The cysts are not the cause of the symptoms and abnormalities, but are an associated feature. Up to 20 per cent of women have the ultrasound scan appearances of polycystic ovaries, but less than a quarter of these have any associated symptoms and therefore cannot be diagnosed as having PCOS.
It is estimated that approximately three per cent of women suffer from PCOS.
What causes PCOS?
It seems that it is due to a mixture of genetic and environmental factors. If a woman has a genetic predisposition to PCOS, the condition can then be triggered by stress, weight gain, and dietary and lifestyle factors.
What are the symptoms of the Polycystic Ovary Syndrome?
The problem with diagnosing PCOS is that not all of the symptoms or features occurs in every patient. There are a range of things to look out for, and all PCOS patients have one or more of them in addition to the polycystic ovaries. Common symptoms are:
• Excess body and facial hair (hirsutism)
• Irregular or absent periods
• Recurrent miscarriage
A common biochemical abnormality seen in women with PCOS is a high level of luteinising hormone (LH). This is normally produced in small amounts by the pituitary gland, except at the time of ovulation, when there is a surge, which triggers the release of an egg.
PCOS sufferers commonly have a raised level of LH throughout the month. It is thought to be this which creates the multiple small cysts in the ovary and causes the erratic periods. It is also responsible for the increased risk of miscarriage. An increase in testosterone is thought to be responsible for acne and excessive hair growth.
What are the health implications of Polycystic Ovary Syndrome?
• Another common feature of PCOS is the problem of insulin resistance. Lack of sensitivity to normal insulin levels leads to an increase in insulin production. Raised insulin levels increase the risk of developing diabetes, high blood pressure, raised blood fats (hyperlipidaemia), heart attacks and strokes.
Women who have very few or no periods as a result of PCOS have an increased risk of developing cancer of the womb (uterus).
Sufferers who are not trying to conceive can be helped by taking the contraceptive pill. This produces regular periods and so eliminates the risk of uterine cancer. A recent report showed that women with PCOS who took the pill for 10 years gained less weight and had less insulin resistance than those who did not take the pill.
Also, women with PCOS are more likely to conceive in the first six months after stopping the pill. If acne and hirsutism are prominent symptoms, a pill called Dianette produces additional benefits because it contains cyproterone, which is an 'anti-testosterone'.
How does weight affect Polycystic Ovary Syndrome?
• Body weight and body fat are important in determining the severity of PCOS symptoms.
• Obese patients have a higher incidence of hirsutism (excessive hair growth), acne, irregular periods, infertility and miscarriage.
• As body weight increases, insulin resistance increases, SHBG levels fall and free testosterone levels rise. Weight reduction reverses these processes and symptoms improve.
• The reduction in free testosterone levels reverses the hirsutism and acne. Even a small amount of weight loss has been shown to restart normal, regular ovulation and so improve fertility.
• Weight loss has also been shown to benefit overweight women who have suffered from recurrent miscarriage.
How does diet impact PCOS?
• Dietary changes are also important for PCOS sufferers who are not obese, because slim sufferers still have insulin resistance.
• Avoiding sugary foods is important as these lead to a further increase in insulin levels.
• It is better to eat more complex carbohydrates, preferably whole-wheat, as these do not raise insulin levels to the same extent.
• Because of the increased risk of heart disease, it is important to eat five portions of fruit and vegetables a day and to cut down on all fats, especially saturated fats. The inclusion of oily fish in the diet is also beneficial. Salt restriction is important to reduce the risk of high blood pressure.
• Exercise is also important, not only to help with weight control and to reduce the risk of heart disease, but also because it has been shown to improve insulin sensitivity.
• It is important for PCOS sufferers to avoid smoking as this further increases the risks associated with insulin resistance. Women with PCOS should be screened regularly for diabetes, high blood pressure and raised blood fats (hyperlipidaemia).
More facts about PCOS
To find out more detailed advice or to speak to an expert about the condition, visit Verity or read this detailed guide on NetDoctor.co.uk.
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