Polycystic Ovary Syndrome: The What and the Why
By Emma Fosker- UEA Bloody Good Society collaboration
Many of us may have heard of polycystic ovary syndrome (PCOS) whether that be on the front of one of many leaflets on the wall at the GP surgery (the front being as much as you have ever read) or from one of those posts on Facebook, with an image of a ribbon, raising awareness for yet another disease you have barely heard of. However, few of us may know what PCOS actually is.
What is it?
In short PCOS is a condition affecting how the ovaries work due to abnormal hormone levels. It is a very common condition affecting as many as 1 in 10 women, although not everyone shows symptoms therefore some women do not even know they have it. For the women that do show symptoms possible symptoms include irregular or no periods, acne, weight gain, excessive hair growth on the body, thinning of hair on the head and difficulty getting pregnant. Different women experience different severity of symptoms meaning everyone has an individual experience with the condition.
The main features:
There are 3 main features of PCOS, the first is irregular periods due to ovulation (the release of an egg) not occurring regularly each month.
The next feature is high levels of androgens, these are hormones that are typically considered to be male, such as testosterone.
The third is polycystic ovaries, this means ovaries may be enlarged and have follicles inside them, each of these follicles contains an immature egg. A common misconception is that because the condition is called polycystic ovary syndrome you have to have polycystic ovaries in order to have the condition, when in fact having only 2 of these 3 features can lead to a diagnosis.
Despite being so common, as with many conditions involving women’s health, the exact cause of PCOS is still unknown. There has been evidence to show that insulin resistance, obesity, as well as a genetic factor play a role in excess androgens. Insulin resistance is when cells in the body stop responding to the release of the hormone insulin, to compensate for this the body releases high levels of insulin, which is believed to contribute to the increased production of androgens. The immature egg in polycystic ovaries means there are low levels of oestrogen and progesterone, in combination with the increased levels of androgens this hormone imbalance results in irregular periods.
Risks and complications:
In this section I am at risk of sounding like one of those NHS leaflets I previously mentioned; however, it is important to know that an increased risk of developing certain health conditions has been associated with having PCOS. One of these is type 2 diabetes, as this condition is also a result of being resistant to insulin. It has also been associated with having high cholesterol levels which can cause heart problems and strokes. Additionally, a link has been found between having no or irregular periods and having an increased risk of developing endometrial cancer (cancer of the womb lining).
Having PCOS also increases the risk of complications during pregnancy, risks such as pre-eclampsia, gestational diabetes and miscarriage. Furthermore, PCOS is one of the most common causes of fertility problems in women, as often ovulation is infrequent or completely absent.
Currently there is not cure for PCOS, only treatments to help ease the symptoms. One of the most effective treatments for women that are overweight is to lose weight, it has been found that even losing a small amount of weight can have a significant impact. There is also a range of medicines available to treat different symptoms.
The combined contraceptive pill is a common treatment used both to help regulate periods as well as reduce excessive hair growth. To help with fertility problems the most common drug used is called ‘Clomifene’ this encourages ovulation. If a woman does not respond to medicine it is possible to have a surgery, called laparoscopic ovarian drilling (LOD), this involves destroying the androgen producing tissue using heat or a laser, in order to correct the hormone imbalance.
The impact of PCOS:
As well as the range of physical symptoms associated with PCOS, it can also have an impact on mental health. Studies have found people living with PCOS are more likely to have symptoms of anxiety and depression. The reason for this is likely due to a combination of factors, such as difference in hormone levels as well as a result of the symptoms. For example, the symptom of excessive facial hair can lead to low self-esteem, and fertility problems can have serious impacts on mental health.
Why is more research needed?
For this question there is quite a simple answer, it affects 1 in 10 women yet the exact cause of PCOS is still unknown. Both in the general public and within the medical field there is a lack of awareness of PCOS despite it being such a common condition. This means as many as 70% of women go undiagnosed for years, therefore unable to manage the condition. Furthermore, the lack of understanding around the cause of PCOS means it is difficult to develop effective treatments or find a cure.
There are campaigns around the globe, the main one being PCOS awareness month every September, to raise money and educate. It is very common and it is likely someone you know will be affected, so it is important to get involved in raising awareness of PCOS. This will hopefully lead to more women getting diagnosed and treated, as well as more funding being given to research so that a cure can be found in the future.