All About PCOS

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age.

Women may initially present with either or all of these symptoms:

  • Hirsutism (Excess hair growth)
  • Acne
  • Alopecia (loss of hair, front of head)
  • Menstrual disturbance
  • Infertility
  • Weight gain

Potential long-term complications of PCOS include:

  • Type 2 diabetes mellitus
  • Gestational diabetes
  • Elevated lipids
  • Hypertension
  • Stroke
  • Coronary artery disease
  • Endometrial cancer
  • Sleep apnoea
  • Obesity
  • Depression/Anxiety
  • Eating disorders
  • Sexual dysfunction

Symptoms vary considerably among women.

Hirsutism and acne are both symptoms of excess male hormones and can be very distressing. Hirsutism is characterised by hair growth in a male distribution pattern which includes chin, upper lip, chest, back, abdomen, upper arm, thigh, and buttocks. Electrolysis, laser photo thermolysis, topical therapies like eflornithine and oral medical/hormonal therapies are available for hirsutism.

Around 3-fold increased risk for endometrial cancer is seen in women with PCOS.

Diagnosis and investigations

The definition of PCOS based on the Rotterdam Criteria requires the presence of two out of the three following criteria to make the diagnosis:

  1. Menstrual cycle disturbance
  2. Hirsutism/acne
  3. Polycystic ovaries on ultrasound scan

An endocrinologist makes a diagnosis of PCOS based on a detailed history and examination followed by blood tests and scans.

It is important to be aware similar symptoms and presentation can be seen in other endocrine conditions like Cushing’s syndrome, ovarian tumours, adrenal tumours and late onset congenital adrenal hyperplasia.

Endocrinologist will arrange the following blood tests:

  • FBC
  • UE
  • LFT
  • HbA1C
  • TFT
  • Cortisol,
  • Oestradiol
  • Prolactin
  • LH, FSH, Testosterone, SHBG

It is important that they are interpreted keeping in view the symptoms, current medications and presentations.

A transabdominal pelvic ultrasound scan is required to assess the ovaries and to assess endometrial thickness. A transvaginal ultrasound scan may be considered in some situations.

The baseline ultrasound scan is best performed in the first three days of the menstrual cycle. Blood test should also be done around the same time. If you are on pills or do not have periods, endocrinologist will advise you accordingly.

Treatment: This depends on the current symptoms encountered. Whilst managing the symptoms it is also important to change one’s lifestyle to prevent long term complications of PCOS. Healthy weight loss, which is sustained would greatly benefit.

Please ensure you prepare well before you consult an endocrinologist near you. Make a list of all the problems you have. Read the information above to understand what problems you are currently encountering. Take with you all the medications you have been prescribed and also the list of medications you have tried in the past.

Useful Links

https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/

https://patient.info/womens-health/polycystic-ovary-syndrome-leaflet

https://www.verity-pcos.org.uk

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