Polycystic Ovary Syndrome (PCOS) was first described in 1935 as a hormonal disease that affects premenopausal women that may result in infertility. The main clinical features are:
- Enlarged thickened ovaries with cyst-like follicles
- Absence of periods
- Anovulation
- Excessive production of steroid hormones,
- Acne
- Pigmentation of the skin
- Skin tags
- Pelvic pain
- Sleep apnoea
- Excessive hair growth
However symptoms may vary in each patient, not all patients will show all symptoms making it more difficult to diagnose.
In PCOS the development of an egg in the ovary does not occur, instead multiple follicles form and continue to mature to form cysts. Pelvic pain may occur due to the inflammation of the abnormal cyst tissue.
Abnormal skin pigmentation is caused by increased levels of insulin in the blood, infiltrating the skin and causing pigmentation. It is seen behind the neck and in skin folds. It is a symptom for insulin resistance which is common in PCOS sufferers particularly where obesity is a factor.
Diagnosis of PCOS is made by investigating blood levels of Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH) and Testosterone. FSH is expected to be either normal or below the normal range.
The relevant range depends on the stage of the menstrual cycle when the sample is taken. LH is expected to be increased in PSOS. The normal ratio for FSH and LH is expected to 1:1. A positive result for PCOS would show a ratio of 3 or more.
Testosterone levels are also expected to be high. Women with PCOS may also show abnormal lipid and insulin levels. Testosterone is responsible for the abnormal hair growth seen in PCOS. Ultrasound scans are also carried out to confirm the diagnosis.
PCOS has a connection to insulin resistance caused by a defect in the normal response to insulin. Studies show that there is a reduced insulin activity in adipose (fat storing) tissue and skeletal muscle. It is believed that high levels of fatty acids may affect the liver causing glucose intolerance and insulin resistance.
It is thought that, excluding polycystic ovaries, men may suffer from the same symptoms as women such as increased levels of steroid hormone, insulin resistance, abnormal hair growth and acne, particularly those with female relatives who have been diagnosed with PCOS. It may therefore be beneficial to check insulin resistance in male relatives of PCOS women.
Genetics and environmental influences seem to affect the prevalence of PCOS. The environmental issues such as obesity and a sedentary lifestyle can be reversed causing an improvement in insulin resistance. It can also reduce the probability of developing type 2 diabetes mellitus.
A diagnosis of PCOS means that other possible conditions need to be monitored for life eg. cardiac disease, metabolic syndrome, infertility, cancer and problems during pregnancy. There is a possibility of developing type 2 diabetes mellitus however this possibility can be reduced in obese women if they lose weight and maintain a health exercise regime.
Weight loss also improves cardiac function and so reduces the probability of developing cardiac disease. It is possible that cancer may develop with PCOS. This is more likely to be due to the hormone imbalance than polycystic ovaries.
It is therefore important to eat healthily and take regular exercise to reduce your risk of insulin resistance related diseases. It is also important to have regular health checks to monitor your weight and watch for the early signs of abnormal changes. Remember, if an abnormality is found sooner rather than later it is far more likely to improve the chance of successful treatment.
If you are in any doubt make sure you speak to your doctor.
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