Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome, also known as Stein-Leventhal syndrome, is a common cause of infertility. The condition is characterised by the development of multiple cysts in the ovaries and has a range of hormonal and metabolic effects. Estimates are that PCOS affects up to 10% of all premenopausal women. It is one of the leading causes of infertility, yet many women do not know they have it. The condition begins to appear in childhood or adolescence and continues for the entirety of a woman’s life. PCOS is a relatively common condition.

While polycystic ovarian syndrome cannot be cured, usually it can be effectively treated. When left untreated there is an increased risk of heart disease, diabetes and endometrial cancer.

Signs and Symptoms

There are a number of symptoms of polycystic ovarian syndrome (PCOS) which vary in nature and severity from woman to woman:

• Excess hair growth (hirsutism) on the face and body
• Weight gain
• Acne
• Infertility
• Hair loss
• Irregular or absent periods
• Abnormal bleeding from the uterus
• High blood pressure
• Obesity, particularly centred around the middle
• Problems getting pregnant, or infertility
• symptoms of diabetes, such as thirst or excessive urination, vaginal thrush (candidiasis) or chronic skin infections
• polycystic ovaries, shown on ultrasound scans

Causes

The cause of PCOS is not fully understood. The condition has a tendency to run in families and a gene influencing the development of the condition has been identified.  It is through that the following factors also influence its development:

• Excessive levels of male hormones being made in the ovaries
• A problem with the enzymes involved in male hormone production
• A problem with insulin metabolism

Each month in a healthy ovary an immature egg begins to develop and is released from the ovary when mature. Hormones released by the pituitary gland, luteinizing hormone (LH) and follicle stimulating hormone (FSH) assist in this process known as ovulation. In PCOS an imbalance of LH and FSH disrupts the ovulation process. As a result, an egg begins to develop but does not fully mature and therefore is not released. Instead, the follicle in which the immature egg is contained becomes a fluid-filled cyst. Each cyst is usually between two to six millimetres in diameter and, over time, multiple cysts can cover the ovary.  In approximately 75% of women with this condition the ovaries may become enlarged.
However not all women with PCOS will have cysts on their ovaries and not all women with cysts on their ovaries will have PCOS.

Diagnosis

Diagnosis will involve taking a full medical history and making an assessment of symptoms. Other tests used to diagnose the condition include:

• A pelvic examination in order to determine if the ovaries are enlarged
• Blood tests to assess hormone levels
• An ultrasound scan of the ovaries

Treatment

Medications are primarily used in the treatment of PCOS.
An oral contraceptive pill may be prescribed to regulate periods.

Excessive hair growth and acne can be treated with medications that block the action of male hormones (androgens). These medications – such as spironolactone, cyproterone acetate and metformin - are often referred to as anti-androgens. The oral contraceptive pill Diane 35 may also be used to treat excessive hair growth and acne as it has anti-androgen properties.

If infertility is a problem, medications to stimulate the ovaries to produce more eggs, eg: clomiphene citrate (also sometimes know as Clomed), may be prescribed.

Medications to improve the functioning of insulin in the body eg: metformin, may be also be used. Metformin also helps to stimulate ovulation.

Weight loss plays an important role in the treatment of PCOS. Weight loss reduces the amount of male hormones being produced by the body and it can improve the body’s ability to use insulin. Regular exercise and maintaining a healthy balanced diet low in refined and sugary foods, but high in fibre and complex carbohydrates, is also important.

Further Information and Support

Fertility New Zealand can assist with support and information. They have a number of local societies throughout New Zealand.

Contact details are as follows:
Fertility NZ
Box 34 151
Birkenhead
Auckland
Freephone: 0800 333 306
E-mail: contact.us@fertilitynz.org.nz
Website: www.fertilitynz.org.nz 

References
www.southerncross.co.nz
Anderson, K. N., Anderson, L. E. & Glanze, W. D. (Eds.) (2006) Mosby’s Medical, Nursing and Allied Health Dictionary. (6th ed.) St. Louis: The C.V. Mosby Company
Canterbury District Health Board (2007) Polycystic Ovary Syndrome. In Endolab Quality Manual REC-26. Canterbury District Health Board.
Fallon, L. F. (2006) Polycystic Ovary Syndrome. The Gale Encyclopedia of Medicine, Third Edition. Jacqueline L. Longe, Editor. Farmington Hills, MI. Thomson Gale.
Fenton, A. (2005) Polycystic Ovarian Syndrome. In New Zealand Family Physician, Volume 32, No 2, April 2005.