The Facts

Polycystic ovary syndrome (PCOS) is not a disease in the usual sense; rather, it is a collection of symptoms that can affect a woman's reproductive health and heart health, and it can have other significant effects on health and lifestyle. It affects 5% to 10% of women in their reproductive years. Its risk factors are not well known, but heredity does play a role.

Causes

The causes of PCOS are unknown. Researchers believe that insulin resistance and an imbalance of male hormones (e.g., testosterone) and female hormones (e.g., estrogens and progestins, those important for the menstrual cycle) contribute to the development of this condition. Research suggests a family history of PCOS, may be a risk factor for its development.

Symptoms and Complications

There are many possible symptoms, and you can have PCOS without having all of them. Some of the common symptoms include:

• acne
• difficulty becoming pregnant (infertility)
• irregular menstrual periods
• obesity
• skin discolorations
• unwanted hair growth or loss

Symptoms most commonly associated with PCOS are unwanted hair growth and irregular menstrual periods. Women may have fewer menstrual periods (oligomenorrhea) or miss their periods for 6 months or more (amenorrhea).

Many women do not know they have PCOS until they try to become pregnant. Infertility is an issue for about 75% of those with PCOS. If these women do become pregnant, they are at an increased risk of complications and of miscarriage. About half of those with PCOS have acanthosis nigricans (a grey-brown skin discoloration), signifying that the body has too much insulin.

Up to 50% of women with PCOS are obese, and in many cases the extra body weight is centered around the abdomen. Central obesity increases the risk of developing many conditions, including:

• cholesterol problems
• heart disease
• high blood pressure
• type 2 diabetes
• depression and anxiety
• sleep apnea

Regardless of their body weight, women with PCOS have an increased risk for developing these conditions.

Acne is another symptom seen by some women with PCOS. 85% of women older than age 20 who suffer from acne likely have PCOS. Loss of hair from the scalp is also possible. A woman with PCOS may also experience male-pattern hair growth due to hormone imbalance.

Complications of PCOS can include endometrial cancer: if a woman has irregular menstrual periods for an extended time, the lining of the uterus can build up and develop cancerous cells. This may take many years to develop. Women who do not have regular periods (or any periods at all) should consult their doctor.

Making the Diagnosis

PCOS is a diagnosis that is made once other conditions causing similar signs and symptoms have been investigated and ruled out by your doctor.

To rule out other conditions, your doctor performs a physical examination and may order a series of laboratory tests, including:

• testosterone
• dehydroepiandrosterone (DHEA-S), a steroid hormone made by the adrenal gland
• female hormones (follicle stimulating hormone [FSH] and prolactin)
• blood sugar
• cholesterol
• thyroid function

Your doctor may also ask you to have a pelvic ultrasound. This will allow your doctor to visualize your ovaries and the diagnosis of PCOS may be confirmed.

If you have PCOS, the ultrasound may show 8 to 10 cysts smaller than 10 mm in size on each ovary. These are often said to look like a string of pearls. Interestingly, these lesions are not actually cysts but the remains of ovarian follicles that did not successfully make or release an ovum (egg). However, about 20% of all women will have ovarian cysts visible on the ultrasound, so having one or two cysts does not necessarily mean you have PCOS.

Treatment and Prevention

Given that the cause(s) of PCOS are unknown, there is no cure for the condition. The focus, instead, is on managing bothersome symptoms or those that increase the risk for other diseases.

A healthy diet and exercise are important parts of managing PCOS regardless of your weight. Weight loss is recommended for women with obesity – while it will not cure PCOS, it will lessen symptoms and may help improve fertility.

Medications used to manage PCOS often influence how the body uses insulin or restore the balance between male and female hormones in the body.

Oral contraceptives are used to manage many symptoms associated with PCOS for women who are not trying to become pregnant. They regulate menstrual periods and can reduce acne. Other options that affect hormone levels and are used by women not planning pregnancy include progestins and antiandrogens (e.g., spironolactone*). Medications that improve the body's ability to use insulin help to regulate blood sugar. Metformin, an antidiabetes medication, may be an alternative in women who cannot take oral contraceptives. Metformin can also help reduce weight.

For women who do desire to become pregnant, infertility medications which help ovulation to occur (e.g., clomiphene, gonadotropins) may be recommended. Although not officially approved by Health Canada for this use, the medication letrozole may also be used to induce ovulation. Women with PCOS are at higher risk for pregnancy complications.

Hair loss on the scalp may be managed with medications such as minoxidil and spironolactone. Shaving, waxing, or other hair removal methods may be required to eliminate unwanted body hair. Acne may also be managed with medications available with or without a prescription that can be taken by mouth or applied directly to the skin.

Acanthosis nigricans may fade with the use of prescription medications applied directly to the skin. Examples include 15% urea, alpha-hydroxy acid, and salicylic acid. This symptom may lessen with the use of metformin as well.