Polycystic ovary syndrome (PCOS) is a condition that affects your ovaries and means you don't produce eggs (ovulate) regularly.

Most women have cysts in their ovaries.1 However, if you have polycystic - meaning many - ovaries, you'll have nearly twice as many cysts as women without the condition.1

The cysts contain egg follicles that haven't developed properly because of hormones not working effectively.1

PCOS is common and affects around 20 percent of women.1

If you have PCOS, then you will experience one or more symptom, such as menstrual problems, infertility and excessive body hair growth.1

Although PCOS can be treated, it cannot be cured.Causes

Doctors are still unsure what causes PCOS.1

One theory is that the condition could run in families, and that some women go on to develop PCOS because of different factors linked to lifestyle and diet.2

Diagnosis

If you think you have PCOS, visit your GP.1

If possible, book a double appointment so you can have plenty of time to talk about your symptoms.1It will also help if you keep a PCOS diary noting down symptoms and frequency of periods, which you can refer to during your discussion.1

You will probably have your blood pressure and if you are overweight, your blood sugar level, checked.1

Your GP will send you for an ultrasound scan to check for polycystic ovaries and blood tests to detect hormonal abnormalities.1 These tests will also rule out any other conditions, such as thyroid problems.1

Once a diagnosis has been made, your doctor may refer you to a gynaecologist, or an endocrinologist, a doctor specialising in the hormonal system.1

Treatment

Weight loss

This will improve your chances of ovulating and getting pregnant.1 Losing weight will reduce high insulin levels and will reduce the amount of testosterone being produced.1 It may also help to reduce hair growth and acne.1

Talk to your GP about getting support to lose weight through a healthy diet and 30 minutes of exercise every day.1

Statins

If you are overweight and you have a high amount of cholesterol then you may be prescribed with statins, such as simvastatin, to reduce blood fats.1

Regulating periods

Your GP may put you on a contraceptive pill, combining an antitestosterone drug with oestrogen.1 The pill may also improve acne, any excess hair and hair loss.1

You can also take a progestogen hormone for several days every month which will cause a monthly bleed like a period.1 Having regular periods will reduce the risk of developing cancer of the lining of the womb.1

If neither of these is suitable, your GP may advise a regular ultrasound scan of your uterus to detect any problems early.1

Improving fertility

  • Your GP may prescribe a drug that helps to lower the level of insulin.1 Metformin is commonly used to treat people with type 2 diabetes while newer drugs include rosiglitazone and pioglitazone.1,2 More research is needed to confirm how successful these drugs are in the treatment of PCOS and you will need to ask your GP about any side effects.1,2
  • Clomiphene citrate works by causing an increase in the levels of hormones in your body which control the development and release of an egg.1,5 Side effects include headaches and there is an increased risk of multiple pregnancy.
  • Hormone injections containing a mixture of luteinising hormone and follicle stimulating hormone stimulate ovarian follicles to grow.1 Risks include a danger of multiple pregnancies.1,7
  • Laparoscopic ovarian diathermy which sees short burst of heat or laser treatment to the surface of each ovary bringing on hormone changes.
  • In vitro fertilisation (IVF) may also be an option.1,7

(See Fertility for more details).

Reducing hair growth

  • Shaving, waxing, sugaring, plucking, bleaching and laser removal. There's no evidence that hair will grow back faster and thicker if you remove it.1
  • Your GP may suggest a cream which you rub into the affected area.1 It contains eflornithine, a type of medicine which works by blocking the action of an enzyme (chemical) involved in hair growth.1
  • Types of contraceptive pill also help to reduce hair growth.
  • Drugs such as flutamide and finasteride reduce hair growth.4 Side effects include diarrhoea and dry skin and could harm an unborn baby.4 They may also take between three to nine months to work, so you may want to remove hair through other methods until they begin to work. 4

Treating acne

  • Some contraceptive pills can help improve the condition.6
  • For mild acne, blackheads and whiteheads, you can use over-the-counter creams, gels and lotions applied directly to the skin. 6
  • Sometimes, oral antibiotics are prescribed.6
  • Stronger medication such as isotretinoin can cause side effects and can only be prescribed by a dermatologist.6

Deal with stress

It's vital to manage your stress levels if you have PCOS.1

When stress hormones are released they make your body produce more testosterone, which can cause more insulin resistance, weight gain, depression, loss of sex drive, irregular periods and bad skin.1

Try to:1

  • Make time for yourself, even if it's just a walk during your lunch hour.
  • Exercise - it boosts levels of endorphins, the body's own happy hormones.
  • Get enough sleep.
  • Try complementary therapies like acupuncture, reflexology, aromatherapy, but if you're taking drugs, tell your GP before starting any treatments as they can affect medicines.
  • Talk to your GP if you feel stressed.
  • Get support and help through Verity, a UK charity that helps to run support groups.

Symptoms

The most common symptoms appear in your late teens and early twenties.1 They include irregular or light periods, or none at all, leading to fertility problems.1

Other symptoms include:1

  • Weight problems.
  • Acne.
  • Excessive hair growth.
  • Thinning hair or loss of hair.
  • Depression and changes in mood.

You won't necessarily have all the symptoms, and may only have them mildly.1

Long-terms health problems

These include:1

  • Type 2 diabetes - If you have too much sugar in your bloodstream, you're at risk of developing diabetes.1 If left untreated, it can lead to organ damage.1 Many women with PCOS have a long-term resistance to insulin, which controls blood sugar levels.1 They make too much which can lead to weight gain, irregular periods and infertility - mirroring PCOS symptoms - and makes them at greater risk of diabetes.1

    Ask your GP to check for any signs, especially if you have diabetes in the family.1Losing weight and exercising regularly will minimise the risk.1
     
  • Endometrial cancer - Women who have irregular periods, or don't have periods for many years have a higher than average risk of developing cancer of the womb lining.1

    The cancer develops if the womb lining isn't lost regularly.1 If you have less than three periods a year, you have an increased risk.1

    Your GP can prescribe a low-dose contraceptive pill to bring on menstruation, or if you haven't had a period for over a year, can arrange an ultrasound scan to check your womb lining.1
     
  • Heart disease - Women with PCOS are also at increased risk of developing high blood pressure and high blood cholesterol levels, causing stroke and heart disease.1

    Ask your GP to check your blood-fat levels but it's important, if you are overweight, to improve your diet and take exercise regularly.1 Your GP may prescribe statins to lower the fat in your blood.1 Give up smoking.1

Experts do know that symptoms are caused by higher than normal levels of hormones.1

Insulin is thought to play a major role.1,2 It controls our blood sugar level but any women with PCOS are insulin resistant.1 This means the level of insulin in the blood needs to be higher than normal to control your blood sugar level.1 The high level of insulin causes the ovaries to make too much testosterone, which results in excess hair and acne.1

Another hormone called luteinising hormone (LH) is made in the pituitary gland.1 It stimulates the ovaries to ovulate and works alongside insulin to promote testosterone production.1 A high LH level combined with a high insulin level means that the ovaries are likely to produce too much testosterone.1

Being overweight or obese doesn't cause PCOS but it can make insulin resistance worse, causing the level of insulin to rise even higher, creating a 'vicious cycle'.1

Research is being carried out into the causes of these hormonal abnormalities.1 There may be several causes which would explain why different women have such different symptoms.1