Gynaecology › Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome is the commonest hormonal disorder among women of reproductive age. Its name is misleading: the underlying problem is not the appearance of the ovaries but irregular ovulation.
Symptoms
- Periods becoming infrequent or absent
- Increased hair growth on the face, chest and abdomen
- Persistent acne and oily skin
- Gaining weight easily and losing it with difficulty
- Difficulty conceiving
- Hair thinning
How the diagnosis is made
The diagnosis does not rest on a single test. The menstrual pattern, findings such as excess hair and acne, hormone assays and ultrasound are assessed together. Conditions that produce a similar picture, such as thyroid disease and raised prolactin, must be excluded.
A "polycystic appearance" on ultrasound is not diagnostic on its own; it also occurs in healthy women.
Why it matters
PCOS is not only a matter of menstrual regularity. In the longer term it raises the risk of insulin resistance, diabetes, raised cholesterol and excessive thickening of the lining of the womb. Treatment therefore addresses future health as well as present symptoms.
Approach to treatment
- Lifestyle: nutrition and regular activity — even a small reduction in body weight can restore ovulation
- Hormonal treatment to regulate periods and protect the lining of the womb
- Medication directed at insulin resistance
- Targeted treatment for excess hair growth and acne
- Ovulation induction where pregnancy is wanted
When pregnancy is wanted
PCOS makes conception harder but does not prevent it. Many women conceive naturally with ovulation-inducing medication; where there is no response, further treatment is considered. Assessing the male partner before starting saves time.
