Polycystic Ovarian Syndrome (PCOS) is a common hormonal disorder that many women suffer from. 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. 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 and symptoms
PCOS is characterised by the appearance of cysts on the ovaries, excess hair growth, obesity, androgen excess (excessive levels of male hormones such as testosterone), irregular periods (anovulation or oligo-ovulation). Women with PCOS might have some or all of these symptoms – it is highly variable from one patient to the next.
Common symptoms include:
➜ Hormonal disruption: higher levels of male hormones (androgens) which leads to acne, hirsutism or excess hair growth on the body and male-pattern hair loss4. Women with PCOS tend to have higher levels of androgens (male hormones)5.
➜ Menstrual cycle: a disrupted menstrual cycle is common. Symptoms range from normal menstruation being delayed 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 bleeding3.
➜ 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 sufferers to gain weight, and difficult for them to lose weight.
➜ Insulin: levels can be elevated in women with PCOS. Often they can be insulin resistant, which can increase the risk of heart disease and diabetes4.
➜ Infertility: many women with PCOS experience difficulty getting pregnant. Some medications that are commonly prescribed (see below) can help and speaking to a doctor or fertility specialist is recommended.
Treatments
There are a range of commonly prescribed medications. Women’s Health Action recommends you speak to a doctor about the best available options for your needs, as treatment may vary over time and from person to person.
Metformin
This drug is commonly prescribed to people with Type 2 Diabetes, but can also can help to reduce some symptoms of PCOS. It can help to regulate periods and enhance ovulation and reduce the effect of elevated male hormones4. Common side effects are nausea, digestive upset and vomiting. Women with PCOS have a high likelihood of developing Type 2 Diabetes due to insulin resistance, but taking Metformin can help delay or prevent this. Metformin should be used together with increased exercise and a nutritious diet6, not as a replacement 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 effective1.
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 twins2.
Diet and exercise
Women with PCOS are recommended to choose foods with a low glycaemic index (such as wholegrain bread, chickpeas, kidney beans, lentils, milk, yogurt, apples, pears, grapes, kiwifruit, pasta, noodles, oats, and bran) 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 hips3. 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 strength6.
Useful Links
Understanding Polycystic Ovary Syndrome » Best Practice Advocacy Centre NZ information page on PCOS
Soul Cysters » women with PCOS speak about their experiences.
References
1Huang 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.
2Legro, R. S., Barnhart, H. X., Schlaff, W. D., Carr, B. R., Diamond, M. P., Carson, S. A., … & Gosman, G. G. (2007). Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. New England Journal of Medicine, 356(6), 551-566.
3Sayed, M. Salem, M. Sweed (2012). Effect of Lifestyle Modifications on Polycystic Ovari-an Syndrome Symptoms, Journal of American Science 8(8), 535.
4Lord, J., Balen, A., Norman, R., Tang, T. (2003). Insulin-sensitising drugs (metformin, troglita-zone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome, The Cochrane Collaboration, The Cochrane Library, Issue 2.
5Michelmore, K. F., Balen, A. H., Dunger, D. B., & Vessey, M. P. (1999). Polycystic ovaries and associated clinical and biochemical features in young women. Clinical endocrinology, 51(6), 779-786.
6Lifchez, A., Jasulaitis, S. (2009). Polycystic Ovarian Syndrome, Medical and Reproductive Implications, The OB/GYN & Infertility Nurse – NP/PA, October 2009, Vol 1, No 1.