Polycystic Ovary Syndrome (PCOS) What are Polycystic Ovaries? Polycystic ovaries are slightly larger than normal ovaries and have twice the number of follicles (small cysts). Polycystic ovaries are very common, affecting 20 in 100 (20%) of women. Having polycystic ovaries does not necessarily mean you have Polycystic Ovary Syndrome (PCOS). Around 6 or 7 in 100 (6 7%) of women with polycystic ovaries have PCOS. What is PCOS? PCOS is a condition which can affect a woman s menstrual cycle, fertility, hormones and some aspects of her appearance. It can also affect long-term health. Doctors are not entirely clear why some women develop PCOS. There is often a hereditary link and a link with diabetes in the family. In recent years it has become clear that PCOS is closely related to a problem with insulin. Insulin is a hormone released from the pancreas after a meal and it allows the organs of the body to take up energy in the form of glucose. In PCOS there is a 'resistance' of cells in the body to insulin, so the pancreas makes more insulin to try and compensate. The excessively high levels of insulin have an effect on the ovary, causing a rise in testosterone hormone levels and preventing ovulation. It may also make weight loss more difficult. Reducing insulin levels by weight loss, exercise or drugs can result in a lowering of testosterone and an improvement of the symptoms of PCOS. What are the symptoms of PCOS? The symptoms of PCOS can include: Irregular periods or no periods at all Difficulty becoming pregnant (reduced fertility) Having more facial or body hair than is usual for you (hirsutism) Loss of hair on your head Being overweight, rapid increase in weight, difficulty losing weight Oily skin, acne Depression and mood swings These symptoms may vary from woman to woman. Page 1 of 5
How is PCOS diagnosed? Women with PCOS often have a range of signs and symptoms which may come and go. This can make PCOS a difficult condition to diagnose. Because of this, it may take a while to get a diagnosis. A combination of the following symptoms may point to a diagnosis of PCOS: Irregular, infrequent periods or no periods More facial or body hair than is usual for you Blood tests which show higher testosterone levels than normal An ultrasound scan which shows polycystic ovaries What could PCOS mean for my long-term health? You are at greater risk of developing some long-term health problems if you have PCOS: 1. Insulin resistance and diabetes Up to 2 in every 10 (10 20%) women with PCOS go on to develop diabetes at some time. If you have PCOS, your risk of developing diabetes is increased further if you: Are over 40 years of age Have relatives with diabetes Developed diabetes during a pregnancy (known as gestational diabetes) Are obese - body mass index (BMI) over 30 If you are diagnosed with diabetes, you will be given dietary advice and may be prescribed tablets or insulin injections. 2. High blood pressure Women with PCOS tend to have high blood pressure, which is likely to be related to insulin resistance and to being overweight. High blood pressure can lead to heart problems and should be treated. Page 2 of 5
3. Cancer With fewer periods (less than three a year), the endometrium (lining of the womb) can thicken and this may lead to endometrial cancer in a small number of women. There are several ways to protect the lining of the womb using the hormone progestogen. Your doctor will discuss the options with you. These may include a five to seven day course of progestogen tablets used every three or four months, taking a contraceptive pill or using the intrauterine contraceptive system (Mirena ). PCOS does not increase your chance of breast, cervical or ovarian cancer. What can I do to help? The main ways to reduce your overall risk of long-term health problems are to eat a healthy diet, exercise regularly (30 minutes, three times per week) and aim to keep your weight to a level which is normal (a BMI between 19 and 25). Your diet should include fruit, vegetables, whole foods (such as wholemeal bread, whole grain cereals, brown rice, and whole-wheat pasta), lean meat, fish and chicken. You should decrease sugar, salt, and alcohol (14 units of alcohol is the recommended maximum units a week for women). The Royal College of Obstetricians and Gynaecologists (RCOG) currently recommend that if a woman becomes pregnant she should not drink alcohol. The benefits of losing weight include: A lower risk of insulin resistance and developing diabetes A lower risk of heart problems A lower risk of cancer of the womb More regular periods An increased chance of becoming pregnant Reduction in acne and a decrease in excess hair growth over time Improved mood and self-esteem Is there a cure? There is no cure for PCOS. Medical treatments aim to manage and reduce the symptoms or consequences of having PCOS. Medication alone has not been shown to be any better than healthy lifestyle changes (weight loss and exercise). Many women with PCOS successfully manage their symptoms and long-term health risks without medical intervention, by eating a healthy diet, exercising regularly and maintaining a healthy lifestyle. Page 3 of 5
Fertility and PCOS Women with PCOS may have reduced fertility. Treatments used in this case involve: Weight loss Metformin Clomifene citrate (clomid) Or a combination of the above The use of Metformin in women with PCOS Metformin is a drug that is normally used to treat diabetes and it has been used for this purpose for over 30 years. However, Metformin is only licensed for the treatment of diabetes, not PCOS. Metformin is not an experimental drug but its use in PCOS is relatively new. There have been several studies looking at the use of Metformin in women with PCOS, the majority have shown that Metformin can make periods more regular and improve ovulation in women with PCOS. The use of Metformin may also make weight loss easier if women actively diet whilst taking the drug. Metformin works best in overweight women with PCOS. However, it is less effective in women with a BMI of over 35. Its effects are enhanced by weight loss. Metformin is only used in women with PCOS who are trying to become pregnant. Risks and side effects To date, research shows that Metformin is safe in pregnancy. However, once pregnancy is confirmed, then the Fertility Unit recommends that Metformin should be stopped at 12-14 weeks of pregnancy. The Consultant will advise you. Metformin can cause nausea, abdominal bloating and flatulence. In severe cases, it can cause vomiting or diarrhoea. Most women tolerate it very well, particularly if the dose is increased gradually. Additionally, to minimise side effects, the tablets should be taken in the middle of a meal or straight after a meal. Side effects usually settle after 1-2 weeks. Use of Metformin in PCOS Women with kidney failure or severe liver disease should not take Metformin. Page 4 of 5
How to take Metformin: Start Metformin gradually 500mg a day. Once this is well tolerated for 2 weeks then to increase to: 500mg twice a day for 2 weeks then once this is tolerated for 2 weeks then increase to: 500mg three times a day for 2 weeks then: 850mg twice a day Do not increase the dose if side effects develop - wait until they have settled first. If you have any questions or need further advice, please telephone the nurse on 01270 273499. The use of Clomifene citrate (clomid) in women with PCOS Clomifene citrate is an anti-oestrogen drug. There is a 10% risk of a multiple pregnancy whilst taking this drug. We therefore recommend having an ultrasound scan with your first cycle in order to monitor the effects of the drug. Please see separate patient information leaflet on Clomifene citrate. Reviewed by the Readers Panel November 2013. This information is available in audio, Braille, large print and other languages. To request a copy, please telephone 01270 273499. Revised and reprinted August 2018 Review August 2020 Ref: WC/FC/0010818 NHS Choices: www.nhs.uk Page 5 of 5