What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome is a problem in which a woman’s hormones are out of balance. It can cause upsetting changes in the way you look and problems with your periods. If it is not treated, over time it can lead to serious health problems, such as diabetes and heart disease.

Polycystic ovary syndrome (or PCOS) affects up to 1 in 10 women, and often the symptoms begin in the teen years. Treatment can help control the symptoms and prevent long-term problems.

What are hormones, and what happens in PCOS?

Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone.

For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another. This makes a vicious circle of out-of-balance hormones. For example:

The sex hormones get out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making more androgens. This may cause you to stop ovulating, get acne, gain weight, and grow extra facial and body hair.

The body may have a problem using insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar levels go up. Over time, this increases your chance of getting diabetes.

What are the symptoms?

Symptoms tend to be mild at first. You may have only a few symptoms or a lot of them. The most common symptoms are:

• Acne.
• Weight gain and trouble losing weight.
• Extra hair on the face and body. Often women get thicker and darker facial hair and more hair on the chest, belly, and back.
• Thinning hair on the scalp.
• Irregular periods. Often women with PCOS have fewer than 9 periods a year. Some women have no periods. Others have very heavy bleeding.
• Fertility problems. Many women with PCOS have trouble getting pregnant (infertility).
• Some women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. But this doesn't always happen, and the cysts are not harmful.

What causes PCOS?

The symptoms of PCOS are caused by changes in hormone levels. But experts are not sure what causes the hormone changes.

PCOS seems to run in families, so your chance of having it is higher if other women in your family have it.

How is PCOS diagnosed?

To diagnose PCOS, your doctor will:

• Ask questions about your past health, symptoms, and menstrual cycles.
• Do a physical exam to look for signs of PCOS, such as extra body hair and high blood pressure. The doctor will also check your height and weight to see if you have a healthy body mass index (BMI).
• Do a number of lab tests to check your blood sugar, insulin, and other hormone levels. Hormone tests can help rule out thyroid or other gland problems that could cause similar symptoms.
• You may also have a pelvic ultrasound to look for cysts on your ovaries. This test is not always done, because many women with PCOS do not have cysts.

How is it treated?

Regular exercise, a healthy diet, and weight control are key treatments for PCOS. Medicines to balance hormones may also be used. Getting treatment can reduce unpleasant symptoms. But more important, it can help prevent possible long-term health problems.

The first step in managing PCOS is to get regular exercise and eat a healthy GI diet. This can help lower blood pressure and cholesterol and reduce the risk of diabetes and heart disease. It can also help you lose weight if you need to.

Try to get 30 minutes of physical activity most days of the week. Walking is a great exercise that most people can do.

A doctor may also prescribe medicines, such as:

• Birth control pills. They can help your periods be regular and can reduce symptoms such as excess facial hair and acne. An androgen-lowering medicine, spironolactone, may be used with birth control pills to help reduce symptoms even more. These medicines are not used if you are trying to get pregnant.
• A diabetes medicine called metformin. It can help control insulin and blood sugar levels and reduce androgen levels. This lowers your risk for diabetes and heart disease and can help restore regular menstrual cycles and fertility.
• Fertility medicines, if you are trying to get pregnant.
• It is important to see your doctor for follow-up to make sure treatment is working and adjust it if needed. You may also need regular tests to check for diabetes, high blood pressure, and other possible problems.

It may take a while for treatments to help with symptoms such as facial hair or acne. In the meantime:

• Over-the-counter or prescription acne medicines may help with skin problems.
• Waxing, tweezing, and shaving are easy ways to get rid of unwanted hair. Electrolysis or laser treatments can permanently remove the hair but are more expensive. Your doctor can also prescribe a skin cream that slows hair growth for as long as you use it regularly.
• It can be hard to deal with having PCOS. If you are feeling sad or depressed, it may help to talk to a counselor or to other women who have PCOS. Ask your doctor about local support groups, or look for an online group. It can make a big difference to know that you are not alone.

What sort of diet should I follow to stay healthy and maintain a healthy weight?

You should try to eat a well balanced GI diet. In general, this diet has lots of vegetables, fruits, nuts, beans, pulses and whole grains. Choosing these foods will help to stabilise your blood sugar levels, therefore reducing your risk of diabetes, as well as helping you to feel fuller for longer so you will not be tempted to snack on high calorie, high sugar foods. Choose low fat dairy products and lean cuts of meat and poultry. Try to include fish (especially oily fish – salmon, mackerel, herring, sardines) in your diet a couple of times a week.

Most women with PCOS can benefit from losing weight. Even losing 10 lb may help get your hormones in balance and regulate your menstrual cycle. PCOS can make it hard to lose weight, so find a plan that suits you as you will be more likely to stick with it.