Gynecology For The Everyday Woman

Definition

Polycystic Ovary Syndrome (PCOS) is a common hormonal condition where the ovaries produce higher levels of “male” hormones (androgens), causing irregular periods, acne, excess hair growth, and sometimes small fluid-filled follicles on the ovaries.

It affects ovulation, fertility, skin, weight, and long-term health. It can’t be cured but can be managed effectively.

Prevalence (How Common It Is)

Region	Estimated Prevalence	Notes
Worldwide	~6–13% of reproductive-aged women	WHO estimate (~70% undiagnosed)
United Kingdom	~1 in 10 (≈10%)	NICE / NHS data
United States	6–10%	CDC, NIH
Europe	6–12%	ESHRE reviews
Asia & Africa	5–20% (variable)	Under-diagnosed, limited data

Causes of PCOS

1. Genetic Factors (Family History)
   • What it means: If your mother, sister, or close female relative has PCOS, you’re more likely to have it. This suggests certain genes may make you prone to PCOS.
   • Source: ESHRE and ACOG emphasize a strong genetic link, noting that PCOS often runs in families. RCOG mentions heredity as a key factor. NICE acknowledges a familial tendency but notes specific genes are still being studied.
2. Hormonal Imbalances (High Androgens and Insulin)
   • What it means: Women with PCOS often have higher levels of male hormones (androgens) like testosterone, which can cause symptoms like excess hair or acne. They may also have high insulin levels (a hormone that controls blood sugar), which can boost androgen production and disrupt ovulation.
   • Source: RCOG, ESHRE, NICE, and ACOG all highlight elevated androgens as a core feature. ESHRE and ACOG specifically note insulin resistance (where the body doesn’t use insulin well) as a driver, affecting 50-70% of women with PCOS.
3. Insulin Resistance
   • What it means: The body struggles to use insulin properly, leading to higher insulin levels. This can increase androgen production, mess with ovulation, and raise the risk of weight gain or diabetes.
   • Source: NICE and ACOG stress insulin resistance as a major contributor, often linked to obesity but also present in lean women with PCOS. RCOG and ESHRE note it amplifies hormonal imbalances.
4. Environmental and Lifestyle Factors
   • What it means: Things like obesity, poor diet, or lack of exercise can worsen PCOS symptoms, especially by increasing insulin resistance. These aren’t direct causes but make the condition more likely or severe.
   • Source: RCOG and NICE mention obesity as a risk factor that aggravates PCOS. ESHRE notes environmental factors like diet may influence severity. ACOG highlights lifestyle’s role in worsening insulin resistance.
5. Inflammation
   • What it means: Low-grade inflammation (the body’s immune system being overactive) might contribute to PCOS by increasing androgen levels or affecting ovulation.
   • Source: ACOG and ESHRE mention inflammation as a possible factor, though it’s less understood. RCOG and NICE don’t emphasize this but acknowledge it as an emerging area of research.

Key Points

• Multifactorial: PCOS likely results from a combination of these factors, with genetics and hormonal imbalances playing the biggest roles (RCOG, ESHRE).
• Not Fully Understood: All sources agree the precise cause is unclear, and more research is needed (NICE, ACOG).
• Who’s at Risk?: Women with a family history of PCOS, obesity, or insulin resistance are more likely to develop it (ESHRE, ACOG).

Common Symptoms

• Irregular or absent periods

• Difficulty getting pregnant (not ovulating regularly)

• Excess hair growth (face, chest, abdomen)

• Acne or oily skin

• Weight gain or trouble losing weight

• Thinning hair on scalp

• Fatigue, mood swings, anxiety or depression

Long-Term Consequences

• Fertility issues due to lack of ovulation

• Type 2 diabetes / insulin resistance

• Metabolic syndrome (obesity, high BP, high cholesterol)

• Endometrial hyperplasia / cancer risk (if long gaps between periods)

• Depression and anxiety

• Sleep apnoea (especially if overweight)

• Possible future heart disease risk

Investigations

1. History & examination — menstrual pattern, hair growth, weight.

2. Blood tests:

• Hormones: testosterone, LH, FSH, prolactin, thyroid

• Glucose & lipid levels (for diabetes and cholesterol)

3. Pelvic ultrasound: may show many small follicles (“string of pearls” pattern).

4. Diagnosis: usually made if 2 out of 3 features are present (Rotterdam criteria):

• Irregular ovulation

• Signs of high androgens

• Polycystic-appearing ovaries on scan

5. Screen for long-term risks: blood pressure, weight, glucose.

Treatment Options

Individualised — depends on symptoms & pregnancy goals

Lifestyle (first-line):

• Healthy eating, regular exercise, gradual weight loss (even 5–10% helps).

• Improves periods, fertility, and reduces diabetes risk.

For irregular periods / acne / hair:

• Combined oral contraceptive pill (COCP)

• Progestogen-only therapy or Mirena® IUS

• Anti-androgens (spironolactone) or topical acne/hair treatments

For fertility:

• Ovulation induction: Letrozole (first-line), or Clomifene

• Metformin if insulin resistance or glucose issues

• IVF if other methods fail

For metabolic health:

• Regular screening for diabetes and cholesterol

• Metformin, lifestyle changes

Supportive care:

• Counselling for mood & body image

• Hair removal, dermatology care for acne

• Sleep studies if symptoms of sleep apnoea

Key Takeaways

• Very common (≈1 in 10) but often undiagnosed.

• Symptoms vary — some have irregular periods, others mainly acne or fertility issues.

• No cure, but effective control with lifestyle + medical management.

• Early diagnosis & regular monitoring prevent long-term health problems.

• Multidisciplinary care (GP, endocrinologist, dietitian, fertility specialist) gives best outcomes.

Always consult your Gynaecologist to discuss your case/options