What Is PCOS?

Polycystic Ovary Syndrome (PCOS), also known as Stein-Leventhal Syndrome or Polycystic Ovary Disease (PCOD), is a complex syndrome affecting up to 10 percent of all women. It is one of the most common causes of female factor infertility. Although it was identified in the early 20th century, experts are still unsure of what causes PCOS. Mr Shaw can discuss some of the theories with you when you see him.
There is much debate at the moment about the involvement of insulin resistance. It is hypothesized that the abnormally high insulin levels in turn cause abnormally high male hormone levels that in turn will cause the signs and symptoms of the disease The name "polycystic" is very much a misnomer because although most women with the disease do have ovarian cysts, there are many other signs and symptoms that can be found. Indeed the cysts on the ovary are not the type that need to be removed. They are effectively the result of incomplete ovulation.
The syndrome is not curable but can be treated so that symptoms are lessened and pregnancy can be achieved. Infertility is only one concern however. There are many health-related risks associated with PCOS including: endometrial hyperplasia, endometrial cancer, diabetes, high blood pressure, high cholesterol, and heart disease. So although there may be a more immediate focus at first to diagnose PCOS so that infertility or hirsutism may be treated, it will be necessary to have a longer term perspective on the condition.

PCOS is a "syndrome" and so there are many problems that can be associated with it. Not all women will have all symptoms and any combination of symptoms can be seen. It is generally accepted that in order to be diagnosed with PCOS, three symptoms should be noted. The most common signs and symptoms include:

• irregular or absent periods (amenorrhoea)
• irregular or absent ovulation (anovulation)
• numerous ovarian cysts
• excess facial or body hair (hirsuitism)
• insulin resistance
• infertility
• scalp hair loss (alopecia)
• acne
• obesity, especially mid-section

Diagnosing PCOS
There is not one definitive test for PCOS. Many doctors will diagnose it purely on symptoms or after other health problems (e.g. thyroid and pituitary gland) have been ruled out. However, a thorough examination, a scan and blood tests (hormone profile) should be performed to diagnose the disease.

Treating PCOS
Once PCOS has been diagnosed, a treatment plan will be developed by you and your doctor. The treatment does not require the removal of the cysts. Mr Shaw can explain this more when you see him. The approach is dependent on your particular needs.
To begin, there will be some necessary lifestyle changes. If you are overweight, then weight loss should be a focus. A combination of low carbohydrate diet and exercise will aid in weight loss and lower insulin levels. There are medications that can be used in addition to diet and exercise. Insulin sensitising medications used for PCOS include Metformin/Glucophage. These medications have potential side effects and risks and all of these should be discussed with your doctor before starting a medication regimen.

For those trying to achieve pregnancy, the lifestyle factors alone may restart ovulation. Whilst drugs such as clomiphene can help to to induce ovulation, they work better in patients whose Body Mass Index (BMI) is between 20 and 30. Be sure that you are also counselled on the risks and benefits of these medications as well.
If the ovaries prove resistant to stimulation of ovulation with drugs, and you have already reached the target weight that Mr Shaw set for you, then there may be an option to laparoscope you and use a laser to drill the capsule of the ovary which can make the ovaries less resistant to ovulation.
For those not attempting pregnancy at this time, the insulin sensitising medications are still often used to control the symptoms of PCOS. If contraception is required some pills are more suited to PCO than others. Oral contraceptives in general can balance out the hormone levels and alleviate some of the symptoms of PCOS. Some patients who have androgenic symptoms may be better suited to oral contraceptives have an anti-androgenic action. Management of PCO is tailored to the individual patient's needs. These are explored during your first consultation.

Useful Contact
Verity Membership
The Grayston Centre
28 Charles Square
London
N1 6HT

Web: http://www.verity-pcos.org.uk