Polycystic ovary syndrome (PCOS)

What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a common condition which affects how a woman's ovaries work. Ordinarily, an egg is released from a follicle in the ovary, but in PCOS these follicles are unable to release an egg regularly meaning ovulation can’t happen. An ultrasound image would show lots and lots of follicles in the ovaries. 

PCOS symptoms also come about from changes in hormone levels. The hormonal imbalance can cause unwanted symptoms such as facial hair and acne. 

What are the symptoms of polycystic ovary syndrome?

You may or may not have symptoms if you have PCOS. If you do have symptoms, they often start at the time of your first period.

Symptoms of PCOS include:

• Heavy or irregular periods 

• No periods

• Difficulty getting pregnant 

• Increased hair growth (this may be on your face, chest, bottom or back)

• Acne, particularly on the neck

• Oily skin

• Thinning hair or hair loss

• Weight gain

• Patches of darker skin (called nigricans)

How common is polycystic ovary syndrome?

PCOS is very common, affecting around 1 in 10 women in the UK. However, many cases are undiagnosed.

What causes polycystic ovary syndrome?

There isn’t a clear cause of PCOS, but many factors are thought to be linked to the condition. These include:

• Inflammation – this makes ovaries produce more hormones which causes a hormonal imbalance

• Insulin resistance – if your body is resistant to insulin, you’ll produce more of the hormone. Increased levels of inulin can increase the levels of masculine hormones (androgens)

• Family history – you’re more likely to have PCOS if someone in your family has had the condition.

How is polycystic ovary syndrome diagnosed?

A PCOS diagnosis is done by looking at 3 key features. If you have 2 out of the 3, you’ll be diagnosed with polycystic ovarian syndrome. These 3 features are:

• Irregular periods – this suggests an egg is not being released each month

• High ‘male hormone’ levels – these hormones are called androgens 

• Polycystic ovaries – this is where your ovaries have sacs which are filled with fluid, containing an egg. This would be shown with a scan

You may have some examinations to help identify these, which include:

• Blood tests – to look at different hormone levels

• Ultrasound – this will look at your ovaries and whether they have cysts

How is polycystic ovary syndrome treated?

Unfortunately, there’s no cure for polycystic ovaries, but there are treatments that can help your symptoms. Treatment of PCOS will depend on you and your symptoms.

If you’re overweight you may be advised to:

• Eat a healthier diet 

• Exercise more 

If you’d like more regular periods you may be recommended:

• The contraceptive pill 

• Progestogen tablets

If you have no periods at all then it is recommended to have at least 4 a year to protect the lining of your womb.

If you have unwanted hair growth or hair loss on your head, you may be suggested:

• The contraceptive pill

• Eflornithine cream which helps treat unwanted hair growth

• Usual hair removal approaches such as threading, waxing or laser hair removal 

• Spironolactone which reduces the male hormone 

Not all women with PCOS struggle to get pregnant but, if you are, there are medications that can help. It is likely that your doctor may refer you to a fertility clinic before prescribing medications such as clomifene or metformin. 

How can Livi help? 

If you’ve noticed symptoms of PCOS, a Livi doctor can talk to you about your symptoms and give you advice on the best next steps.