PCOS

PCOS: Free advice – ask me today!

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By Dr Helen Webberley MBChB MRCGP MFSRH | GMC no. 3657058

I am a GP and a sexual health and hormone specialist. I can give advice on any medical matter, and I offer safe access to medical advice, prescription medication, blood tests and x-rays, and specialist referrals to your local private hospital as needed.

PCOS

 

PCOS is a condition that affects around 1 in 15 adult women. There is a hereditary component to it, but many women develop it without any other family members having been affected and quite often it is picked up quite by chance on pelvic ultrasound scans. It is caused by having too much of the male hormone testosterone, which causes a hormonal imbalance. This may occur as a result of being overweight and some doctors feel that the condition is related to poor diet and lack of exercise in modern society.

Typical features are obesity, excess  facial hair, acne, irregular periods, infertility, type II diabetes and the appearance of multiple cysts on the ovaries, seen on ultrasound scans.

All of these different features can be helped with sensible advice and the use of  medication.

Frequently Asked Questions

Why have I got PCOS?
Between 1 in 10 and 1 in 20 women have PCOS and 120 million women worldwide. There is a genetic element to it, with the gene being passed down through families although it might ‘skip’ a generation. In many women however, there is no apparent cause.

The main symptoms are thought to be due higher levels of the male hormone testosterone, which is manufactured in fat cells and so being overweight or even obese can lead to the development of PCOS. It is thought to be a ‘modern western’ condition, brought about by poor diet, lack of exercise and obesity although some women with PCOS have none of these features.

How do I know if I have PCOS?
PCOS is usually fairly easy to diagnose based on all the symptoms and signs. There have been several algorithms to define 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 the male hormone, testosterone
  • Multiple cysts on the ovaries on an ultrasound scan.

Sometimes PCOS is diagnosed quite by accident in women who undergo surgery or scans for other reasons.

What causes PCOS?
Nobody really knows what causes PCOS  but the main abnormality seems to be higher than expected  levels of the male hormone testosterone, in women. Some studies have suggested that higher levels of circulating insulin, which we typically see in overweight patients, especially if they have type II diabetes, may stimulate excess testosterone production.

This in turn leads to the development of multiple cysts within the ovaries and many of the other symptoms and signs of PCOS. A hormonal imbalance occurs which has an effect on periods, fertility, weight, skin, hair and the ability of the body to cope with blood sugar levels. Managing this hormone imbalance is the mainstay for treating PCOS.

Is PCOS curable?
At this moment in time there is no evidence to suggest that PCOS is ‘curable’. However there are lots of ways in which we can manage and treat many of the symptoms and signs of PCOS so that sufferers of this condition, can enjoy normal and happy lives. The main treatments are aimed at improving the hormone imbalance with contraceptive pills, weight loss management with diet and exercise, controlling blood sugar levels with metformin and improving the acne and facial hair with creams and antibiotics. The combination of weight loss, metformin and the use of fertility drugs such as clomid, also significantly improve fertility.
I have had PCOS all my adult life and I am worried that I will pass it on to my daughter?
Unfortunately it is possible to pass on the ‘PCOS gene’ to your daughter. We understand that there is a hereditary component to this condition and that it is probably autosomal dominant but that the gene has variable expressivity!

In layman’s terms That means that if you have the gene then there is 50% chance of your daughter having it and if she has it, then she may show some, or all of the features of PCOS. Many of these features can be attenuated (reduced) however, by encouraging your daughter to eat healthily, take regular exercise and keep her weight down, as most of the problems we see with PCOS arise because of the weight problems that women with PCOS usually have.

There is no reason at all that if your daughter is able to maintain her weight at reasonable levels and adopt a healthy lifestyle, then she can easily live a long, happy and fertile life.

What are the main symptoms of PCOS?
As a result of the hormone imbalance we see in PCOS, several problems occur.

Women are much more likely to be overweight and to have real difficulties getting their weight down.

Women may experience bouts of lower abdominal pain which may be related to periods or sexual intercourse.

Women often have unsightly facial hair which is usually dark and coarse (to make matters worse!) This is because the testosterone is converted to DHT (dihydro testosterone) which promotes hair growth.

Acne can be a real problem and this is often difficult to treat.

Periods can be very troublesome, either scanty or absent, or can be frequent and heavy.

Type II diabetes is very common and the term ‘insulin resistance’ is used frequently in PCOS.

Infertility and difficulty in conceiving is also very common. This is usually due to anovulatory (absent ovulation) cycles.

Is PCOS dangerous?
In general terms, PCOS is a real nuisance but not  dangerous.

Diabetes is more common in women with PCOS, but this tends to be the less severe but more common form of the condition, called type II.

Women with type II diabetes  are more prone to the usual complications of diabetes, such as more frequent infections (especially urinary, but also spots, boils and fungal infections of the groin, feet and toenails ). Long term damage to kidneys, eyes and nerves can also occur if the diabetes is not very well controlled. Type II diabetes occurs because of insulin resistance (cells don’t react to insulin as they should, in allowing sugar to be taken in) and therefore more insulin tends to be produced leading to higher insulin levels  as well as blood sugar levels. Weight reduction can significantly improve and even cure type II diabetes.

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 these fortunately, are rare complications.

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

So PCOS does have certain risks attached to it, but with proper management and medical advice, these risks can be significantly reduced and even abolished altogether!

Can I get pregnant if I have PCOS?
There is no doubt that fertility may be 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.

I have PCOS, what can I do to help myself?
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 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 this scenario.

I know I have PCOS, but why do I still have acne at my age and what can I do about it?
Unfortunately acne is a common problem in women who have PCOS and not just in their adolescence or young adulthood. In the same way that hormonal changes around puberty can cause acne in teenagers and young adults, the hormonal imbalance we see in PCOS due to higher levels of testosterone, causes acne in older women too. 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 can be effective, but oral isotretinoin and co-cyprindiol should probably only be used under medical supervision.

Medication

Metformin

Metformin can be prescribed to help with weight loss and also to improve fertility.

Oral contraceptive pill

Oral contraceptive pill can help with regularising your periods and therefore improve fertility. Dianette is particularly good at helping balance the testosterone levels.

Clomid

Clomid is very good at improving fertility and the chance of conceiving. Its effect may improve even further when prescribed with metformin.

Vaniqa

Vaniqa is a cream which helps control excess and unsightly facial hair

Safe, real prescriptions for PCOS.

Whether you know which HRT suits you best or whether you need advice on what you should take,

ask me here about safe prescriptions for hormone replacement therapy.

Blood Tests

Serum hormone levels

These include oestrogen, testosterone and FSH levels. We know that PCOS is caused by a hormone imbalance and it is important to know what your levels are, so that we can monitor the effects of your treatment.

21 day progesterone

If you are trying for a baby then the 21 day progesterone is the most accurate way of showing whether you have ovulated. Over the counter ovulation kits detect an FSH surge but don’t necessarily show whether you have ovulated. It is particularly important to monitor 21 day progesterone if you are taking Clomid, as this will determine what dose of Clomid you need.

Blood sugar levels, HbA1c

Women with PCOS are more likely to develop type II diabetes. This condition can have serious consequences for health if not properly controlled. The blood sugar levels tell us the ‘real time’ amount of sugar circulating at the time of the test. The HbA1c tells us how well the blood sugar levels have been controlled over the preceding 3 months.

Contact me now for advice, prescriptions, blood tests and referrals.

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 never to be used in the case of a medical emergency.

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