PCOS is a complex hormonal disturbance in which the presence of multiple (more than 10) small cysts on the ovaries is associated with a variable group of symptoms and biochemical abnormalities.

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.

Symptoms
The problem with diagnosing PCOS is that not all of the symptoms or features occurs in every patient. There is 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:

acne excess body and facial hair (hirsutism) irregular or absent periods infertility obesity 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 release of the 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.

The polycystic ovary commonly produces an increased amount of the male hormone, testosterone. This is responsible for the tendency to acne and hirsutism. Some patients do not have excess testosterone production but have low levels of a binding protein, sex hormone binding globulin (SHBG). This means that although testosterone levels are not raised, there is more testosterone, which is unbound to SHBG and therefore free to attach to testosterone receptors in skin to produce acne and hirsutism.

Health implications
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'.

Self help
Body weight and body fat are important in determining the severity of PCOS symptoms. Obese patients have a higher incidence of hirsutism, 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. The reduction in insulin resistance, which occurs as a result of weight loss, reduces the long-term health risks associated with raised insulin levels. A gradual weight loss of one t two pounds per week is ideal. Studies have shown that a modest five per cent weight loss produced a 40 per cent improvement in hirsutism and regulated periods with an improvement in fertility. Achieving regular periods through weight loss will also eliminate the risk of uterine cancer.

Dietary changes
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 wholewheat, 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).

Recommended reading:
PCOS: How to Cope with Polycystic Ovary Syndrome by Colette and Adam Carey.

For further PCOS information and support, contact verity-pcos.org.uk