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PCOS is a condition related to the body’s hormones which can affect physical and emotional health.
Hormones are chemical messengers that tell the body what to do (e.g. when to release an egg from the ovaries or when to start a period/monthly).
PCOS affects 12-18% of Australian women of reproductive age and maybe as high as 21% of Aboriginal and Torres Strait Islander women.
The cause of PCOS is probably a combination of:
All women have male-type hormones in their body in small amounts, in women with PCOS there may be more of these male type hormones. There is also often a change in insulin (a hormone that helps the body take up glucose). When the hormones are out of balance this can change or upset the messages that are sent to different parts of the body.
In PCOS these changes can cause some of the following:
The symptoms vary between different women and can change as a woman ages.
To diagnose PCOS, a doctor takes a medical history asking about:
A medical examination includes:
Other tests include:
A woman is diagnosed with PCOS if she has two or more of these:
Figure 1: A normal ovary and a PCOS ovary
During a normal menstrual cycle a number of follicles start to grow. All except one will stop growing and be re-absorbed. In women without polycystic ovaries, a small number of follicles can be seen on ultrasound.
In women with polycystic ovaries, there is an excess number (> 10) of small follicles seen on ultrasound. These small follicles develop but are no re-absorbed in the same way. In women with PCOS this is due to the hormone change.
Polycystic ovaries can happen for other reasons and up to 20% of women have polycystic ovaries on ultrasound without having PCOS. It is more common in young women in the first few years after starting periods, so ultrasound is not a good investigation for PCOS in teenage women.
PCOS can affect physical and emotional health. There are lots of ways for a woman herself to manage PCOS but she will also need some medical help and advice. If a woman can understand how PCOS affects the body it might help her to manage it better.
Lifestyle and weight management:
Insulin resistance and diabetes:
Many women with PCOS have insulin resistance, this means the insulin in the body cannot keep blood sugar levels stable or normal.
To improve insulin resistance:
A woman’s period or monthly usually comes every 28 days. Women with PCOS have higher levels of male hormones and insulin and this causes the period/monthly to be more irregular or stop altogether. It is important to have regular periods or monthlies. It keeps the lining inside the uterus from thickening and stops abnormal cells from developing. It is good to have at least four cycles per year. Medications like the pill, other hormone tablets (e.g. Provera) or metformin can be prescribed to help periods occur regularly.
Increased hair growth:
Anxiety and depression:
Women with PCOS are more likely to experience feelings of sadness, anxiety and depression than other women. This can be due to symptoms of PCOS, including more facial and body hair, acne, weight changes and fertility problems. They can affect mood, self-esteem and how women feel about themselves. Women can talk to their doctor or health professional about mental health problems; treatments include counselling, psychology or medication.
In some women with PCOS the ovaries do not release an egg every month so periods/monthlies are irregular. Many women with PCOS (40%) will get pregnant without medical help but some women do have trouble becoming pregnant.
Weight loss may:
If a woman has been trying to have a baby for 12 months or more, or if she is trying to get pregnant but her periods do not come very often, it is important that she talks to a doctor. The doctor will do some tests to find out why she is not becoming pregnant. If a women is not ovulating/releasing an egg from the ovaries, there are a number of medications (take as in tablets) that can bring back ovulation. If this treatment is not successful there are other hormonal treatments available. Sometimes surgery on the ovaries can help as can hormone injections to help ovulation. IVF is another option if pregnancy does not occur or if there are other reasons for infertility.
Women with PCOS can have increased risk factors for heart disease associated with:
It is important that women with PCOS have regular ongoing monitoring and health checks every 1-2 years depending on their individual needs.
A regular health check would include asking about the regularity of periods/monthlies before menopause and measuring:
Routine women’s checks are also important including:
If you think a woman might have PCOS, it is important that you tell her to see a doctor or nurse. If she is diagnosed early it helps the woman to manage the condition better and can also help to prevent problems such as type 2 diabetes and high cholesterol.