What is PCOS (Polycystic ovarian syndrome)?

The symptoms of PCOS are embarrassing and distressing. Diagnosis is often tricky. But if you are one of the growing numbers of women affected by this syndrome there is hope.

What is PCOS (Polycystic ovarian syndrome)?

IT’S BEEN DESCRIBED as the most common hormonal disorder affecting women today. Officially, the polycystic ovarian syndrome affects approximately 4-7 percent of Australian women, but the true figures could be much higher the Polycystic Ovarian Syndrome Association of Australia (POSAA) suggests the real figure could be as high as 12 percent.

This equates to one in eight women or half a million Australian women of childbearing age, they estimate.

The symptoms related to PCOS usually start in teenagers during puberty or in the early to mid-20s but can also occur at any age.

The PCOS symptoms may include irregular or absent periods infertility or reduced fertility, excess hair growth on the face, (chest and abdomen hirsutism); scalp hair loss (alopecia); ache, dark skin pigmentation, most commonly found at the back of the neck and under the arms and breasts (acanthosis nigricans), obesity and/or difficulty losing weight; increased risk of miscarriage.

The main problem with diagnosing PCOS is there is no one, simple test available that can be used. Diagnosis usually involves considering a combination of symptoms, testing hormone levels (including insulin), and performing an ultrasound to look for cysts and enlargement of the ovaries.

Current guidelines suggest women need to have two of the following three symptoms to be diagnosed with PCOS:

1. Irregular or absent periods;

2. Polycystic ovaries (which will show on ultrasound);

3. High levels of male hormones in the blood or symptoms of excess male hormones, such as excess hair on the face and body or acne.

Many women suffer from PCOS in silence because they haven’t made the connection between the symptoms, so continue to seek treatment for the individual problems. Others know something is wrong, but have trouble getting a proper diagnosis due to a lack of understanding of this condition amongst general practitioners and even many gynecologists.

For this reason, the POSAA is pushing to establish a national task force to develop guidelines for the diagnosis and treatment of PCOS.

WHY IT HAPPENS

Exactly why this syndrome develops remains unknown and there may be a number of different reasons, but for the majority of women it is caused by high levels of insulin in the bloodstream. This condition, known as insulin resistance, is due to the insensitivity of a person’s body to the hormone insulin, which is produced by the pancreas to help regulate blood glucose levels.

Because the insulin they’re producing does pot work effectively, their body needs to produce increasing amounts to keep the blood glucose levels under control.
Unfortunately, these high levels of insulin circulating in the blood can cause many health problems, including PCOS. This is because high insulin levels act on the ovaries to increase the production of male hormones, which disrupt the normal ovulation cycle and cause many of the symptoms of PCOS.

This link also means women with PCOS are at an increased risk of developing health problems such as impaired glucose tolerance (“pre-diabetes”), gestational diabetes (diabetes during pregnancy), type 2 diabetes, and cardiovascular disease.
The good news is that by improving insulin resistance many of the problems of PCOS are resolved, or at least improved.

WHAT TO DO

Until recently, doctors have focused on simply treating the individual symptoms, such as acne, infertility, or excess hair. But for women who have PCOS and related insulin resistance, it has been found that treating the insulin resistance can significantly improve all or most of the symptoms associated with PCOS

Getting insulin resistance under control will also help to reduce the long-term risks of developing diabetes and heart disease.

You can do this with lifestyle modifications – changing your diet, starting or increasing exercise, and losing excess weight (see Sabra Lane’s story, previous page, and left, to see the effects). Medication may also be needed but is only effective if used in combination with healthy living.
Metformin, a drug commonly used by people with type 2 diabetes, is now being widely used to treat women with PCOS.

WHAT YOU EAT IS KEY

The impact of weight loss on reducing PCOS symptoms is significant – a reduction of just 5-10 percent of body weight has been shown to reduce insulin and testosterone levels; improve hirsutism and acne symptoms, improve menstrual function; restore ovulation and increase fertility

Also, when insulin resistance is the underlying problem, women with PCOS need to focus on lowering their insulin levels and improving their body’s sensitivity to it. The best eating plan to do this includes food low in saturated fat and high in fiber, as well as carbohydrates that have a low glycaemic index (GI).

Spreading food intake evenly across the day and avoiding eating large amounts of carbohydrate foods at one time can also help, as this will prevent sudden large rises in blood glucose and insulin levels

The ideal is to combine a healthy PCOS diet plan with regular exercise – women with PCOS need to induce at least 30-40 minutes of activity on most days. Aim for a combination of aerobic exercise (walking, running, dancing) and resistance training (lifting weights).