What are polycystic ovaries (PCOS)?

Reading about polycystic ovary syndrome (PCOS) may feel overwhelming. If at any stage in this article you feel upset it may be best to stop reading and come back at another time if it feels right for you. The symptoms and risks associated with PCOS will not be experienced by everyone in the same way. Until you have spoken to a healthcare professional, you will not know whether your symptoms are due to PCOS or something else. Treatment is available for PCOS. Having PCOS does not mean for certain that you will not be able to get pregnant. 

Polycystic ovary syndrome (PCOS) is a syndrome that can affect how the ovaries work. The ovaries are a pair of glands, on either side of the uterus/womb, where eggs form and most of the body’s supply of the hormones oestrogen and progesterone are made. These hormones help breast development and affect body shape and body hair distribution. They are also involved in the menstrual cycle, fertility, pregnancy and menopause. 

With polycystic ovaries, the ovaries contain many fluid-filled sacs (follicles) surrounding the eggs. Although PCOS can also cause pregnancy complications, the risk of complications can be reduced. There is no cure for PCOS but there are many treatments available. The treatment offered will depend on whether you hope to become pregnant or not.

What are the signs and symptoms of polycystic ovaries?

Polycystic ovaries contain a large number of tiny cysts from follicles (sacs). In PCOS, these sacs are often unable to release an egg. This means that ovulation may not take place each month.

If you have signs and symptoms of PCOS, they’ll usually appear during your late teens or early 20s.

They can include:

• Irregular or light period (e.g every two to three months) or no periods at all
• Difficulty getting pregnant if you are trying to get pregnant
• Increased hair growth (hirsutism)
• Weight gain
• Thinning hair and hair loss from the head
• Oily skin or acne

What causes polycystic ovaries?

The exact cause of PCOS is unknown. It’s thought to be linked to abnormal hormone levels in the body, including high insulin levels.

Resistance to insulin and PCOS

Insulin is a hormone that helps your body control the sugar in your blood (glucose). It helps to move glucose from your blood into your body’s cells, where it’s broken down to produce energy. Insulin resistance means your body’s tissues are resistant to the effects of insulin and your body has to produce extra insulin.

High levels of insulin cause the ovaries to produce too much testosterone. This interferes with the development of the follicles and prevents ovulation. The follicles are sacs in the ovaries where eggs develop.

Hormone imbalance and PCOS

Many people with PCOS have an imbalance in certain hormones. This can include raised levels of testosterone, luteinising hormone or low levels of sex hormone-binding globulin. Raised levels of these hormones can cause PCOS and some of the symptoms of PCOS.

Genetics and PCOS

PCOS sometimes runs in families. If any of your relatives have PCOS, you might be at an increased risk of developing it. Specific genes associated with the condition have not yet been identified but research to understand this condition is progressing fast.

How are polycystic ovaries (PCOS) diagnosed?

The three main features of PCOS are:

• Irregular periods
• Excess androgen – a hormone that can cause increased facial or body hair
• Polycystic ovaries on ultrasound examination

The “normal” period occurs every four weeks, but most people will have a period every three to five weeks. Irregular periods mean you do not have a period every three to five weeks but instead maybe every two to three months. This could be a sign that your ovaries are not producing an egg each month. If you have at least two of these features, you may be diagnosed with PCOS. If you think you may have PCOS, the best step is to speak to your GP or a gynaecological health professional.

Speaking to your GP about PCOS

At an appointment to diagnose PCOS, you will be asked about your symptoms. Your GP may also check your blood pressure which can help rule out other possible causes.

They will need to ask you questions about your periods such as:

• At what age you first got your period
• If you get your period every month – keeping a calendar can be very useful 
• If you have painful or heavy periods
• They might also ask you if you have noticed weight gain, increased hair growth, hair loss or acne

If your GP thinks you may have PCOS, you might need some tests done to confirm the diagnosis. It is also to check for other causes of hormone imbalance.

What are the tests for PCOS?

Blood test

You may have blood tests done to check your hormone levels. If you have PCOS, you might have higher testosterone levels than usual. You might also have a higher ratio of luteinising hormone/follicle-stimulating hormone.

Your GP might also recommend other blood tests. They might advise you to have screening for diabetes or to have your cholesterol levels checked.

Ultrasound scan

Your GP might refer you for an ultrasound scan. They use sound waves to create pictures of your body on a TV screen. Ultrasounds are usually done through your tummy, but sometimes you may need an internal ultrasound to see things easier – this will be discussed with you and you can decide if you want to go ahead. 

 If you have PCOS, an ultrasound scan may pick up features of PCOS. These include having lots of follicles at the edge of your ovaries that may look bigger than usual (polycystic ovaries). The follicles are fluid-filled sacs in which eggs develop.

Not everyone with cystic ovaries on the ultrasound scan has PCOS. You can have polycystic ovaries, but if your periods and hormone levels are normal you will not be diagnosed with PCOS. 

What are the diagnostic criteria for PCOS?

A diagnosis can usually be made if other rare causes of the same symptoms are ruled out.

You will also need to meet at least two of the following three criteria:

• You have irregular or infrequent periods or no periods at all
• You have increased hair growth on your face or body, or blood tests show you’ve higher levels of testosterone than usual
• An ultrasound scan shows you have polycystic ovaries

Only two of these need to be present to diagnose PCOS. You may not need to have an ultrasound scan.

Infrequent periods are when you get your period less than six to eight times a year. Irregular periods are when the length of your menstrual cycle keeps changing. This means the gap between your periods changes and your periods might come early or late. Missed, early, or late periods are also considered signs of an irregular cycle (missed periods can also be a sign of pregnancy).

Referral to a specialist for PCOS

If you have PCOS, your GP will treat you. They may also refer you to a specialist, especially if you’re trying to get pregnant.

This could be:

• A gynaecologist – a doctor specialising in treating conditions of the reproductive system
• An endocrinologist – a doctor specialising in treating hormone conditions
• A fertility specialist – a doctor specialist in conceiving 
• A nurse specialist 

Your GP or specialist will discuss the best way to manage your symptoms. If your weight is considered a concern for your treatment, your doctor may advise diet or exercise changes.

Polycystic Ovary Syndrome Treatment

PCOS, once diagnosed, is often managed well with a combination of medication and life changes. With treatment, most people with PCOS can get pregnant. Improving your health by eating a healthy, balanced diet and exercising regularly can also help reduce the symptoms of PCOS.

If you have PCOS, you may also need to be checked every year for:

• Blood pressure
• Diabetes

Pregnancy risks associated with PCOS

If you have PCOS, you may have a higher risk of pregnancy complications.

For example:

• High blood pressure (hypertension)
• Pre-eclampsia (a combination of raised blood pressure and often protein in your urine or problems with the kidneys or liver) 
• Gestational diabetes (a type of diabetes that can develop during pregnancy)
• Miscarriage (miscarriage is common without PCOS, with one in four of all pregnancies ending in miscarriage)

You can reduce your risks by maintaining a healthy weight. If you are struggling with this, ask your GP for advice.

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