Polycystic ovary syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) is the most common female hormone condition and manifests differently in each individual. It can be incredibly devastating to a woman’s self-esteem and quality of life.
In support of World PCOS day (1st September) with registered charity Verity, I have detailed what it is and how to deal with the condition, in hope that it may help demystify the condition. #PCOSAwareness
What is PCOS?
Polycystic Ovary Syndrome (PCOS) is an endocrine disorder whereby polycystic ovaries are one of an array of possible symptoms caused by an underlying hormone imbalance.
PCOS affects women and AFAB individuals in different ways, so not everyone will have all these symptoms. Some may have only mild symptoms, while others may have a wider range of more severe symptoms.
PCOS symptoms include:
irregular periods, or a complete lack of periods
irregular ovulation, or no ovulation at all
reduced fertility – difficulty becoming pregnant
unwanted facial or body hair (hirsutism)
oily skin, acne
thinning hair or hair loss from the scalp (alopecia)
weight problems – being overweight, rapid weight gain, difficulty losing weight
depression and mood changes
Explore more about what PCOS is on the Verity PCOS charity website.
There's no test to definitively diagnose PCOS. Your doctor is likely to start with a discussion of your medical history, including your menstrual periods and weight changes. A physical exam will include checking for signs of excess hair growth, insulin resistance and acne. Your doctor might then recommend:
A pelvic exam. The doctor visually and manually inspects your reproductive organs for masses, growths or other abnormalities.
Blood tests. Your blood may be analyzed to measure hormone levels. This testing can exclude possible causes of menstrual abnormalities or androgen excess that mimics PCOS. You might have additional blood testing to measure glucose tolerance and fasting cholesterol and triglyceride levels.
An ultrasound. Your doctor checks the appearance of your ovaries and the thickness of the lining of your uterus. A wandlike device (transducer) is placed in your vagina (transvaginal ultrasound). The transducer emits sound waves that are translated into images on a computer screen.
If you have a diagnosis of PCOS, your doctor might recommend additional tests for complications. Those tests can include:
Periodic checks of blood pressure, glucose tolerance, and cholesterol and triglyceride levels
Screening for depression and anxiety
Screening for obstructive sleep apnea
PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication.
Your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — for example, losing 5% of your body weight — might improve your condition. Losing weight may also increase the effectiveness of medications your doctor recommends for PCOS and can help with infertility.
To help decrease the effects of PCOS, try to:
Maintain a healthy weight. Weight loss can reduce insulin and androgen levels and may restore ovulation. Ask your doctor about a weight-control program, and meet regularly with a dietitian for help in reaching weight-loss goals.
Limit carbohydrates. Low-fat, high-carbohydrate diets might increase insulin levels. Ask your doctor about a low refined-carbohydrate diet if you have PCOS. Choose complex carbohydrates, which raise your blood sugar levels more slowly.
Be active. Exercise helps lower blood sugar levels. If you have PCOS, increasing your daily activity and participating in a regular exercise program may treat or even prevent insulin resistance and help you keep your weight under control and avoid developing diabetes.
Diets. Not all diets work the same for everyone, as women, we need to be wary of hormones in meat and dairy and the effects it has on our hormone - that's not to say we should cut it out altogether. Many PCOS'ers benefit from gluten-free diets to avoid the bloat and some from Keto to lose the weight (which is not a sustainable diet and not recommended long term).
Yoga and meditation. This is really important to practise and is so easily accessible these days. Through our gyms, youtube channels and apps. After you've perfected it, you can self-guide.
Be kind to yourself. This has never been so important and also teaching those closest to you that it can be hard sometimes.
There are many uncompleted studies which suggest various medications to help certain types of PCOS deal with symptoms and pregnancy. Not all of them are as effective for everyone but some do help depending on what life stage you are at. This is something you need to speak to the doctor about.
To regulate your menstrual cycle, your doctor might recommend:
Combination birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin.
Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn't improve androgen levels and won't prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.
To help you ovulate, your doctor might recommend:
Clomiphene (Clomid). This oral anti-estrogen medication is taken during the first part of your menstrual cycle.
Letrozole (Femara). This breast cancer treatment can work to stimulate the ovaries.
Metformin (Glucophage, Fortamet, others). This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels. If you don't become pregnant using clomiphene, your doctor might recommend adding metformin. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss.
Gonadotropins. These hormone medications are given by injection.
To reduce excessive hair growth, your doctor might recommend:
Birth control pills. These pills decrease androgen production that can cause excessive hair growth.
Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin. Spironolactone can cause a birth defect, so effective contraception is required while taking this medication. It isn't recommended if you're pregnant or planning to become pregnant.
Eflornithine (Vaniqa). This cream can slow facial hair growth in women.
Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments.
Preparing for your appointment
You may be referred to a specialist in female reproductive medicine (gynaecologist), a specialist in hormone disorders (endocrinologist) or an infertility specialist (reproductive endocrinologist).
Here's some information to help you get ready for your appointment. What you can do:
List symptoms you've been having, and for how long
List all medications, vitamins and supplements you take, including the doses
List key personal and medical information, including other conditions, recent life changes and stressors
Prepare questions to ask your doctor
Keep a record of your menstrual cycles
For PCOS, some basic questions to ask your doctor include:
What tests do you recommend?
How does PCOS affect my ability to become pregnant?
What medications do you recommend to help improve my symptoms or ability to conceive?
What lifestyle modifications do you recommend to help improve my symptoms or ability to conceive?
What are the long-term health implications of PCOS?
I have other medical conditions. How can I best manage them together?
During your appointment, don't hesitate to ask other questions as they occur to you.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
What are your signs and symptoms? How often do they occur?
How severe are your symptoms?
When did each symptom begin?
When was your last period?
Have you gained weight since you first started having periods? How much weight did you gain, and when did you gain it?
Does anything improve or worsen your symptoms?
Are you trying to become pregnant, or do you wish to become pregnant?
Has your mother or sister ever been diagnosed with PCOS?
How has PCOS changed your life since being diagnosed, when where you diagnosed? DO you have any tips which work for you?