Polycystic Ovaries

What is Polycystic Ovarian Syndrome (PCOS)?

It is a collection of symptoms including the formation of small cysts within the ovary. In a normal ovary a batch of follicles begins to develop each month, one or two of which matures, and releases one or two eggs, whilst the remaining follicles die off. Abnormally high levels of insulin in the blood stream (the hormone responsible for keeping blood sugar levels steady) stops these follicles from dying off.

What are the symptoms?

These vary greatly in type and severity and not all symptoms occur in all women.

Classic symptoms

Irregular or absent periods (30% to 50% of women)
Problems in getting pregnant (20% to 30%)
Weight gain (especially around the abdomen / above waist)
Loss of scalp hair
Excessive hair growth on face or body
Acne

Other symptoms can include

Hot flushes, night sweats, panic attacks, palpitations, poor sleep/sudden wakening, vivid dreams/nightmares
Bladder problems including irritable bladder, urinary frequency/urgency, stress incontinence, vaginal dryness, recurrent thrush, lack of sexual interest, vaginal discharge
Joint pain, dry eyes, dry nose, dry mouth, dry vagina, dry ears, blurred vision, brittle nails, thirsty, increased facial/body hair
Bowel problem including disordered bowel motility, early morning nausea/ metallic taste/ burning mouth, reflux/ oesophageal damage, bloating, irritable bowel, bowel pain
Blood flow symptoms / syndrome x, headaches, chest pain, leg cramps, fidgety legs
Fluid retention, tingling fingers and toes, puffiness, water retention, breast tenderness
Symptoms of oestrogen deficiency due to poor follicle development
Mood Concentration/Psychological symptoms of tiredness, lethargy, mood swings, aggressive/short fuse, depressed/low feeling, paranoid/negative feelings, loss of confidence, reduced memory/concentration, disorientated/out of body feeling, clumsiness

Other risks

Due to the link of PCOS with Insulin Resistance, there may also be an increased risk of the following:-

Heart and vascular disease including stroke and dementia
Type 2 diabetes
Reproductive cancers
Miscarriage
Infertility
Obesity is associated with Insulin Resistance and PCOS, but not in all women

What is the cause of PCOS?

Whilst the exact cause is unknown, Insulin Resistance seems to be important factor, particularly in women who are overweight. In essence those with PCOS tend to be resistant to insulin that is released by the pancreas to control sugars in the bloodstream. Higher levels of insulin are needed to act on the sugars in the fat and muscle cells, but the increased insulin levels cause the ovaries to produce too much testosterone. The effect of the excess insulin and testosterone is to interfere with the development of the follicles, leading to a lack of ovulation.

How is PCOS diagnosed?

Ultrasound scan
Symptoms such as raised waist hip ratio
Blood tests (raised levels of the pituitary hormone, luteinising hormone (LH), abnormal fasting levels of insulin in relation to glucose, abnormal levels of insulin in response to a 75 gram glucose drink as part of a fasting glucose tolerance test.
Or, all three of the above

What is the treatment for PCOS?

The aim of the treatment is to improve insulin resistance by a means of diet and medication. In some instances surgery may be required (see below)

Diet

A change in diet makes a great difference to insulin resistance and to the response of medication. Snacking/ high carbohydrate diets worsen insulin production and therefore if the diet is abnormal, medication will not work.

Medication

Oestradiol As many symptoms are associated with lack of oestrogen, initially replacing this with oestradiol (not the Pill which is ethinyl oestradiol and synthetic) helps correct symptoms in the short term whilst insulin resistance and the bodies own hormones are being corrected in the long term. Oestrogen preparations best suited to treat this include those which go directly into the blood stream including gel, patches, implants.

Metformin/Glitazones These are medications which by improving the bodies sensitivity and response to insulin, result in reduced insulin production by the pancreas. This lowers levels of insulin and reduces symptoms

Surgery

Diathermy release of the multiple small cysts within the ovaries can allow the natural development of the follicle to restart again. Ovarian drilling is done during an operation at the time of a laparoscopy. This requires a general anaesthetic and an in patient hospital stay usually overnight. This particularly helps with 'androgenic' or 'male related' symptoms such as acne and facial hair.

What makes Insulin Resistance / PCOS Worse?

High Carbohydrate diet and high fat diets
Snacking
Sedentary lifestyle
Weight gain
Genetic pre disposition (family history of cardiovascular disease, diabetes, hormone problems, miscarriage)
Some medications (the Pill, Beta blockers, Progesterone)
Puberty
Pregnancy and breast feeding
Lack of ovarian hormones e.g. Menopause
Stress
Vegetarianism
Ovarian failure
Androgen failure
Advancing age
High Carbohydrate / sugary diet as a child
Grazing/ Snacking as a child

What makes Insulin Resistance / PCOS better?

Higher Protein, lower carbohydrate, non snack diet
Metformin and Glitazones (in conjunction with diet correction only)
Improving oestrogen levels where oestrogen is deficient
Diathermy of persisting abnormal follicles on the ovary
Weight loss
Exercise