Date:May 06, 2015

Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is a common hormonal disorder that many women suffer from during their reproductive period. It is a multi-faceted illness, affecting the body in several different ways including infertility, hair growth, disrupted or absent menstrual cycles, weight gain and resistance to insulin. It has impacts on the reproductive, metabolic and cardiovascular health of sufferers.7

Common symptoms of the syndrome include weight gain, irregular periods, cysts on the ovaries that show up during ultrasound scans, and facial hair on areas such as the chin or upper lip.

Women with PCOS can struggle to get pregnant unassisted. They can also have a higher risk of heart disease, Type 2 diabetes, elevated cholesterol, hypertension and obesity. However, these symptoms may be able to be managed and fertility can be assisted through lifestyle changes and the prescription of medications.

Diagnosis

PCOS is characterised by the appearance of cysts on the ovaries, excess hair growth, obesity, androgen excess, irregular periods (anovulation or oligo-ovulation).7 Women with PCOS might have some or all of these symptoms, it is highly variable from one patient to the next.

Symptoms

Hormonal disruption

A common symptom of PCOS is higher levels of male hormones (androgens) which leads to acne, hirsutism or excess hair growth on the body and male-pattern hair loss.4 Women with PCOS tend to have higher serum testosterone concentrations.5

Menstrual cycle

A disrupted menstrual cycle is common. Symptoms range from normal menstruation being de-layed or fewer than normal periods to not having a period at all for more than three months. For some women with PCOS, their menstrual cycle may not be associated with ovulation and they could have heavy bleeding.3

Weight

Women with PCOS often have higher body weight with fat disposition on areas of the body such as lower abdomen and upper thighs. Insulin resistance as a result of PCOS can make it easier for suf-ferers to gain weight, and difficult for them to lose weight.

Insulin

Insulin levels can be elevated in women with PCOS. Often they can be insulin resistant, which can increase the risk of heart disease and diabetes.4

Infertility

Because the menstrual cycle can be disrupted, many women with PCOS experience difficulty get-ting pregnant. Some medications that are commonly prescribed (see below) can help and speak-ing to a doctor or fertility specialist is recommended.

Treatments

The following is an overview of commonly prescribed medications. Women’s Health Action rec-ommends women speak to a doctor about the best available options for their needs as treatment may vary over time and from person to person.

Metformin

Taking Metformin, the drug commonly prescribed to people with Type 2 Diabetes, can help to re-duce some symptoms of PCOS. Metformin sensitises the body to insulin, which helps women with PCOS who are resistant to insulin. It can help to regulate periods and enhance ovulation and re-ducing the effect of elevated male hormones.4 Common side effects are nausea, digestive upset and vomiting. Women with PCOS have a high likelihood of developing Type 2 Diabetes due to their insulin resistance, but taking Metformin can help delay or prevent this.

Metformin should be used together with increased exercise and a nutritious diet,6 not as a replace-ment for lifestyle changes.

Spironolactone
This drug is known to reduce male-pattern hair growth and acne. It can reduce androgen levels. It is a diuretic so it will rid the body of excess salt and water. Common side effects are nausea, vomiting, headaches and rarely, rashes. Up to 80% of women with PCOS see a reduction in excess hair growth when using spironolactone. It can take up to six months of daily use for it to become effective.1

Clomiphene or clomid
The ovulation stimulating drug clomiphene, also known as clomid, is often prescribed to women with PCOS who are seeking to get pregnant, because it can help periods to regulate by indirectly causing eggs to mature and be released. It can assist women with PCOS to achieve pregnancy, but can increase the likelihood of twins.2

Diet and exercise

Women with PCOS are recommended to choose foods with a low glycemic index and limit their intake of carbohydrates by spacing them out over the day and combining them with protein and fats. Speaking to a registered dietitian is recommended.

Regular exercise is important for women with PCOS. It helps to counteract insulin resistance, and can lead to weight loss which can help with regulating the menstrual cycle. This can also improve the chance of achieving pregnancy.

A study undertaken in 2011-2012 found that after six months of regular exercise, women with PCOS saw significant improvement in their menstrual frequency and reduced problems with menstrual cycle. Their hormonal profile improved and many found they lost weight around their waist and hips.3

Consistent and varied types of exercise are positive for women with PCOS: cardio can help with weight loss, lower blood pressure and potentially decrease insulin resistance, while weight training builds lean muscle mass and improves strength.6

  • References

    1. Huang I, et al. (2007). Endocrine disorders. In JS Berek, ed., Berek and Novak’s Gynecology, 14th ed., pp. 1069–1135. Philadelphia: Lippincott Williams and Wilkins.

    2. Legro RS, Barnhart HX, Schlaff WD, et al. (2007). Clomiphene, metformin or both for infertility in polycystic ovary syndrome, New England Journal of Medicine, 356:551.
    3. E. Sayed, M. Salem, M. Sweed (2012). Effect of Lifestyle Modifications on Polycystic Ovari-an Syndrome Symptoms, Journal of American Science 2012;8(8), 535.
    4. J. Lord, A. Balen, R. Norman, T. Tang (2003 ). Insulin-sensitising drugs (metformin, troglita-zone,rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary symdrome, The Cochran Col-laboration, The Cochrane Library 2003, Issue 2.
    5. K Michelmore, A Baden, D. Dunger, M. Vessey (1999). Polycystic ovaries and associated clini-cal and biochemical features in young women, Clin Endocrine (Oxf), 1999 Dec; 51(6)779-86.
    6. A. Lifchez, S. Jasulaitis (2009). Polycystic Ovarian Syndrome, Medical and Reproductive Impli-cations, The OB/GYN & Infertility Nurse – NP/PA, October 2009, Vol 1, No 1.
    7. David A Ehrmann, M.D. (2005). Polycystic Ovary Syndrome, New England Journal of Medicine, 352:1223-1236.

  • Acknowledgement

    Thank you to Jazial Crossley for researching and writing this health topic.