PCOS

Polycystic ovary syndrome (PCOS) is the most common reproductive and endocrine disorder affecting reproductive aged women with one in every 6 to 7 women affected. It has classically been associated with irregular periods although it is possible to have a regular menstrual cycle with PCOS. At least two of the following features must be present before a diagnosis of PCOS can be made:

Irregular (more than 35 days apart) or absent periods.
Clinical signs of increased androgens (a group of hormones associated with male traits) such as thick hair growth in places like the face, chest and back OR evidence of increased androgens on a blood test.
Polycystic ovaries on ultrasound (more than 18 follicles per ovary or volume of the ovary more than 10 mL).

The criteria above are slightly altered for women under 20 years of age, as ultrasound results can be misleading in this age group.

The clinical features of PCOS can be grouped into three areas:

Reproductive – Irregular periods, poor fertility, excessive hair growth
Metabolic – Insulin resistance and diabetes, obesity, abnormal fat levels in the blood and increased risks of heart disease
Psychological – Increased risks of depression and anxiety, eating disorders and negative body image

The exact cause of PCOS remains unknown however it is known that women with PCOS express a genetic predisposition and lifestyle choices (diet and exercise) can worsen or improve the disorder. Many women with PCOS are diagnosed during their early reproductive life and report feeling isolated, depressed and anxious about their fertility and appearance.

Management options

For some women no immediate treatment is required. Dr Budden will discuss how the results of any test results have provided a diagnosis of PCOS and any interventions that are required immediately or may be required in the future.

Management of PCOS is centred around:

Lifestyle interventions (for example diet and exercise)
Hormonal and non-hormonal medication to manage high levels of androgens and irregular periods
Fertility treatment
Pre-pregnancy assessments and maximising health prior to conception

Lifestyle interventions are centred around maintenance of weight and reducing the risk of developing diabetes and heart disease. Dr Budden will discuss your current diet and exercise level in detail and may recommend you seek some advice from a dietician. He may also recommend seeing a naturopath, who will discuss how nutrition and herbal medicines may be incorporated to improve general health and wellbeing.

Hormonal medication may be discussed for women with irregular periods who would like the certainty of knowing when their period is due, but it is not necessary for all women. Hormonal medication may also be discussed for women with high levels of androgens and irregular hair distribution. Non-hormonal medication such as metformin may be recommended to address irregular periods and high levels of androgens in women who have insulin resistance or diabetes.

Fertility treatment often starts with lifestyle factors to improve fertility. If this is not successful, Dr Budden may recommend a trial of non-hormonal (metformin) or hormonal medications (letrozole) to make your cycle more regular, or hormonal medication to directly stimulate the ovary. This is often combined with regular monitoring of your ovarian hormones (estrogen and progesterone) followed by ultrasound surveillance of developing eggs each month. If these early interventions fail, Dr Budden may recommend you attend a fertility specialist to discuss IVF.

Pre-pregnancy assessments are recommended for all women with PCOS who intend to fall pregnant. This involves investigations to look for insulin resistance/diabetes and optimise other lifestyle factors that can impact pregnancy including weight control, diet and exercise, smoking and alcohol consumption and pre-conception vitamin supplementation.