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Polycystic Ovary Syndrome (PCOS)

Advice, Treatment, Testing - Dr Helen Webberley

PCOS - Polycystic Ovary Syndrome

Free Advice, Prescription Medication, Blood Tests

Dr Helen Webberley MBChB MRCGP MFSRH

GMC no 3657058

Polycystic Ovary Syndrome (PCOS) is a condition that affects the way your ovaries work. Your ovaries may have lots of small cysts or follicles (small, fluid-filled lumps or pockets) on them and they may be larger than usual. In the UK, about seven in every 100 women have PCOS and this can affect the way your ovaries work in producing your female hormones and also the eggs needed for your fertility.

If you are having problems with PCIS or would like to have a test then we can provide you will a comprehensive service here.

For frequently asked questions, click below!
What is PCOS and who gets it?

PCOS is a complicated disorder which can cause multiple medical problems in differing ways. It is sometimes referred to as Stein-Leventhal syndrome, named after the 2 American gynaecologists who first described it.

It occurs in women of menstrual age at an incidence of between  1 in 10 to 1 in 20 women and the incidence is similar across all ethnic groups. It is the commonest endocrine disorder in women of this age group, even more common than diabetes and thyroid disease.

Many women who probably have PCOS have never been diagnosed and for this reason, WHO’s estimate of approximately 116 million women worldwide having it, is likely to be a gross underestimation.

There is a definite hereditary component to the condition. It can be passed from mother to daughter and if one identical twin has it, then there is a high chance of the other twin developing it too. The gene can also be passed onto males (who may have features of early baldness or even excess hair) and then passed onto their daughters. The gene hasn’t yet been fully identified and is certainly complex. The other confusing factor is that the gene has variable expressivity or penetrance. This means that the features of PCOS may appear to differing degrees in different women who carry the gene. They may show all or only a few of the symptoms and signs.

A propensity to being overweight also increases the likelihood of PCOS developing.

The most consistent features are the presence of multiple cysts on the ovaries seen on ultrasound and a hormonal imbalance with higher than expected circulating levels of the male hormone, testosterone. That is not to say that every woman with PCOS will have cysts, or that every woman with cysts will have PCOS!

What are the Common Symptoms of PCOS?

Polycystic ovary syndrome is a complicated disorder with multiple symptoms and signs, but not all women demonstrate all of the symptoms!

Sadly many of the symptoms of PCOS are just those ones to make a woman feel really unwomanly and unfeminine and this can lead to quite serious problems with confidence, self doubt and anxiety.

Weight gain

Many women who have PCOS  have real problems with weight control and have struggled through much of their lives in trying to keep their weight down. Surprisingly losing weight can help control many of the symptoms of PCOS and in particular diabetes as well as significantly increasing your chances of conceiving. This is particularly important when considering taking Clomid.

We are able to help you with weight loss diets and support, and can prescribe medications such as orlistat to make the whole journey much easier!

Infertility and treatment of difficult periods

Because of the hormonal imbalances seen in PCOS and in particular the high testosterone levels, problems with periods and ovulation occur frequently. These can simply be irregular, absent or heavy periods, or more seriously, difficulties in conceiving and infertility.

We can provide blood tests to assess your hormone levels through your menstrual cycle, to give an accurate picture of what is going on and whether you are ovulating normally.

Based on the results of these blood tests,  we can regularise your periods with hormones or even prescribe you Clomid to help you conceive. There is also evidence to suggest that a combination of metformin and clomid increases your chances even further of becoming pregnant.

Our nurses and doctors have years of expertise in this field and are available to help you with all your worries.

 

Diabetes and insulin resistance

Type II diabetes is common in women with PCOS. It is part of the ‘metabolic syndrome’ that is sometimes described as part of this condition. It is caused by insulin resistance at the surface membrane of cells. Insulin is needed to drive glucose from the bloodstream into cells to keep the blood levels low, at the same time as providing energy for the cells.

In women with PCOS the cells seem to be resistant to this action and insulin levels rise, as do the levels of blood sugar, causing diabetes. It is helped by weight loss and exercise, but also by taking drugs such as metformin.

Our medical team can give you advice and monitoring for your diabetes as well as prescribing metformin for you as necessary.

Acne

As with the hormonal imbalances that occur in adolescents around puberty, acne is also very common in women with PCOS. This can occur even into the third and fourth decade.

We are able to provide advice about acne management and can provide prescriptions for all kinds of creams and lotions as well as oral antibiotics for managing this embarrassing condition.

Unsightly facial hair

This is a very distressing symptom for women who experience this problem. To make matters worse, the facial hair is often dark and coarse. This occurs because the excess testosterone is converted into dihydrotestosterone (DHT) which stimulate hair follicles.

We can provide advice about simple methods for managing this problem, such as the use of metformin tablets or vaniqa cream, both of which can be highly effective in controlling this.

We are able to prescribe these for you and if these do not provide the results you want, recommend other types of hair management techniques such as dyeing,  epilators, threading or even electrolysis.

Hormonal imbalance

At the end of the day, many of the problems seen in PCOS are associated with higher levels of circulating levels of testosterone, so medical interventions aimed at lowering testosterone to normal levels, can help greatly.

Use of the oral contraceptive pill  increases levels of sex hormone binding globulin which in turn, soaks up any excess free testosterone floating around. Free testosterone is thought to be the main culprit!

Other anti-androgens such as spironolactone, have also been shown to reduce facial hair and 5-alpha reductase inhibitors such as finasteride have  also been used as  second line agents. However it is extremely important that adequate contraception is in place because of the risk of abnormalities in the foetus.

How is PCOS diagnosed?

PCOS is usually fairly easy to diagnose based on all the symptoms and signs. Any woman who has a combination of being overweight, having excess facial hair and/or acne, a history of irregular periods and even infertility, is likely to have PCOS.

There have been several algorithms to help diagnose PCOS but probably the simplest is the Rotterdam algorithm. This states that the diagnosis can be made if either of 2 of the following symptoms/signs are present;

  • Absent or very irregular ovulation, with very irregular, heavy or absent periods
  • High levels of testosterone
  • Multiple cysts on the ovaries on an ultrasound scan.

 

How is PCOS treated?

The treatment of PCOS is quite complicated because there are so many different clinical aspects to the condition. However, there are a few simple measures that can be done to help the symptoms.

  • Weight loss – You should consider taking regular exercise, (even if it is only brisk walking) at least once a day, avoid too much fat, sugar and dairy in your diet, eat plenty of fresh vegetables and fruit, stop smoking and cut back on alcohol and make sure you get a good night’s sleep! Metformin has been shown to aid weight reduction in PCOS and certain prescription medications such as orlistat (Xenical) can also be very helpful in his scenario.
  • Hormonal imbalance – The oral contraceptive pill can be very effective at regularising the menstrual cycle. Weight loss has also been shown to significantly improve irregular periods and the chances of conceiving, particularly if metformin is also used to achieve this. If you are really struggling to conceive then we can prescribe you Clomid (clomiphene) to help you with this.

 

  • Acne – Unfortunately acne is a common problem in women who have PCOS and may occur even into the 4th decade! This can be distressing and difficult to treat, particularly if your skin has a tendency to be oily. Treatment is really no different from the acne seen in teenagers. Keeping the skin clean and non-greasy is really important.You should avoid washing your face too frequently and certainly no more than twice a day as this can be irritating to the skin. When you do wash make sure it is with a weak detergent only.  Benzoyl peroxide is excellent as antiseptic wash and may be all you need. Otherwise treatment with topical retinoids, antibiotics and azelaic acid can be very effective. Oral antibiotics such as tetracycline and lymecycline are also very effective. We can give you expert medical advice on how to manage your acne and provide prescriptions for the medications.
  • Type II diabetes – This is caused by insulin resistance at the surface membrane of cells. Insulin is needed to drive glucose from the bloodstream into cells to keep the blood levels low, at the same time as providing energy for the cells. In women with PCOS the cells seem to be resistant to this action and insulin levels rise, as do the levels of blood sugar, causing diabetes. It is helped by weight loss and exercise, but also by taking drugs such as metformin. Our medical team can give you advice regarding this as well as prescribing metformin for you as necessary.
  • Facial hair – This is a very distressing symptom. We can provide advice about simple methods for managing this problem, such as the use of metformin tablets or vaniqa cream both of which can be very effective. Other anti-androgens such as spironolactone, have also been shown to reduce facial hair and 5-alpha reductase inhibitors such as finasteride have  also been used as  second line agents. We are able to prescribe these for you and if these do not provide the results you want, recommend other types of hair management techniques such as dyeing, epilators, threading or even electrolysis.

Although this can all seem very daunting, our doctors can help you decide how you best want to mange your symptoms. We can provide tests for monitoring hormone levels and ovulation and prescribe appropriate medications to help you

What Causes PCOS?

Nobody fully understands why PCOS occurs in some women.

There is a definite hereditary component to the condition. It can be passed from mother to daughter and if one identical twin has it, then there is a high chance of the other twin developing it too. The gene can also be passed onto males (who may have features of early baldness or even excess hair) and then passed onto their daughters. The gene hasn’t yet been fully identified and is certainly complex. The other confusing factor is that the gene has variable expressivity or penetrance. This means that the features of PCOS may appear to differing degrees in different women who carry the gene. They may show all or only a few of the symptoms and signs.

A propensity to being overweight also increases the likelihood of PCOS developing.

How is Metformin Useful for PCOS?

Metformin is an extremely useful drug for managing PCOS. It works in several different ways.

It is the first line treatment for type II diabetes and insulin resistance which is commonly seen in PCOS. It aids weight reduction, helps control excess facial hair, regularises menstrual irregularities and also helps improve fertility! It is a very important weapon in the PCOS armamentarium and is generally very safe with few side-effects, although some patients do experience some diarrhoea when they first start it! However many GPs are reluctant to prescribe this if there is no evidence of diabetes.

Our doctors will be very happy to discuss this with you and where appropriate, prescribe it for you.

 

What are the complications of PCOS?

In general, PCOS is more of a nuisance than causing serious medical complications.

Type II diabetes is common in women with PCOS and so these women are prone to the usual complications of diabetes, such as frequent infections (especially urinary, but also spots and boils), long term damage to kidneys, eyes and nerves. The dangerous coma we see in type I diabetes (either hypoglycaemic or ketoacidosis) does not really occur in PCOS although there have been rare reports of this occurring.

In the long term, women who have PCOS are also prone to high cholesterol and this in turn can cause heart disease and an increased risk of stroke, although fortunately, these are rare complications.

The weight problem may make women prone to thrombosis especially on long haul flights or periods of immobilisation such as after an illness or surgery.

What is hyperstimulation syndrome?

Ovarian hyperstimulation syndrome (OHSS) occurs when the ovaries are stimulated to release eggs. It mainly occurs in treatments for IVF with drugs such as HCG and only rarely occurs with Clomid. Clomid is used to stimulate the ovaries in women with PCOS, increasing their chance of becoming pregnant

The vast majority of women who are treated with Clomid have no problems at all and in the rare case of OHSS developing, the symptoms are only mild or not present at all. These may include bloating or mild abdominal pain. Rarely the symptoms may be more severe and under these circumstances the Clomid should be discontinued immediately.

Can I get pregnant if I have PCOS?

There is no doubt that fertility is significantly reduced in women who have PCOS. Periods can become very irregular or even absent due to the hormone imbalance and ovulation may be infrequent or not happen at all. This seems to be as a result of the weight problems associated with PCOS, the multiple cysts seen on the ovaries and the higher levels of testosterone in the blood.

However, pregnancy is still achievable.

Various approaches can be used to improve the chances of conceiving. The oral contraceptive pill can be very effective at regularising the menstrual cycle. Weight loss has been shown to significantly improve the chances of conceiving, particularly if metformin is also used to achieve this. Clomid seems to be very effective in PCOS especially if weight reduction has been successful and metformin is also being used.

Ultimately if none of these strategies are successful, then IVF is also available to many patients.

Should I lose weight?

Lifestyle improvements can greatly help the symptoms of PCOS. Probably the most important lifestyle improvement you should consider, is to lose weight. It is well recognised that many of the problems associated with PCOS such as menstruation and fertility problems, type II diabetes, unsightly facial and body hair and acne, all get better with concerted weight loss.

You should consider taking regular exercise, (even if it is only brisk walking) at least once a day, avoid too much fat, sugar and dairy in your diet, eat plenty of fresh vegetables and fruit, stop smoking and cut back on alcohol and make sure you get a good night’s sleep!

Metformin has been shown to aid weight reduction in PCOS and certain prescription medications such as orlistat can also be very helpful in his scenario.

What is Clomid?

Clomid is otherwise known as clomiphene citrate and is an artificial oestrogen-like substance that acts directly on the hypothalamus to stimulate the release of FSH and LH. It is highly effective in women with poor ovulation and in particular, in PCOS.

It is usually taken daily as a 50mg tablet, for 5 days between days 2 or 3 and days 6 or 7.

It is recommended that it should be taken for no longer than 6 months at a time mainly because it suppresses levels of normal oestrogen, although these levels bounce back as soon as clomid is stopped.

It is remarkably side-effect free, but can cause dizziness, nausea, hot flushes, headaches and occasionally mild abdominal discomfort.

Before it can be prescribed for you, we would normally recommend that some evidence of poor ovulation is provided, either through ovulation kits, or monitoring temperature.

It is also important to ensure that the fertility problem lies not only with the woman and the man’s sperm test should  also be checked.

Click HERE to ask questions or use the contact form below!

 

Online Medical Services – by Dr Helen Webberley

GMC no 3657058

Please note that this service does not aim to replace advice given to you by your own doctor, it is meant to supplement your health knowledge and awareness. It is not ever to be used in the case of a medical emergency.

PCOS - Polycystic Ovary Syndrome

Free Advice, Prescription Medication, Blood Tests

Dr Helen Webberley MBChB MRCGP MFSRH

GMC no 3657058

FSRS