Polycystic Ovaries
Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome is a common hormonal disorder. Although the exact cause is still unknown, it usually results in excess secretion by the ovaries of male hormones (androgens). It affects approximately 1 in 10 women, usually between early teenage years to late 30s.
Symptoms
- Excessive hair (hirsutism) on face, abdomen, breasts, legs
- Irregular menstrual periods
- Acne
- Thinning/ balding of the hair
- Infertility
- Obesity
If left untreated, PCOS is associated with an increased risk of diabetes, hypertension, increased cholesterol and heart disease.
Diagnosis
There is no single specific blood test for the diagnosis of PCOS. It requires specialist measurement of a number of different hormones, including the androgens, testosterone, dehydroepiandrostenedione sulphate (DHEAS) and androstenedione. Other hormone tests include luteinising hormone (LH), follicle stimulating hormone (FSH), 17-hydroxyprogesterone, sex hormone binding globulin (SHBG), and prolactin, as well as measurement of thyroid gland function.
If your male hormones are elevated, you may be required to undergo a 'dexamethasone suppression test' in order to confirm that the high levels of hormones are coming from your ovaries and not your adrenal glands, which would indicate a different diagnosis.
An ultrasound scan will usually be performed to look at your ovaries. This often, but not always shows a number of cysts on the ovaries.
Treatment
The treatment of PCOS should be tailored towards your specific concerns i.e. infertility, excess hair, acne, irregular periods, as there are specific treatments for each of these which are often mutually exclusive. In the long-term, attention should be to reduce your risks of the long-term complications such as hypertension, heart disease and diabetes.
As obesity is a frequent occurrence in PCOS and fat tissue exacerbates the hormonal disturbances, much attention will focus on trying to help you lose weight. You may be referred to a specialist dietician with experience in this field, as well as receiving sensitive and practical advice about how best to reduce your calorie intake and increase your exercise commitment.
Medications
If you are overweight, a commonly used drug is called metformin. This is also frequently prescribed to people with diabetes. It works by making you more sensitive to insulin and often helps individuals with their weight reduction. It is particularly good for irregular periods or infertility, as it often induces regular ovulation. An additional medication for infertility is clomiphene (Clomid) which is an oral anti-estrogen medication that you take in the first part of your menstrual cycle. The two can safely be used together.
An old-fashioned but very effective and safe treatment for irregular periods and/or infertility is a medicine called prednisolone. This is effectively the same hormone as is made by the adrenal glands, cortisol. However, by taking the prednisolone in a specific way, namely a larger dose at night before retiring and a smaller dose first thing in the morning, the adrenal glands are tricked into not making any male hormone and therefore the total amount of male hormones in your body is decreased.
Mild cases of hirsutism are often treated with topical measures to the affected area such as shaving, plucking, waxing, electrolysis, or laser treatment. The first line medication is usually a specific female contraceptive pill, 'Dianette'. This is the only Pill which contains a small amount of the anti-male hormone, cyproterone acetate. Dianette is also very effective in restoring normal cyclicity of periods, but it is a contraceptive and therefore will not be helpful if you are trying to conceive.
More severe cases of hirsutism may be treated with the addition of a larger dose of an anti-male hormone medication, such as cyproterone acetate, finasteride or a water tablet called spironolactone. As these will result in fetal abnormalities if you became pregnant while taking them, most endocrinologists will only prescribe them if you are also taking Dianette, or an alternative effective form of contraception. While the anti-androgens are the most effective medication for excess hair, you will not see any improvement until after 4-5 months and the maximum effects will not be seen for 9 months.
A topical cream called Vaniqa (eflornithine) can also be effective in reducing hair growth, especially on the face.
If medications don't help you become pregnant, your doctor may rarely recommend a procedure called laparoscopic ovarian drilling. This involves the insertion of a small telescope through a tiny incision in your abdomen and subsequent lasering of the cysts on your ovaries to reduce the secretion of LH and androgens.