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:

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:

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 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.