PCOS: symptoms, treatment and causes

What is PCOS?

Polycystic ovary syndrome is a condition that causes the production of irregular hormone levels, affecting the ovaries and causing missed periods. It's extremely common – affecting one in five women in the UK. It can also be treated. Polycystic ovaries have more follicles than non-polycystic ovaries. The NHS calls these follicles 'underdeveloped sacs', and says that they're 'often unable to release an egg'. When this happens, ovulation can't take place.

What causes PCOS?

PCOS causes are unknown – but there are a few factors thought to have an effect:

• Genetics: It sometimes runs in families – so if your mum, sister or another female family member suffers from the condition, you might be at greater risk.

• Hormones: Lots of women diagnosed are found to have a hormonal imbalance. They 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). It's not 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.

Do you know when you're ovulating?

What are the symptoms of PCOS?

PCOS symptoms can come and go, but you'll usually first experience them in your late teens or early twenties. The symptoms of PCOS can become apparent later on, though, and many women don't realise they have it until they have trouble trying to conceive.

Not all women will experience all the possible symptoms, and each symptom can vary from mild to severe.

Take a look at this PCOS symptoms checklist for the ones you might experience:

• Disruption to your menstrual cycle – resulting in absent or irregular periods.

• Infertility (because ovulation isn’t occurring).

• A tendency towards excess hair growth, 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.

• Loss or thinning of the hair on your head.

• Spots and oily skin.

• Weight gain, which can make things worse in itself – raising insulin levels and stimulating testosterone production.

• Pelvic pain.

• Dark patches of skin in your groin, neck and armpits (acanthosis nigricans).

• Depression.

• Mood swings.

These symptoms (particularly depression) may be caused by other issues – so if you're struggling with any of them, do see your GP.

How is PCOS diagnosed?

To make a diagnosis of polycystic ovary syndrome, 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're polycystic, in combination with blood tests to check testosterone levels.

If you're diagnosed, your GP will discuss the lifestyle changes you can make to keep the condition under control. They'll also start you on medication if you need it. And you could be referred to an endocrinologist or gynaecologist, depending on your treatment needs.

PCOS treatment options

Although there is no cure for PCOS, the symptoms can be treated, enabling most women who are trying to conceive.

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’.

• Gonadotrophin injections to stimulate the ovaries (there is, however, the risk of overstimulation here – potentially causing multiple pregnancies).

• Laparoscopic ovarian drilling – which 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. The tissue producing the male hormones is then lasered off.

If you haven't conceived within six months to a year of treatment, assisted conception such as IUI or IVF could be considered.

How can I improve my chances of getting pregnant with polycystic ovary syndrome?

There's lots you can do to help reduce the effects of polycystic ovary syndrome and boost your fertility.

If you're overweight, try to lose some of it to help break the cycle of raised insulin levels. They, in turn, increase the amount of testosterone produced in your body. The NHS says that even a 5% weight loss can make a big difference to the syndrome’s effect on your fertility. It could also reduce your risk of developing long-term problems associated with polycystic ovary syndrome – including diabetes, high blood pressure, heart disease and endometrial cancer.

Is there a recommended PCOS diet?

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.

You should also aim to:

• Eat less meat – reduce your intake of meat and when you do eat it, try to eat good-quality, organic meat. Too much meat can worsen any imbalance in your oestrogen levels.

• Eat more plant-based protein – try to up your intake of beans, nuts, legumes and other non-meat sources of protein.

• Include Omega 3 fats in your diet – they've been shown to lower testosterone levels in women.

• Eat a little bit of full-fat dairy – although you should avoid consuming too much dairy, a small amount of full-fat, good-quality dairy can actually be beneficial.

• Take supplements – a lack of certain vitamins and minerals can negatively affect your ability to conceive. Your doctor can advise you on which supplements you may need to take.

A recent study (February 2019) also found that 'increasing dietary fibre and magnesium intakes may assist in reducing IR and hyperandrogenemia in women with polycystic ovary syndrome.' But what does this mean? Put simply, you should opt for carbs high in fibre that digest more slowly. This includes fruit and veg, wholegrains and legumes.

How will PCOS affect me in pregnancy?

Having the syndrome 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, it 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. Your GP will also be able to suggest options for keeping symptoms under control during pregnancy and beyond.

Associated health conditions

Unfortunately, polycystic ovary syndrome can increase your risk of developing other health conditions later on in life. For example, if you have it you have an increased risk of developing:

• Type 2 diabetes, a condition that causes blood sugar levels to become too high.

• Depression and mood swings, because the symptoms can affect your confidence, self-esteem and general sense of wellbeing.

• High blood pressure and high cholesterol, which can lead to heart disease and stroke.

• Sleep apnoea, a condition that causes interrupted breathing during sleep.

That's not to say that you'll definitely develop these conditions – but it's good to be aware that there's a link. If you find yourself struggling with any of them, don't hesitate to go and see your GP. There's plenty of support available to you.

And if you just want a listening ear, remember that the Mumsnet forums are always open.

More support

These two charities are built solely around polycystic ovary syndrome; spreading awareness as well as providing resources and support networks.

• Verity

• PCOS Awareness Association

• Talk to other Mumsnetters about getting pregnant with PCOS