Polycystic Ovarian Syndrome (PCOS)

Approximately 1 in 10 women of a reproductive age are affected by PCOS in Australia

Polycystic ovarian syndrome, also referred to as polycystic ovary syndrome or PCOS for short, is one of the more common causes of infertility in women. The positive is that it also happens to be something that is manageable through treatment and lifestyle.

What exactly is PCOS?

Polycystic ovarian syndrome is a hormonal imbalance that impacts the function of the female ovaries. It can often manifest in high levels of male hormones (hyperandrogenism), insulin resistance, and enlarged ovaries or ovaries with many cysts – hence the name!

Each of these also impact your body’s appearance and function. For example, hyperandrogenism often results in irregular menstrual cycles, excessive facial and body hair, hair loss from the head, or acne on the skin.

Although the exact cause of PCOS is unclear, genes do appear to play some role as women who have immediate female relatives with polycystic ovarian syndrome are 50% more likely to develop the condition. Women of Asian, Aboriginal and Torres Strait Islander and African descent also seem to present with it more often.

How do you diagnose PCOS?

Because of the many different symptoms of polycystic ovarian syndrome, it can be a difficult condition to diagnose. The current criteria for diagnosis in Australia is for the female patient to present with at least two of the three criteria below:

1. Abnormal menstrual cycles – either irregular periods or no periods at all
2. High levels of male hormones (androgens) in the bloodstream – as evidenced by a blood test and/or physical symptoms
3. Detection of 20+ visible follicles or enlarged ovaries of over 10ml in size through ultrasound – these called polycystic ovaries, which is where the name of polycystic ovarian syndrome comes from

It is important to note that even if you present with all three of these symptoms, you may not have PCOS. A medical professional should also try to rule out any other conditions that may be causing hyperandrogenism, such as Cushing’s syndrome.

Aside from fertility problems, PCOS is also associated with obesity, high cholesterol levels, type II diabetes and increased risk of endometrial cancer. Which is why it is important to manage your symptoms.

How do you treat PCOS?

Although a proven method to cure polycystic ovarian syndrome is not yet available, treatment options are available to manage your symptoms and assist with fertility if you’re looking to conceive.

In my experience, a healthy diet and exercise are paramount to initial treatment in all cases as they are so important for overall health. Losing weight if you are overweight can also have a significant impact on your symptoms.

Other approaches to treatment are more dependent on the individual and the symptoms they are looking to manage. This is something I work through with each of my patients with PCOS: helping them fully understand all their options and guiding them on what is best suited to their needs and objectives.

For example, if a woman is not trying to fall pregnant, the combined oral conceptive pill (“the pill”) can often be the first step in management. It helps to regulate their period and protects the lining of the uterus from cancer. Taking the pill can also sometimes assist with the symptoms of PCOS that relate to your physical appearance.

If these physical appearance symptoms of excess hair growth, hair loss, or acne on the face or body are of particular concern, there are also specific topical and oral medications that can help with the management of these.

If a woman is trying to conceive, and PCOS is established as a cause of infertility through testing for both the male and female partner then the focus may be on fertility management. This could be achieved through medicines such as Clomiphene, or a minor laparoscopic surgical procedure to drill tiny holes in your ovaries in order to stimulate ovulation.

Are there more “natural” ways to manage PCOS?

Over 70% of Australian females with polycystic ovarian syndrome use natural or complementary therapies as part of their care and management plan. How they are used really depends on how the symptoms of PCOS presents in the individual – and what is important to them. The most common natural remedies are supplements or herbal medicines but at this stage, no conclusive evidence is available on the effectiveness of natural therapies for the management of PCOS symptoms.

That being said, my philosophy toward the management of polycystic ovarian syndrome is very much multidisciplinary. As a specialist gynaecologist, I believe it is important to involve other medical specialists in the management of PCOS and regularly work alongside dieticians, physiotherapists and general practitioners to help achieve the best outcomes for each individual.