What is polycystic ovary syndrome?
Polycystic ovary syndrome (PCOS) is a hormonal condition of the ovaries, and affects around one in five women in the UK. PCOS makes ovulation rare or irregular, and can make it harder to get pregnant. The good news is that, with treatment, most women with PCOS do eventually conceive.
What causes PCOS?
An absolute cause is still unknown – but there are a few factors thought to have an effect:
- Genetics: If your mum or sister suffered from PCOS you might be at greater risk.
- Hormones: Lots of women diagnosed with PCOS are found to have raised levels of testosterone (the ‘male' hormone), prolactin (the hormone that causes the breasts to produce milk) or luteinising hormone (which usually stimulates ovulation but can cause problems with PCOS). It’s not yet known exactly why these changes to hormone levels take place.
- Insulin resistance: High levels of insulin cause the ovaries to produce too much testosterone. This in turn can cause weight gain, which again triggers the body to produce more insulin.
What are the symptoms of PCOS?I was diagnosed with PCOS about eight years ago. I had the classic symptoms – overweight, spots etc but my cycle was fairly regular. I had strong insulin resistance and really struggled to lose any weight.
The symptoms of PCOS can come and go. Many women don’t realise they have it until they have trouble trying to conceive.
These are some of the symptoms you might experience:
- Disruption to periods, which might be totally absent or irregular.
- Infertility (because ovulation isn’t occurring).
- A tendency to excess hair, particularly on the tummy, face and nipples. This is caused by extra testosterone, which may also make the hair on your head a bit thinner.
- Spots and oily skin.
- Weight gain, which can itself exacerbate the syndrome by raising insulin levels in the blood and stimulating testosterone production.
How is PCOS diagnosed?
To make a diagnosis of PCOS two of the three following factors need to be present:
- Polycystic ovaries (you can have these, without having the full syndrome – and confusingly, you may have the syndrome even if your ovaries aren’t polycystic)
- Anovulation (no egg released)
- Raised testosterone levels
A diagnosis is normally made after a vaginal ultrasound scan to look at the ovaries and see if they are polycystic, in combination with blood tests to check testosterone levels.
If you’re diagnosed with PCOS your GP will discuss the lifestyle changes you can make to help keep the condition under control, as well as start you on medication if you need it. You may also be referred to an endocrinologist or gynaecologist, depending on your treatment needs.
Can PCOS be treated?
Yes. Although PCOS can’t be cured, the symptoms can be treated, enabling most women who are trying to conceive to get pregnant.
The treatment recommended may include:
- Drugs such as Clomifene to stimulate ovulation.
- Medication like Metformin which lowers insulin. It’s a drug usually given for type 2 diabetes but can be used ‘off label’ to treat this particular symptom of PCOS.
- Gonadotrophin injections to stimulate the ovaries (there is the risk of overstimulation, causing multiple pregnancies, however).
- Laparoscopic ovarian drilling – this isn’t nearly as horrific as it sounds! Under general anaesthetic, a tiny microscope is inserted into the lower abdomen to look at the ovaries and then the tissue that’s producing the male hormones is lasered off.
If you haven’t conceived within six months to a year of treatment, assisted conception such as IUI or IVF might be considered.
How can I improve my chances of getting pregnant with PCOS?
There’s lots you can do to help reduce the effects of PCOS and boost your fertility.I had suggestive PCOS. It took us two years to conceive our daughter naturally – fell pregnant after initial fertility tests and cancelled our first fertility clinic appointment as I was pregnant when it came through.
If you're overweight, try to lose some of it to help break the cycle of raised insulin levels that in turn increase the amount of testosterone produced. NHS Choices says even a 5% weight loss could make a big difference to the syndrome’s effect on your fertility as well as reducing your risk of developing long-term problems associated with PCOS including diabetes, high blood pressure, heart disease and endometrial cancer.
Having a balanced diet and taking regular exercise are the easiest ways you can help limit the effects of the syndrome. Try to avoid sugary foods, alcohol and caffeine as these can all affect insulin resistance.
How will PCOS affect me in pregnancy?
Having PCOS while pregnant will put you at greater risk of weight-related complications such as gestational diabetes, high blood pressure and preeclampsia. You can lower your risk of developing these by losing weight before you conceive.
Unfortunately, PCOS does also increase your risk of having an early miscarriage.
Being diagnosed prior to getting pregnant will give you time to make as many changes to your lifestyle as possible and your GP will be able to discuss options for keeping symptoms under control during pregnancy and beyond.