Polycystic ovarian syndrome.
Polycystic, ovarian syndrome, or PCOS is one of, if not the most common endocrine conditions that women get, affecting up to around 15% of women.
If you found yourself reading this page, and you feel overwhelmed, please remember that you are not alone. PCOS isn’t talked about nearly enough, and many people, although they may have heard about it, have no idea what it really is. This means that diagnosis can often be delayed as people don’t realise that symptoms they are experiencing are actually due a condition that is being controlled by hormones.
The amazing thing about PCOS is that we can optimise it or treat it in most people, and even reverse it. Although the syndrome might not continue to affect you for your whole life, once you have a diagnosis, is it important that you continue routine health screening for conditions that you will be more at risk of developing such as diabetes and maintain vigilance around it returning. Please touch base with your doctor, if you have any concerns around PCOS, as we have so many options available to you and are here to help support you in anyway that we can.
Let’s start from basics
Just because you have multiple cysts on your ovaries, does not mean that you necessarily have PCOS, in fact, multiple cysts on the ovaries are VERY common in the first 8 years after your period starting, so we in fact do not screen women for PCOS in these first few years of them starting their periods.
To you have the syndrome of PCOS (which differers from PCO – or poly cystic ovaries), you need to have 2 out of 3 criteria. The criteria we use is called the modified Rotterdam Criteria.
* Having periods less often than 21 days, or more often than 35 days
*Hormonal, imbalance, either on bloodwork, or physical symptoms, such as acne or hair, growing, where it shouldn’t, for women, such as under the chin or around the face
*Multiple cysts on either ovary (20 or more)
Just because we don’t screen for PCOS in the first 8 years of a woman’s period, doesn’t mean periods can’t be heavy, irregular, very painful or all of these. If they are, we have multiple treatment options for this, however, we just don’t look for, and put a formal diagnosis of PCOS on a patient who has so PLEASE come and see your GP if you are experiencing trouble symptoms around your period.
Implications of PCOS
PCOS can leave women at higher risk of things, such as obesity, cardiovascular disease (heart disease), cancer, type2 diabetes, as well as infertility.
Infertility, obesity or weight issues, and irregular periods are the things that patients most often present to me for. These are the very ‘real world’ things that a patient often identifies as an issue and seeks medical advice for, and depending on where they are on their health journey, and what their short, medium and long term goals are, will often define what treatment options we have to offer.
Treating PCOS
PCOS can affect different women differently (which makes sense), and management for this condition is tailored to the individual woman. Treatment for a woman who is actively trying to get pregnant, is going to be different than treatment for a woman who is more concerned about the physical features such as acne, or having difficulty, trying to lose weight.
There are many dieticians who specialise in PCOS, and can help tailor a diet to the patient. There are also medications which we can use if we have things such as insulin resistance, one of them being the oral medication, Metformin, which is used as a diabetic medication, to reduce insulin resistance. We after need to Taylor, medications and prayers to the individual.
With fertility, as mentioned before, 5 to 10% body, weight reduction can help significantly in bringing on ovulations, which help make cycles more regular. Although quite heavy reading, here’s a link on weight loss and PCOS by O&G The Women’s Medical Specialist
PCOS – How losing weight can help
If you are not ovulating, this makes the period cycle less regular. We have treatment options to help bring on ovulation in women with PCOS, such as Metformin, which will reduce the insulin resistance, as well as that weight loss, 5 to 10%, if you are outside the normal BMI range. We can also bring on ovulation through ovulation induction meaning infertility is something we can treat.
Many people with PCOS find themselves with the BMI between 20 to 25, and if this is a case, weight loss is not something that I often recommend or needs to occur, however, we do still need to be aware that you might be more prone to gaining weight, and have more difficulty losing it.
As you can see, PCOS is very complex condition, and how we treat it ill really depend on the individual woman, and what she’s hoping to achieve.
Why does PCOS exist?
There’s a lot of different theories regarding my PCOS exists, and most of the stem from the fact that over thousands of years, people have had to live in very harsh conditions including famines and starvation.
People with PCOS have a metabolism and hormone system that can work very well with very little.
A way that I explain it to people in 2024, is that if we were to suddenly go into a famine, people who are overweight with PCOS who struggle to lose weight normally, will maintain their weight, and do much better, then people with a lower BMI, and her lose weight very quickly (and will often stop cycling themselves). In fact, many women with PCOS who are not ovulation will start to ovulate and become fertile once weight loss occurs.
If you have around 15% of the population in this PCOS category, it means that society as a whole will continue. So it’s an evolutionary advantage to have a large portion of your population wired this way.
We are not about to hit a famine, however, and we have plenty of food (thankfully) meaning this evolutionary advantage is not currently being tested out. What is happening, however, is that our current lifestyle and diet means people with PCOS are able to put on more weight than they need, which is leading to other health conditions. I suppose why I discuss this is to show that this condition is a combination of both our genetics, but also our environment, and although we can’t change our genetics, we can definitely make a big difference with lifestyle and medicine, so please, don’t lose hope.
Here are some useful PCOS links I like to share with patients
Dr Rosie Gentle 