Polycystic Ovaries | Rapid Access Gynaecology

Polycystic Ovarian Syndrome (PCOS) is a very common hormonal disturbance. In my clinical experience, the majority of patient’s concerns are about menstrual cycle changes (irregular or absent periods), infertility issues and skin problems (acne and hirsutism the unwanted hair growth on the face or body) and Acanthosis nigricans, deep pigmentation on the neck and in the armpits). Some women have irregular periods from the onset of menstruation.

Not all patient’s experience the full spectrum of PCOS symptoms, and these will change over the years. Weight gain is a significant problem, and many patients despite dieting, are unable to control their body weight. This increases the risk of infertility.

Approximately 25-% of the female population have polycystic ovaries, but still menstruate and ovulate. A smaller percentage 10-15% will have some of the signs and symptoms although a smaller proportion will have symptoms of the polycystic ovary syndrome–up to 15% of women.

Polycystic ovaries affect up to 25% of them female population.
PCOS is less common and affects 10-15%.
Irregular periods often from the onset of menstruation.
Weight gain is difficult to manage.

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The ovary has 2 purposes: the production of female sex hormones, oestrogen and progesterone and the male hormone testosterone, and also the release of a monthly egg. Once a woman reaches puberty, and starts to menstruate, she will then become fertile and ovulate. We know that ovaries will contain many thousands of eggs which are present in the fetus.

Polycystic ovaries as the name implies will consist of many small follicles, which each contain an egg and may have started to grow but stall, and the ultrasound appearances will confirm that they remain small at a size of about 2-9 mm in diameter.

A polycystic ovary on ultrasound will normally consist of 12 small follicles or cysts. The ovaries tend to be bigger than in women with normal ovaries. I use the Anti-Mullerian hormone blood test as one of the markers for PCOS, and Testosterone as this hormone is usually elevated. I will assess the risks of Diabetes and Adrenal dysfunction.

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.

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.
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.
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.