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Polycystic Ovarian Syndrome

Gynaecology 

Polycystic Ovarian Syndrome or PCOS, is a condition with many different features.

The key features include:

  • Menstrual cycle disturbance (usually very irregular periods)
  • Hyperandrogenism (high levels of male hormones)
  • Obesity
  • Associations with Type 2 diabetes and cardiovascular disease

The diagnosis of PCOS is often over-called (based on an ultrasound alone) and there are a number of other criteria that must be matched before the diagnosis can be made.

The criteria for diagnosis include:

  • Very irregular periods (or none at all)
  • Clinical signs or blood tests that indicate hyperandrogenism
  • Polycystic ovaries on ultrasound (25% of women without PCOS will have polycystic appearing ovaries on ultrasound)
  • Excluding other causes e.g adrenal tumours

Signs of hyperandrogenism or high androgen levels include:

  • Hirsutism – abnormal hair growth not consistent with a woman’s ethnic background
  • Acne
  • Androgenic alopecia or male pattern baldness
  • Raised androgens on a blood test

The treatment and management of PCOS depends upon the patient’s goals whether that be fertility, menstrual regulation, control of high androgen levels or reducing the long term risks of PCOS. In general, weight loss is a very important part of managing PCOS.

Hirsutism can be controlled with cosmetic methods, hormonal contraceptives or medications such as spironolactone.

Menstrual irreugularity and protecting the lining of the womb from developing cancer can be achieved with various hormonal contraceptives.

Infertility requires an evaluation of both the patient and her partner as male conditions can also cause infertility. PCOS with infertility can be managed with a combination of weight loss and medications which help ovulation such as metformin and clomiphene. Occasionally, surgery is necessary as part of the evaluation.

There are long term health risks associated with PCOS. These include:

  • Diabetes
  • Cardiovascular disease
  • High cholesterol levels
  • Abnormalities of the lining of the womb which may become cancerous
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