Polycystic ovary syndrome affects millions of women in the UK and around the world – so what actually is it?
PCOS, or polycystic ovary syndrome, is a hormonal condition that affects millions of women all over the world. But despite it being so common, there’s a lot of misunderstanding surrounding it.
For example, many presume that PCOS means you can’t have children – when actually, the NHS reports that most PCOS-suffering women can get pregnant with treatment.
Despite there being no cure, there are a number of ways that the disorder can be managed so that it doesn’t have as much of an impact on your life. Below we break down the main symptoms and treatment options, as well as dispelling a few more common myths about PCOS.
What is PCOS?
Characterised by having small, fluid-filled sacs known as follicles (not cysts as the name suggests)in your ovaries, PCOS can disrupt your periods as well as a number of other possible side effects.
‘It’s the most common hormonal disorder in women, with some studies suggesting up to one in five of us are affected,’ says gynaecologist Dr Anita Mitra, aka Gynae Geek. ‘Diagnosis requires two out of the following three to be present: Irregular or absent periods; Signs of excess male hormones, including excess body/facial hair or acne, or high levels on a blood test; and polycystic ovaries seen on an ultrasound.’
‘About 70% of women with PCOS also have a degree of insulin resistance, the hormone that regulates our blood sugar. This results in excess production, which drives the ovaries to produce lots of testosterone, the root of many of the symptoms.’
Currently the exact cause of PCOS is unknown, and although it’s thought that there could be a genetic link at play, this hasn’t yet been proven through scientific research.
Symptoms of PCOS
There are a number of different symptoms that are frequently seen in PCOS cases. ‘The most common symptoms are acne and or problems with periods – either irregular (oligomeorrhoea) or total absence (amenorrhoea),’ says Dr Anita.
The NHS lists other common symptoms as excessive hair growth on the face and body, weight gain, thinning hair or hair loss from the head, and difficulty getting pregnant.
Any of these symptoms are worth a trip to see your GP and discuss, especially if you are concerned that you may have PCOS.
To diagnose the condition, your doctor will likely arrange some form of hormonal testing, but also to rule out other possible hormonal disorders. They may also arrange an ultrasound to examine your ovaries, and/or a blood test to measure your hormone levels.
Anita is about to publish her first book, The Gynae Geek: Your No-Nonsense Guide to ‘Down There’ Healthcare – a complete guide to reproductive health covering everything from your first period to post-menopause. Pre-order your copy now (because it’s essential reading for us all).
So we know that PCOS is treatable, but what are the options? Your doctor will be able to advise which are best for you, but below we’ve broken down some of the most common.
‘Firstly, the combined oral contraceptive pill doesn’t “balance” your hormones in the way many people believe,’ explains Anita. ‘It will give you a regular cycle back again, but it’s likely your periods will revert to being irregular once you stop, because this doesn’t correct the underlying hormonal problem. Taking this will also usually help with acne.’
One treatment option for women who want to get pregnant is medication that encourages ovulation; the first option is usually a drug called Clomefine and if this does not work, Metformin may be recommended.
‘This is a medication for diabetes that can be used to improve insulin sensitivity, which can be the root of PCOS in many women,’ Anita tells us. ‘It has been shown to improve menstrual cycle regularity and increase the chance of ovulation, which is important if you’re trying to get pregnant.
‘However, the most common side effects are diarrhoea and stomach cramps.’
‘A supplement that can be bought over the counter, this one has gained a lot of popularity,’ explains Anita. ‘It also seems to work as an insulin sensitiser, but doesn’t seem to have the same side effects as Metformin. There are a couple of different types of inositol and it’s the “myo-inositiol” form that seems to be most effective.
‘However, there haven’t been any really large studies or trials conducted yet, so we aren’t really sure of the optimum dose. As such, you probably won’t find many doctors recommending it as yet – but I think that’ll come in the future.’
‘Spironolactone is a prescription medication with anti-androgen activity,’ explains Harley Street dermatologist Dr Justine Kluk. ‘Higher levels and more potent activity of androgens, such as testosterone, can be seen in women with PCOS and contribute to the typical features of thinning hair on the scalp, excess body hair and acne, known as “hyperandrogenism”.’
While the drug can be very effective in reducing these symptoms, it’s not currently licensed for treating acne in the absence of PCOS. However: ‘Interestingly, it’s now believed that 19-39% of women with adult acne actually have underlying PCOS,’ Justine adds.
Can PCOS be managed through diet and lifestyle? ‘Absolutely! This is one of my favourite topics to talk about,’ Anita enthuses. ‘I did a whole podcast on the subject with Dr Rupy Aujla (@doctorskitchen). In general:
The benefits of getting enough sleep are very well documented and, if nothing else, all of us will agree that we feel better after getting our full eight hours.
But it’s also important in terms of PCOS: ‘This helps to reduce stress hormone levels, which can also increase insulin resistance,’ Anita confirms. If you’re struggling with your sleep at the moment, try one of these great sleep apps.
‘Reduce excess sugar intake, ignore ketogenic diets and instead think about carbs as quality over quantity. Go for wholegrains, oats etc that contain plenty of fibre, which will help your body get rid of old oestrogen that can otherwise recirculate and worsen the hormonal imbalance.’
‘Eat a really colourful diet to get plenty of fibre, but also for all the phytonutrients (plant-based) that contain all the chemicals that are vital for the chemical processes involved in healthy hormone production and ovulation. Healthy fats are also required for healthy hormone production. What’s basically a Mediterranean diet has been shown to be the healthiest for PCOS.’
‘Extreme exercise can worsen hormonal imbalances,’ Anita says. ‘Exercise is important for women to help build lean muscle, which can increase insulin sensitivity, so some form of strength training such as weights or body weight-centred training. I don’t think there’s one “best exercise for PCOS” – it’s whatever you enjoy and are going to stick to.
Yoga has been shown to be helpful in a few studies, and I think it can also be very useful as a way of building strength but also relaxing the mind.’
‘Lots of patients tell me they’ve been told to lose weight,’ Anita tells us. ‘Weight loss will also help with PCOS, because excess fat tissue can contribute to insulin resistance. However, I don’t ever make this the focus of my advice because I think it can be quite negative.’
In fact, a 2013 study conducted at Georgia Regents University found that the relationship between PCOS and obesity may be exaggerated because the women who seek treatment for this will be heavier.
‘If you’re able to adapt your lifestyle and focus on the positive things you can add to your body through diet and movement, I think you can get to the same point but with a healthier mindset.’
PCOS and pregnancy
It’s true that the condition is one of the leading causes of infertility – but it’s very treatable. ‘PCOS can affect fertility because it can stop ovulation; if you don’t ovulate, you don’t release an egg and therefore cannot get pregnant,’ Anita explains.
As outlined above, medications are available to encourage ovulation, and the NHS writes: ‘With treatment, most women with PCOS are able to get pregnant.’
However, Anita reminds us that a lack of ovulation ‘does not apply to everyone with PCOS and, even if you do have PCOS and aren’t currently ovulating, it doesn’t mean you won’t in future.
‘If you have PCOS and don’t want to get pregnant, please use contraception; I’ve seen plenty of “surprise” pregnancies in women with PCOS because they thought they couldn’t get pregnant.’
For more information and resources for living with PCOS, visit the NHS’s website or pcosaa.org.
Note that the purpose of this feature is to inform, not replace one-to-one medical consultations. For advice tailored specifically to you, always discuss your health with a doctor.