Polycystic ovarian syndrome (PCOS) affects around ten percent of women of reproductive age and many women are never formally diagnosed or experience a significant delay in diagnosis.
The diversity of presentations in women with PCOS and ethnic variation in symptoms contribute to the difficulty in making the diagnosis, seeking and receiving effective treatment. Some of the common presentations of PCOS include menstrual irregularity or infrequent or absent periods, unwanted hair growth, acne and hair loss.
To make the diagnosis of PCOS, women must have two of the following features:
- Polycystic ovaries on ultrasound: more than 20 small on either or both ovaries measured on a high quality ultrasound
- Clinical or biochemical hyperandrogenism: symptoms of excess androgen hormones such as acne or excessive hair growth or evidence of elevated androgen levels in the circulation on blood testing
- Irregular, infrequent or absent periods
It is really important to note that to be able to diagnose PCOS, other conditions that may cause the same or similar symptoms need to be excluded. Therefore, the assessment for PCOS usually involves a comprehensive assessment of symptoms, general examination, blood tests and a pelvic ultrasound.
For women that have PCOS, treatment is targeted to the particular features and concerns for that woman. Management is also centred on reducing the other long term health issues associated with PCOS such as depression and other mood disorders, metabolic syndrome and diabetes and preventing endometrial cancer. For some women, lifestyle changes and weight loss may help in the treatment of PCOS. Weight loss of between 5 to 10 percent may help restore regular menstrual cycles. Often the support of a multidisciplinary team including dietician, exercise physiologist, counselling and the assistance of other medical specialists can help with setting achievable lifestyle goals and implementing these changes.
The combined oral contraceptive pill is often recommended in the treatment of PCOS to give a predictable, regular withdrawal bleed and to protect the endometrium (uterine lining) from developing abnormal or cancerous cells. The pill also has the benefit of helping to treat the symptoms of androgen excess and providing effective contraception if the woman isn’t trying to conceive. Other treatments to protect the endometrium include progesterone preparations including the progesterone containing intrauterine device.
Women with unwanted hair growth may consider treatment with anti-androgen medications if they are not trying to conceive and may also consider other methods of hair removal including laser hair removal. For a multitude of reasons, women with PCOS can suffer from body image issues and psychosexual dysfunction and may benefit from psychological support and counselling.
Some women with PCOS will also experience difficulty or delay in falling pregnant. There are many available options to assist these women and couples in achieving a pregnancy. This might include assessing whether ovulation is occurring, the use of oral medications to induce ovulation as well as ovulation induction with injected hormones (gonadotrophins), ovarian surgery and IVF. At the time of planning a pregnancy, it is important to reassess risk factors such as underlying diabetes, aim for a body mass index in the healthy range and commence on a folic acid supplement.
There is now an international, evidence based guideline for the assessment and management of PCOS by searching the Monash University website as well as resources for women with PCOS developed in collaboration with consumers “Ask PCOS” available online through the Monash Centre for Health Research and Implementation (MCHRI).