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Polycystic Ovarian Syndrome: A Diagnosis

Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disease affecting women of reproductive age, with at least 1 in 10 women diagnosed. Many reports suggest this number could be much higher, closer to 1 in 5. It is a disorder in which the ovaries (which make both male and female hormones) tend to make more male hormone than usual. High levels of male hormone, such as testosterone, cause many PCOS symptoms as when these levels are too high in a woman, they can have a masculinising effect on the female body and interfere with other hormones that in turn, cause disturbances to a woman's normal menstrual cycle. Subsequently, Dr Richard Day, Professor of Clinical Pharmacology at the University of New South Wales, says that these follicles in the ovaries never mature and so ovulation (the release of an egg) does not occur. The term polycystic ovaries comes from the immature follicles turning into small cysts on the ovaries. It is however possible for a woman to be diagnosed without having cysts. More on this later.

The reason for this rise in male hormone is unknown, but a genetic link may be a factor, for example, most PCOS women will have a relative, like a sister, with the condition.

There's no current cure, but it can be managed. With diagnosis and treatment, long-term complications can be significantly delayed or even prevented. PCOS can be difficult to diagnose as many of the symptoms mimic that of other hormonal disorders.

PCOS Symptoms & Triggers for Diagnosis

As you will read in my story, my trigger was acne and a little bit of weight gain. There could be any number of triggers and symptoms, outlined below;

  • Family History / Genetics

  • Menstrual Cycle disruptions such as irregular, heavy or absent periods

  • Slightly enlarged or 'lumpy' ovaries with many small cysts on them - these cysts are fluid filled cavaties that surround immature egg cells. They are not painful and do not burst

  • Difficulty conceiving

  • Pregnancy problems e.g. high blood pressure, gestational diabetes, miscarriage

  • Loss or thinning of hair

  • Excessive hair growth

  • Acne

  • Sleep Apnoea

  • Weight gain, particularly around hips and thighs

  • High blood levels of cholesterol and fats

  • High blood levels of insulin, a hormone made by the pancreas that helps the cells of the body to use sugar; high levels of insulin make weight loss more difficult and can stop the ovaries from releasing eggs. This is why nutrition is so important

Insulin Resistance: A Cause?

There are many potential causes for PCOS and research is ongoing. The most common, affecting around 70-80% of women, is insulin resistance. Insulin Resistance is a condition in which the cells of the body become resistant to the effects of insulin, that is, normal response to a given amount of insulin is reduced. A result of this is that high levels of insulin are needed for it to have it's required effect.

Dr Warren Kidson, Senior Endocrinologist at Sydney's Prince of Wales Hospital and the Royal Hospital for Women explains; 

"Insulin is a hormone produced by the pancreas; small amounts are produced in between meals (fasting levels) and larger amounts during and after meals. One of the main functions of insulin is to control the storage of energy foods (fat and carbohydrate) around the body after a meal. Carbohydrates come in two main forms; starch (from potatoes, bread, rice, pasta etc...) and sucrose, the 'double' sugar (found in sweets, fizzy drinks etc...) In our stomachs, starch and sucrose are both digested to the 'single' sugar, glucose, which is then absorbed into the blood. Fats are digested into smaller fats and then absorbed into the blood too.

"After glucose is absorbed, the meal level of insulin stimulates muscles and the liver to suck up glucose and store it as a carbohydrate called glycogen, for later energy use. In those with insulin resistance, the liver and muscles do not take up glucose from the blood stream as efficiently as other people's livers and muscles at normal meal levels of insulin. In other words, their muscles and liver do not respond efficiently to insulin stimulation of glucose. People with insulin resistance normally have high levels of insulin in their blood both at fast and during/after meals `and these higher levels then have effects in the body that are not normally caused by insulin.

"After years of working at a higher level than normal, the insulin producing cells of the pancreas gland can 'wear' out and die off. Insulin levels fall and blood glucose levels can then rise to the development of type 2 diabetes, a condition that can be prevented if insulin resistance is managed."

People with insulin resistance can gain weight easily, a significant symptom of PCOS. In most cases, fat breakdown is still switched off at the usual low level of insulin, it is therefore harder to lower the blood insulin from the high meal peak level in insulin resistance to the low level below which the process of fat breakdown can switch on. Insulin levels can be lowered by exercise, diet, weight loss and diabetic medication such as Metformin. Insulin levels are increased by factors such as stress, weight gain and lack of exercise.

Diagnosis

Dr Mark Beale advises that pelvic ultrasound, insulin measurements and male hormone analysis may help the diagnosis. Dr Warren Kidson advises that if a woman has two our of three of the following, it is likely that PCOS will be diagnosed;

  1. Increased levels of male hormone, often first noticed due to acne or excess hair growth

  2. Anovulation, the medical term for lack of ovulation 

  3. Finding cysts on the ovaries via ultrasound

It is therefore possible for a woman to have PCOS without having cysts on her ovaries.

Treatment

Treatment that is right for you will be recommended by your Doctor and will depend on the severity and symptoms for each individual and whether or not remaining fertile is important. A combination of treatments is common, and may include lifestyle changes including health & fitness, nutrition, medication and counselling. One thing is certain, PCOS should not be ignored, as the risk of developing diabetes is 40-60% and the treatment of PCOS can go a long way to preventing the onset of Diabetes. If you have concerns about symptoms you are experiencing, or think you might have PCOS, visit your Doctor.

Medication

Dr Mark Beale quotes that, "Metformin is a useful and often under-used treatment...it not only reduces androgen levels and improves acne, but also normalises insulin levels and helps with weight loss and the prevention of diabetes." (Medical Observer, Page 30, 3 April 2009). Dr Warren Kidson adds that it should not be prescribed without a diet and exercise programme to maximise the fall in insulin levels. If you have concerns about the medical treatment you are receiving or would like to investigate it as an option, visit your Doctor.