Polycystic ovarian syndrome (PCOS) is a set of symptoms that occur when you don’t ovulate regularly due to high androgens (hormones responsible for male-type characteristics).
It is normal for women to have some androgens, which are necessary for oestrogen production, libido and keeping bones strong, however during PCOS, excess androgens result in undesirable symptoms such as acne, male-pattern hair growth (hirsutism) and scalp hair loss. These androgens also interfere with ovulation, making the menstrual cycle irregular and causing difficulty with fertility.
If you’ve been diagnosed with PCOS you may have an image in your head that your ovaries are being attacked by cysts. They are not. The cystic appearance of ovaries during PCOS is caused by many tiny eggs trying to develop at the same time, instead of just one.
The hormonal feedback loop needed for ovulation malfunctions and none of the developing eggs reach the maturity needed to be released. As a result you may not get your period for long stretches of time or you may have an irregular cycle.
Symptoms of PCOS
Other than irregular or infrequent periods, the major signs and symptoms of PCOS include:
- Hirsutism: male-pattern hair growth, particularly on the belly, chin, upper lip, chest, back upper arms & inner thighs
- Hair loss: thinning hair or male-pattern scalp hair loss
- Acne
- Anxiety and stress
- Depression
- Sugar cravings
- Difficulty losing weight
- Skin pigmentation (acanthosis nigricans): areas of thicker, darker skin with a velvety texture that tend to occur in body folds such as the neck and groin.
- Trouble conceiving
- Severe premenstrual syndrome (PMS)
Symptoms and severity vary from person to person and you may not have all of the symptoms mentioned above.
The poor blood sugar control that goes hand in hand with PCOS can have consequences if left untreated. Women with PCOS have greater risk of developing type II diabetes and cardiovascular disease.
Diagnosis of PCOS
The Rotterdam criteria is the most commonly used diagnostic tool for PCOS, with two of the three required for a diagnosis:
- No ovulation
- Excess androgens (by hirsutism, male-pattern hair growth, or raised blood androgen levels)
- Ovaries have multiple cysts on both ovaries
Other conditions must be excluded for these presentations, including thyroid disorders, congenital adrenal hyperplasia, hyperprolactinaemia, and androgen-secreting tumours.
Long term risks of PCOS
Women with PCOS who experience infrequent periods (<6-8 per year) have an increased risk of endometrial cancer.
Women with PCOS have an increased risk of high blood pressure, preeclampsia and gestational diabetes during pregnancy and should be screened for these frequently in pregnancy.
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