Polycystic Ovarian Syndrome
The term “polycystic ovaries” refers to the appearance of multiple small cysts in the ovaries as visualised on an ultrasound scan. The polycystic ovarian syndrome (PCOS) is a condition in which women with ultrasonographic features of polycystic ovaries have, in addition, developed one or more symptoms of the disease.
What are the symptoms of PCOS?
Symptoms include hirsutism (excess hair growth), acne, obesity, period problems (irregular, absent, or heavy), lack of ovulation and infertility.
The hormone imbalance of PCOS may result in either irregular ovulation or no ovulation at all (known as ‘anovulation’). Menstrual periods may therefore become irregular – perhaps heavier than usual, perhaps occurring after long gaps (‘oligomenorrhoea’) or perhaps not at all (‘amenorrhoea’).
This is due to irregular ovulation.
Women with PCOS who have high circulating levels of luteinising hormone (LH) may have a higher risk of having miscarriages. The precise mechanism is unknown.
Testosterone, the “male” sex hormone, may be present in excessive amount in PCOS, consequently it may produce acne on the face and back, or unwanted hair on the face, chest, arms and legs.
How is PCOS diagnosed?
Diagnosis can be confirmed by the following tests:
1. Blood test – a blood sample may be taken to measure several hormones : (a) luteinising hormone (LH), and follicle stimulating hormone (FSH). Typically the concentration of LH is greater than 10 iu/l, or the LH/FSH ratio is more than 2 and (b) androgens (male hormone), typically the free androgen index is increased (more than 5).
2. Ultrasound examination – a vaginal (internal) scan is better than a transabdominal (external) scan in the diagnosis of PCOS. It shows multiple (often more than 8), small (usually no more than 8 mm) cysts, in each ovary.
3. Direct visual examination – this may be carried out at the time of laparoscopic (camera) examination.
How is PCOS managed?
Hormone tablets may be used to regulate the periods. In some cases the combined oral contraceptive pill (especially one called dianette which contains an anti-male hormone) may be the simplest solution.
The fertility tablet, clomifene, may be used to stimulate ovulation. If this is not successful a procedure called laparoscopic ovarian drilling, ie making multiple small holes in the ovary through a keyhole technique, achieves very good results. A recent audit at the Jessop Hospital for Women showed that more than 50% of women will conceive within twelve months of the surgery. Recently, metformin, which has been used for some years to treat diabetes, has been found to be an effective treatment for PCOS and may help to induce ovulation.
There is currently no sufficient clinical data to suggest what is the best treatment for miscarriage associated with PCOS. However, laparoscopic ovarian drilling appears to be a logical approach.
Special hormone preparations which include an “anti-male” hormone may provide benefit. Other cosmetic measures such as waxing and electrolysis may also be helpful.
Prof T C Li
7 Williamson Road
Tel: 0114 2550365