Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman’s ovaries work. It occurs in about 20% of women and is one of the main causes of infertility. About half of women with PCOS do not show any symptoms. Women who show symptoms usually show at late teens or early twenties. The cause of PCOS is not known but it seems to run in families. Despite the name, women with PCOS do not have cysts.

What is PCOS

There are three main features of PCOS and having at least two of these features may mean you are diagnosed with PCOS.

These 3 main features of PCOS are:

 Irregular periods as your ovaries are not regularly releasing eggs (ovulation).

 Excess androgen means you have high levels of “male” hormones in your body. It may manifest as excess facial or body hair (hirsutism).

Polycystic ovaries which is when your ovaries become enlarged and contain many fluid-filled sacs (follicles)that surround the eggs. Follicles are sacs in which eggs normally develop. These follicles are harmless and can measure up to 8mm (about 0.3in) in size. When these follicles are underdeveloped, they are unable to release an egg, which means ovulation does not occur.

Symptoms of PCOS

Irregular Periods or absence of periods.

Signs of high levels of androgen e.g. hirsutism (excessive hair growth usually on the face, back, chest and buttocks), thinning of the hair and hair loss from the head.

Overweight and Obesity.

Oily skin or acne.

Inability to get pregnant as you are not having regular ovulation or not ovulating at all.

Insulin resistance.

Increased levels luteinizing hormone.

PCOS is associated with an increased risk of the following:

Gestational diabetes mellitus (GDM)

Type 2 diabetes

Hypertension

Dyslipidaemia is when you have an abnormal amount of lipids in your blood.

Infertility

Spontaneous abortions (Miscarriage)

Cardiovascular events e.g. heart attack.

Ovarian cancer which is cancer of the lining of the womb.

Diagnosis of PCOS

Diagnosis of PCOS is usually based on the 2003 Rotterdam criteria. The Rotterdam criteria for PCOS to be diagnosed is such that having at least two of these features may mean you are diagnosed with PCOS.

  • Irregular periods as your ovaries are not regularly releasing eggs (ovulation).
  • Clinical and biochemical signs of hyperandrogenism (excess androgen) which means you have high levels of “male” hormones in your body. It may manifest as excess facial or body hair (hirsutism).
  • Polycystic ovaries which is when your ovaries become enlarged and contain many fluid-filled sacs (follicles)that surround the eggs. Follicles are sacs in which eggs normally develop. These follicles are harmless and can measure up to 8mm (about 0.3in) in size.

Other conditions, e.g. congenital adrenal hyperplasia, thyroid dysfunction, androgen-secreting tumours, hyperprolactinaemia and Cushing’s syndrome that present in a similar way must be excluded before making a diagnosis of PCOS. 

What is Insulin?

Insulin is a hormone made in your pancreas. The pancreas is a gland behind your stomach that helps with digestion. It helps your body use glucose for energy. When the amount of glucose is high in the bloodstream, the pancreases senses this and releases the right amount of insulin to help drive glucose into your cells where it’s broken down to produce energy that fuel your body. If there is not enough insulin in your body or if your body can’t use insulin properly, your blood sugar levels will become high.

What is Insulin resistance

Insulin resistance is when your body cannot use insulin properly. Insulin resistance is when cells in your liver, muscles and body fat and start resisting or ignoring the signal that the hormone insulin is trying to give out—which is to drive glucose out of the bloodstream and into our cells. This can lead to a rise in blood sugar levels.

Insulin resistance

Genetics, ethnicity and age can be a factor to developing insulin sensitivity. The risk factors for developing insulin resistance include excess body weight, especially too much belly fat, smoking, sleep issues and lack of exercise. At first your body responds by producing more insulin. Over time, the beta cells in your pancreas that are working so hard to make insulin get worn out and can no longer keep pace with the demand for more and more insulin and your blood sugar may begin to rise.

Insulin resistance and PCOS

Many, but not all women who have PCOS also have ‘insulin resistance’. As already explained, insulin resistance can lead to higher than normal insulin levels. This high level of insulin can cause thickening and darkening of the skin on the back of the neck, the groin area and under the armpit. This is known as acanthosis nigricans. These high levels of insulin can also disturb the normal balance of the male and female hormones and make the ovaries to produce more male hormone e.g. testosterone. This leads to some of the symptoms like hirsutism (excessive body hair), acne, irregular or few period or problems getting pregnant which are experienced by women who have PCOS.

Having a higher insulin level can make you to gain weight. This may explain why many women with PCOS are overweight or obese. These elevated insulin levels can also increase your chances of developing type 2 diabetes and endometrial cancer (cancer in the lining of the womb).

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