonal imbalance.

If a regular menstrual cycle is not desired, therapy for an irregular cycle is not necessarily required.  Most experts consider that if a period occurs at least once every three months, the endometrium is being shed often enough to prevent an increased risk of endometrial abnormalities or cancer.  If periods occur less often or not at all, some form of progesterone replacement is recommended.  Some women prefer a uterine progestogen device such as the Mirena coil or the progestin implant Implanon, which provides both contraception and endometrial protection for several years.  An alternative is oral progestogen taken at intervals (eg, every three months) to kickstart predictable menstrual bleeding.

Are there any side-effects to the treatment?

Metformin and spironolactone can cause stomach upset.  Metformin may also cause dizziness, nausea and a metallic taste in the mouth.

Spironolactone can also cause more frequent periods so is often used in conjunction with the oral contraceptive pill.  Cyproterone may cause problems with menstrual periods if taken for a long period of time and, rarely, it may cause liver problems, although liver blood tests will be monitored whilst on this treatment.

Side-effects generally tend to resolve over time as the body adjusts to the medication, although a dose reduction or different formulation may be required if symptoms persist.

What are the longer-term implications of polycystic ovary syndrome?

Long-term, polycystic ovary syndrome can cause problems with fertility if a woman does not have a period for a prolonged time.  It can also increase the risk of developing diabetes and can lead to raised cholesterol.  If a woman goes for a long time without a period, the lining of the uterus can build up and some research studies suggest that potentially this can increase the risk of endometrial cancer.  If a woman has any concerns about the longer-term implications of polycystic ovary syndrome, she should contact her GP.

 

Written: March 2011

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