Women normally release eggs from their ovaries in a monthly cycle. With PCOS, the egg may not develop and be released during ovulation because of hormonal imbalance. The ovaries become enlarged and contain several follicles, under developed sacs where eggs develop but haven’t matured and they are therefore unable to release the egg for ovulation.
The exact cause of PCOS is unknown, but there are several theories, largely a mixture of genetics and environmental factors.
Many women with PCOS have a resistance to insulin, where the body's cells do not respond to the effects of the hormone insulin and so blood sugar levels become higher than normal. As a result, women with PCOS are seven times more likely to develop type 2 diabetes.
In PCOS, women also have high levels of so-called 'male' hormones such as testosterone (which both sexes actually produce), causing symptoms such as excess facial and body hair. Higher levels of luteinising hormone (LH), which stimulates ovulation, can have an abnormal effect on ovulation. Sub-normal levels of Follicle Stimulating Hormone (FSH) means that follicles don't develop into eggs. Lower levels of progesterone results in the lining of the womb not thickening every month, making it difficult for a fertilised egg to embed.
Symptoms of PCOS usually become apparent in your late teens or early 20s, but some women don't get diagnosed until they are trying to get pregnant and experience problems. Common symptoms include: absent or infrequent periods ; increased facial and body hair; thinning hair or hair loss; acne; weight gain, high levels of insulin; depression and mood changes.
Your doctor can order blood tests to check for hormonal imbalances and an ultrasound scan to see if you have a high number of follicles (sometimes referred to as 'cysts' although technically they are not) on your ovaries. They may also ask if you have any female relatives who have PCOS.
A diagnosis can be made if other conditions are ruled out and you have two out of the following three criteria: irregular or infrequent periods; high levels of testosterone hormone; and ultrasound scans showing you have polycystic ovaries.
Who gets PCOS?
PCOS affects around 20 per cent of all women of childbearing age - most of whom are diagnosed during their early 20s or 30s – though it can occur any age after puberty.
You're more at risk of PCOS if you have a female blood relative will the condition and/or a male relative with male pattern baldness or severe acne, but no specific PCOS gene has been identified yet.
A healthy diet and regular exercise is recommended for all women with PCOS, particularly if they're overweight. It’s estimated 40 to 50 per cent of women with PCOS are obese, and by losing weight, the risks of developing long-term health problems such as type 2 diabetes can be reduced. Daily exercise also improves the body’s use of insulin.
Taking the combined contraceptive pill can treat acne, regulate the menstrual cycle, lower your risk of endometrial cancer and reduce excess facial and body hair. The drug clomifene is the one most commonly-prescribed for women trying to get pregnant as it encourages ovulation. Metformin, which is often used to treat type 2 diabetes, may also be an option as it lowers insulin, blood sugar and androgen levels in women with PCOS.
Drugs for excessive hair growth and hair loss may block the effects of hormones such as testosterone, and include types of the combined oral contraceptive pill (such as dianette and Yasmin), spironolactone and finasteride.
If medication doesn’t work for fertility problems, a minor surgical procedure called laparoscopic ovarian drilling (LOD) is an option, whereby your ovaries are surgically treated using heat or laser to destroy the tissue that’s producing androgens.
Chromium supplements may help improve insulin sensitivity. In a 2013 trial, 200mcg daily chromium picolinate supplements were given to women with PCOS who were resistant to the first-line drug treatment clomifene. This significantly reduced their fasting blood sugar levels and improved their insulin sensitivity. The effects were comparable to the diabetes drug metformin, but better tolerated by patients.