Polycystic Ovarian Syndrome (PCOS) and Polycystic Ovaries

• Signs or symptoms of high male hormones androgens (hirsutism, alopecia and thinning of hair from the head.)
• Acne occurs in association with raised testosterone levels.
• Irregular or absent menstrual periods after other causes for this have been excluded.
• Polycystic ovaries detected on ultrasound scan.

• A gain in body weight is often a precipitating cause for the development of PCOS symptoms.
• Familial tendency.
• More common in women from South Asia.
• Southern Asian women have disturbed insulin metabolism, and this increases the risk of PCOS.
• A family history of Diabetes Mellitus.
• Metabolic syndrome.
• A high BMI, overweight.

1. Menstrual problems Women are disturbed by both irregular and unpredictable nature of their periods. They often tell me how upset they become over experiencing scant periods. For these patients who do not want to conceive, I offer a low dose combined oral contraceptive pill, which also will protect the ovary from premature ageing.  

   For women who cannot take the pill, and require alternative hormonal therapy to induce regular periods, I offer the progesterone coil (Mirena Intrauterine System) which releases the hormone progesterone into the womb.

2. Infertility and irregular periods Unfortunately, ovulation is often irregular in PCOS and therefore it will take a longer length of time to conceive. I will therefore arrange the appropriate tests including tracking scans and blood tests to determine the treatment you will need to ovulate, and therefore have a better chance of conceiving. I use not only Clomiphene, but also Metformin.
3. Acne and related skin problems (caused by high androgen levels) The combined oral contraceptive pill will not only regulate the menstrual cycle, but will treat acne and unwanted hair growth. The combined oral contraceptive pill Dianette contains the “anti-androgen” Cyproterone acetate, and Yasmin has Drospirenone which are particularly effective in reducing unwanted hair. They can help improve hair loss. Spironolactone is also effective in treating both acne and hair loss.

Obesity in western society has tripled over the last 40 years, and we know that more than 1.9 billion adults were estimated as overweight in 2016, of whom over 650 million were obese.

• Obesity is now one of the leading causes of premature death.
• 41 million children under the age of 5 and over 340 million children and adolescents were estimated to be overweight or obese in 2016.
• Obesity will  shorten the life and health expectancy of the current generation of children in comparison with earlier generations.
• It also will result in PCOS and infertility.
• Perhaps using GLP-1 Receptor Agonists (semiglutide) provide a new treatment to improve reproductive health, and long term health.

The scientific literature has demonstrated that obesity is responsible for not onlydifficulty in becoming pregnant, but also long-term infertility. Many scientific publications have confirmed that obese women have poorer reproductive outcomes regardless of the mode of conception. They also are at higher risk of poor pregnancy outcome.

A higher body mass index (BMI) (being overweight) is directly associated with poor fertility outcomes. Polycystic ovary syndrome (PCOS) is one of the leading causes of infertility, and many women with PCOS are characteristically overweight or obese.

There is now a potential role for the glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 Ras semiglutide, liraglutide), as potential treatments for obese women with PCOS, who want to conceive.

I currently prescribe metformin as a treatment for PCOS, and it can result in a a 5kg weight loss. This improves the fertility rate, and pregnancy outcome. It improves ovulation, and lowers testosterone.

Clinical researchers have now begun to assess the administration of GLP-1 RA (mainly liraglutide) alone or in combination with metformin in women with obesity and PCOS. Several studies demonstrated significant weight loss and testosterone reduction, but with mixed results relative to improvements in insulin resistance parameters and menstrual patterns.

However, it is clear now that he weight loss effects of GLP-1 RA offer a unique opportunity to expand the treatment options available to PCOS patients.

Weight reduction has demonstrated that there is a clear benefit for women who want to conceive. The existing literature on the effect of weight loss in obese women desiring conception has shown that ovulation was restored in 90% of women and 78% went on to conceive. Weight loss is a vital part of infertility treatment. Weight loss also improved IVF cycle outcomes.

There have now been a series of scientific studies which have shown that short-term treatment with liraglutide either as sole treatment or with metformin, will produce significant weight loss, and improve metabolic function in women who are either overweight or are obese with PCOS.

• The weight loss effects of liraglutide offers Gynaecologists wider treatment options available for women with PCOS.
• Weight loss will not only improve fertility outcomes but also reduces the risk of pregnancy complications.