What is Polycystic Ovarian Syndrome (PCOS)?

Polycystic Ovary Syndrome is a hormonal condition with reproductive, metabolic and mental health impacts. Despite the name, having polycystic ovaries is not essential for a diagnosis of PCOS. Approximately 75 per cent of women with PCOS show polycystic ovaries on ultrasound.

Polycystic ovary syndrome (PCOS) is a hormonal disorder characterised by an excess of the hormones, androgens. Androgens, which include the hormone testosterone, are often referred to as ‘male hormones’. While produced by both the male and female body, the hormones are found in much larger quantities in males.

The excess of androgens has a masculinising effect on the female body and interferes with the levels of other hormones.

These hormonal imbalances cause disruptions to a women's normal menstrual cycle. Without the appropriate levels of hormones the follicles in the ovaries never fully mature and ovulation does not occur (i.e. an egg is not released). The partially developed follicles turn into small cysts on the ovaries, hence the term ‘polycystic ovaries’.

It is important to note that not all women with polycystic ovaries have polycystic ovary syndrome. That is, not all women with the characteristic ovarian cysts experience the symptoms associated with the syndrome. Common symptoms of this syndrome include hirsutism (excess hair growth), often on the face nippples, chest, thighs or in the middle of the abdomen. Some women also suffer from male pattern hair loss. Acne, obesity, menstrual disturbances (including very light or very heavy bleeding, infrequent periods, or absence of periods altogether) and infertility are all possible symptoms.


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PCO is a metabolic condition occuring in young women. It is thought to be an auto-immune type disease  in which all cells in a woman's body become resistant to insulin. As a consequence, to maintain normal cell activity and blood sugar levels, the pancreas is required to produce ever increasing amounts of insulin. Not only does this place a great strain on all cell function in the body, but it also produces an aberrant response in the ovaries of young women.

Part of the PCO  syndrome involves the ovaries failing to respond adequately to  Follicle Stimulating Hormone from the pituitary gland. As a consequence the ovaries fail to produce the normal peak of oestradiol in the mid-menstrual cycle, an event that is necessary to trigger normal ovulation from a single large, mature follicle.  The persistence of many unruptured small follicles leads to a collection of these follicular cysts that continue to produce low levels of oestrogen and low levels of male hormones (testosterone ans androstenedione) but no progesterone. 

Women who have PCO often have irregular scanty periods and because of the persistence of male hormones, often have an increase in hair growth on their cheeks, chin, limbs, chest and abdomen as well as acne on their face. Severe cases of PCO have difficulty in becoming pregnant but the majority of women can achieve pregnancy with appropriate hormone assistance. Overweight women increase the problem of insulin resistance because they require a greater level of insulin to control their metabolic needs. 

Treatment of PCO includes reduction in weight, a drug such as Metformin to increase cell sensitivity to the insulin being produced and the use of ovulation induction therapy such as  Clomid.

Polycystic ovarian syndrome is a common health problem that can affect teenage girls and women. Although no one really knows what causes PCOS, it seems to be related to an imbalance in a girl's or woman’s hormones.
Both males and females produce sex hormones, but in different amounts. In girls, the ovaries produce the hormones oestrogen and progesterone, and also androgens. These hormones regulate a woman’s menstrual cycle and ovulation, when the egg is released. Even though androgens are sometimes referred to as “male hormones,” every female produces them.
In females with PCOS, the ovaries produce higher than normal amounts of androgens, and this can interfere with egg development and release. Sometimes instead of the eggs maturing, cysts, which are little sacs filled with liquid, develop. Instead of an egg being released during ovulation, like during a normal menstrual cycle, the cysts build up in the ovaries and may become enlarged. Because girls with PCOS are not ovulating or releasing an egg each month, it's common for them to have irregular or missed periods.
Although PCOS was first recognized in the 1930s, doctors can't say for sure what causes it. Research has suggested that PCOS may be related to increased insulin production in the body. Women with PCOS may produce too much insulin, which signals their ovaries to release extra male hormones. PCOS seems to run in families, too, so if someone in your family has it, you might be more likely to develop it.
If PCOS is not treated properly, it can put a female at risk for lots of problems. Women with PCOS are more likely to have infertility, excessive hair growth, acne, obesity, diabetes, heart disease, high blood pressure, abnormal bleeding from the uterus, and cancer.
The good news is that, although there's no cure for PCOS, it can be treated. The most important step is diagnosing the condition, because getting treatment for PCOS reduces a woman’s chances of having serious side effects.
 
 

Polycystic Ovary Syndrome (PCOS) is the most common endocrine (hormonal) disorder affecting women.  It is estimated that up to one in 10 women of child-bearing age have PCOS, yet many don’t know it.
The symptoms of PCOS vary from woman to woman but include:

• Irregular or absent menstrual periods
  
• Infertility or reduced fertility
  
• Hirstutism (excess hair growth on the face, chest and abdomen)
  
• Alopecia (scalp hair loss)
  
• Acne
  
• Obesity and difficulty losing weight
  
• Increased risk of miscarriage.
  

 
PCOS arises from a combination of genetics and lifestyle factors.  In the majority of women, however, the underlying problem is high levels of insulin in the bloodstream resulting from insulin resistance.   Insulin resistance is an insensitivity of the body to insulin and is the main cause of type 2 diabetes.  Insulin is a hormone, produced in the body by the pancreas, which helps to regulate blood glucose levels. When you have insulin resistance, your insulin does not work effectively, so the body needs to produce increasing amounts of insulin to keep the blood glucose levels under control.  These high levels of insulin act on the ovaries to cause increased production of male hormones, which disrupts the normal ovulation cycle and causes many of the symptoms of PCOS. 
 
The link between these two conditions means that women with PCOS are at an increased risk of developing health problems including impaired glucose tolerance (pre-diabetes), gestational diabetes (diabetes during pregnancy), type 2 diabetes and heart disease. The good news is that by improving insulin resistance through lifestyle changes, many of the problems of PCOS are resolved or at least improved.