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It’s a topic which is shrouded in mythology and confusion: Polycystic Ovarian Syndrome (PCOS). Most women have heard the term “polycystic” before, but unless you’ve been diagnosed with it, you may not know exactly what it means.
Women often tell me quite confidently that they are “polycystic”, yet they are free from most of the features normally associated with PCOS. Others seem to be perfectly healthy but are plagued by irregular periods and infertility. Why the confusion? Why is it even important to know? Let’s delve into the nether-regions of this perplexing condition…
WHAT IS PCOS?
PCOS is a very common hormonal condition affecting up to 20% of Australian women (depending on the diagnostic criteria used). It’s widely believed that any woman who’s had an ultrasound showing multiple cysts on her ovaries must have PCOS but this is not strictly true. Polycystic ovaries can occur in up to 30% of normal women and 60-80% of normal adolescents, ie. those who do NOT have PCOS. In other words, polycystic ovaries do not necessarily equal Polycystic Ovarian Syndrome.
To be diagnosed with PCOS the most commonly used criteria in Australia (Rotterdam Criteria) require that a woman has two or more of the following three features:
-An irregular menstrual cycle;
-High levels of androgens (male sex hormones) either on blood tests or through symptoms such as excessive body hair or acne; and
-Polycystic Ovaries, usually seen on ultrasound scan.
WHAT CAUSES IT?
We still don’t fully understand the mechanisms of the condition, but what is clear is that a number of different factors contribute to it: genetics, insulin resistance and obesity. Genetically speaking, you are more likely to have PCOS if other women in your immediate family have it.
“Insulin resistance” means that insulin produced by the pancreas to control blood sugar levels is less effective, which is a key feature in the development of diabetes. Insulin resistance is also strongly hereditary, as well as being affected by diet, lifestyle and obesity.
Obesity itself is strongly associated with PCOS; the heavier you are the worse your symptoms are likely to be, but conversely symptoms and diabetic risk can be greatly reduced with even a modest weight loss. PCOS can also occur in women of normal healthy bodyweight, ie. Body Mass Index (BMI*) of 20-25, so preventing weight gain is an important management strategy. To find your BMI, divide your weight (in kgs) by [your height (in metres) squared], eg. 75/ 1.522 = BMI 32.5
WHAT PROBLEMS DOES IT CAUSE?
The main problems associated with PCOS are:
– Irregular periods due to few or no ovulations (ovulation= release of an egg from the ovary);
– Infertility, also due to either infrequent or absent ovulations;
– Hirsuitism (excessive body hair) due to an excess of male sex hormone (hyperandrogenism);
– Acne, again related to hyperandrogenism;
– Increased risk of developing diabetes and cardiovascular disease; and
– Increased risk of psychological and emotional problems such as depression, anxiety, poor self-esteem, eating disorders and sexual dysfunction.
CAN IT BE TREATED?
The cornerstone of PCOS treatment is weight management. As previously mentioned, even a very modest reduction in weight of 5-10% can greatly improve the symptoms of PCOS and may be enough to get a woman ovulating regularly again. This is particularly important for women with PCOS-induced infertility.
For those not wanting to get pregnant the oral contraceptive pill can be very helpful to regulate periods but it must be understood that the irregular periods (and possible fertility problems) will return once the pill is stopped unless other factors like obesity are dealt with. The pill will also improve acne and hirsuitism, with some pills containing an anti-androgenic hormone which makes them particularly suited to PCOS.
For women who can’t take the pill there are other medications available that can be helpful for specific symptoms- have a chat to your GP about those- and of course there are cosmetic options for hair removal such as laser or electrolysis.
The issue of infertility is a huge one, causing more heartache to PCOS sufferers than any other symptom. If weight loss fails there are a number of different treatment options available. For women whose BMI is under 30, treatment with an anti-diabetic drug called metformin may improve ovulation and pregnancy rates; your GP may be able to help you with this. For heavier women the best option is an intensive weight-reduction and lifestyle intervention program, followed by discussions with a fertility specialist to consider ovulation-induction treatments.
LIFELONG GOOD HEALTH…
Besides dealing with the immediate issues and symptoms of PCOS, women who have it should be mindful of the lifelong implications. They remain at increased risk of developing diabetes and cardiovascular disease (especially if their immediate family has it) and therefore should be screened for risk factors every 1-2 years. This includes having blood glucose, cholesterol, lipids, weight and blood pressure measured, as well as being screened for lifestyle factors like smoking, alcohol, diet, exercise levels and psychological wellbeing.
On the upside, a diagnosis of PCOS may well trigger some timely lifestyle changes and weight loss, setting the woman on a path to a lifetime of improved health benefits.
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