PCOSPCOS: Free advice – ask me today!
Online Medical Services
Accessible, affordable private healthcare for all
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 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?
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?
- 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?
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?
I have had PCOS all my adult life and I am worried that I will pass it on to my daughter?
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?
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?
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?
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?
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?
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.
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 is very good at improving fertility and the chance of conceiving. Its effect may improve even further when prescribed with metformin.
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.
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.
Copyright MyWebDoctor. All Rights Reserved.