Polycystic Ovary Syndrome (Handouts)

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of

reproductive age (14-44). Women with PCOS may have infrequent or prolonged menstrual
periods or excess male hormone (androgen) levels. The ovaries may develop numerous small
collections of fluid (follicles) and fail to regularly release eggs. The exact cause of PCOS is
unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term
complications such as type 2 diabetes and heart disease.

Signs and symptoms of PCOS often develop around the time of the first menstrual
period during puberty. Sometimes PCOS develops later, for example, in response to
substantial weight gain.

Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you
experience at least two of these signs:

 Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most
common sign of PCOS. For example, you might have fewer than nine periods a year,
more than 35 days between periods and abnormally heavy periods.

 Excess androgen. Elevated levels of male hormone may result in physical signs, such as
excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern
baldness.

 Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the
eggs. As a result, the ovaries might fail to function regularly.

PCOS signs and symptoms are typically more severe if you're obese.

In addition for the signs and symptoms:

 irregular periods or no periods at all

 difficulty getting pregnant (because of irregular ovulation or failure to ovulate)
 excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks
 weight gain
 thinning hair and hair loss from the head
 oily skin or acne
You should talk to your GP if you have any of these symptoms and think you may have PCOS.

Fertility problems

PCOS is one of the most common causes of female infertility. Many women discover they have
PCOS when they're trying to get pregnant and are unsuccessful.
During each menstrual cycle, the ovaries release an egg (ovum) into the uterus (womb). This
process is called ovulation and usually occurs once a month.

But women with PCOS often fail to ovulate or ovulate infrequently, which means they have
irregular or absent periods and find it difficult to get pregnant.

Risks in later life

Having PCOS can increase your chances of developing other health problems in later life.

For example, women with PCOS are at increased risk of developing:

 type 2 diabetes – a lifelong condition that causes a person's blood sugar level to become too
high
 depression and mood swings – because the symptoms of PCOS can affect your confidence and
self-esteem
 high blood pressure and high cholesterol – which can lead to heart disease and stroke
 sleep apnea – overweight women may also develop sleep apnea, a condition that causes
interrupted breathing during sleep
Women who have had absent or very irregular periods (fewer than 3 or 4 periods a year) for
many years have a higher than average risk of developing cancer of the womb lining
(endometrial cancer).

But the chance of getting endometrial cancer is still small and can be minimized using treatments
to regulate periods, such as the contraceptive pill or an intrauterine system (IUS).

Causes

The exact cause of PCOS isn't known. Factors that might play a role include:

 Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use
sugar, your body's primary energy supply. If your cells become resistant to the action of
insulin, then your blood sugar levels can rise and your body might produce more insulin.
Excess insulin might increase androgen production, causing difficulty with ovulation.

 Low-grade inflammation. This term is used to describe white blood cells' production of
substances to fight infection. Research has shown that women with PCOS have a type of
low-grade inflammation that stimulates polycystic ovaries to produce androgens, which
can lead to heart and blood vessel problems.

 Heredity. Research suggests that certain genes might be linked to PCOS.

  Excess androgen. The ovaries produce abnormally high levels of androgen, resulting in
hirsutism and acne.

Complications
Complications of PCOS can include:

 Infertility

 Gestational diabetes or pregnancy-induced high blood pressure

 Miscarriage or premature birth

 Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in

the liver

 Metabolic syndrome — a cluster of conditions including high blood pressure, high blood
sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of
cardiovascular disease

 Type 2 diabetes or pre-diabetes

 Sleep apnea

 Depression, anxiety and eating disorders

 Abnormal uterine bleeding

 Cancer of the uterine lining (endometrial cancer)

Obesity is associated with PCOS and can worsen complications of the disorder.

Treatment
PCOS treatment focuses on managing your individual concerns, such as infertility,
hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or
medication.
Lifestyle changes

Your doctor may recommend weight loss through a low-calorie diet combined with
moderate exercise activities. Even a modest reduction in your weight — for example,
losing 5 percent of your body weight — might improve your condition. Losing weight
may also increase the effectiveness of medications your doctor recommends for PCOS,
and can help with infertility.
Medications

To regulate your menstrual cycle, your doctor might recommend:

 Combination birth control pills. Pills that contain estrogen and progestin decrease
androgen production and regulate estrogen. Regulating your hormones can lower your risk
of endometrial cancer and correct abnormal bleeding, excess hair growth and acne.
Instead of pills, you might use a skin patch or vaginal ring that contains a combination of
estrogen and progestin.

 Progestin therapy. Taking progestin for 10 to 14 days every one to two months can
regulate your periods and protect against endometrial cancer. Progestin therapy doesn't
improve androgen levels and won't prevent pregnancy. The progestin-only minipill or
progestin-containing intrauterine device is a better choice if you also wish to avoid
pregnancy.

To help you ovulate, your doctor might recommend:

 Clomiphene (Clomid). This oral anti-estrogen medication is taken during the first part of
your menstrual cycle.

 Letrozole (Femara). This breast cancer treatment can work to stimulate the ovaries.

 Metformin (Glucophage, Fortamet, others). This oral medication for type 2 diabetes
improves insulin resistance and lowers insulin levels. If you don't become pregnant using
clomiphene, your doctor might recommend adding metformin. If you have prediabetes,
metformin can also slow the progression to type 2 diabetes and help with weight loss.

 Gonadotropins. These hormone medications are given by injection.

To reduce excessive hair growth, your doctor might recommend:

 Birth control pills. These pills decrease androgen production that can cause excessive
hair growth.

 Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin.
Spironolactone can cause birth defect, so effective contraception is required while taking
this medication. It isn't recommended if you're pregnant or planning to become pregnant.

 Eflornithine (Vaniqa). This cream can slow facial hair growth in women.

 Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of
electric current to damage and eventually destroy the follicle. You might need multiple
treatments.
Lifestyle and home remedies
To help decrease the effects of PCOS, try to:

 Maintain a healthy weight. Weight loss can reduce insulin and androgen levels and may
restore ovulation. Ask your doctor about a weight-control program, and meet regularly with
a dietitian for help in reaching weight-loss goals.

 Limit carbohydrates. Low-fat, high-carbohydrate diets might increase insulin levels. Ask
your doctor about a low-carbohydrate diet if you have PCOS. Choose complex
carbohydrates, which raise your blood sugar levels more slowly.

 Be active. Exercise helps lower blood sugar levels. If you have PCOS, increasing your
daily activity and participating in a regular exercise program may treat or even prevent
insulin resistance and help you keep your weight under control and avoid developing
diabetes.

Preparing for your appointment

You may be referred to a specialist in female reproductive medicine (gynecologist), a
specialist in hormone disorders (endocrinologist) or an infertility specialist (reproductive
endocrinologist).

Here's some information to help you get ready for your appointment.
What you can do

 List symptoms you've been having, and for how long

 List all medications, vitamins and supplements you take, including the doses

 List key personal and medical information, including other conditions, recent life changes
and stressors

 Prepare questions to ask your doctor

 Keep a record of your menstrual cycles

Is PCOS linked to other health problems?

Yes, studies have found links between PCOS and other health problems, including:

 Diabetes. More than half of women with PCOS will have diabetes or prediabetes (glucose
intolerance) before the age of 40.4 Learn more about diabetes on our Diabetes page.
  High blood pressure. Women with PCOS are at greater risk of having high blood pressure
compared with women of the same age without PCOS. High blood pressure is a leading
cause of heart disease and stroke. Learn more about heart disease and stroke.
 Unhealthy cholesterol. Women with PCOS often have higher levels of LDL (bad) cholesterol
and low levels of HDL (good) cholesterol. High cholesterol raises your risk of heart disease
and stroke.
 Sleep apnea. This is when momentary and repeated stops in breathing interrupt sleep. Many
women with PCOS have overweight or obesity, which can cause sleep apnea. Sleep apnea
raises your risk of heart disease and diabetes.
 Depression and anxiety. Depression and anxiety are common among women with PCOS.
 Endometrial cancer. Problems with ovulation, obesity, insulin resistance, and diabetes (all
common in women with PCOS) increase the risk of developing cancer of the endometrium
(lining of the uterus or womb).

Researchers do not know if PCOS causes some of these problems, if these problems cause PCOS, or
if there are other conditions that cause PCOS and other health problems.

Family history
Immediate female relatives (ie daughters or sisters) of women with PCOS have up to a
50% chance of having PCOS. Type 2 diabetes is also common in families of those with
PCOS. So far, no single gene has been found to cause PCOS, so the link is likely to be
complex and involve multiple genes.