GYNAECOLOGY

Polycystic Ovaries

Ovarian hormones

Normally, the ovary produces large amounts of the female hormone oestrogen, lesser amounts of the male hormone testosterone, and the pregnancy hormone progesterone (which is only produced in greater amounts after ovulation and during pregnancy). In PCOS, testosterone levels may be mildly increased.

Causes of PCOS

The causes of PCOS are unknown. In some cases, it seems to run in the family; for other women, the condition only occurs when they are overweight. Recent research suggests that PCOS is related to insulin resistance and the development of diabetes, especially in women who are overweight.

Women who have PCOS may have problems such as

• Irregular menstrual cycles menstruation may be less frequent due to less frequent ovulation, and may be either heavier or lighter than average
• Amenorrhoea some women with PCOS do not menstruate, in some cases for many years
• Obesity the cause of this is unclear
• Excessive hair growth may be due to increased testosterone
• Acne the cause is unclear
• Infertility related to less frequent or absent ovulation

There may also be long term health risks. Some women with PCOS develop diabetes, especially if overweight. Women with infrequent periods are at risk of osteoporosis.

Diagnosing polycystic ovarian syndrome

PCOS is usually diagnosed based on the woman's history and an examination. It may be confirmed by ultrasound and by measuring hormone levels in the blood.  Early diagnosis is important, as it will allow symptoms to be managed and may prevent long term health problems from developing.

Treating PCOS

It is important that a broad approach (by a general practitioner with interest or expertise in this area, or perhaps involving several specialists for example, an endocrinologist or a gynaecologist) be used to manage and treat PCOS. If only one or two symptoms are addressed on a short term basis, the woman may be left with long term clinical problems.

The treatment for PCOS will depend on the problems the woman has. For example, if the woman is suffering from irregular, heavy periods, the oral contraceptive pill is often prescribed to regulate the cycle and prevent the lining of the womb from overgrowing. If the woman has infrequent periods, the oral contraceptive pill is used to reduce the risk of osteoporosis. If infertility is a problem, clomiphene citrate may be given orally to induce ovulation. Weight loss is very important, as it will reduce the risk of diabetes developing and can reduce other symptoms. An operation called ovarian drilling can be used to treat women with PCOS who want to become pregnant and are not ovulating.