Polycystic Ovarian Syndrome (PCOS)

What is PCOS?

Polycystic ovary syndrome (PCOS) is an endocrine (hormonal) disorder. It is sometimes called "hyperandrogen annovulation syndrome" which describes its hormonal imbalance and associated problems with ovulation better. However the term Polycystic Ovarian Syndrome has been used by medical professionals since the early 1930s and is now almost impossible to change to a more appropriate term.

How does PCOS develop?

In general the cause is insulin resistance. The inability of the woman to process insulin effectively causes an overproduction of testosterone by the ovaries. The inability of the woman to process the insulin can also lead to obesity.

The symptoms?

As PCOS is a syndrome it has a number of diagnostic symptoms with no single hard and fast diagnostic test. Each woman presents with a different number of symptoms and together they make PCOS. The following is a list of some of the possible symptoms:

  • Hirsutism (excessive hair growth on the face, chest, abdomen, etc)
  • Hair loss (androgenic alopecia, in a classic "male baldness" pattern)
  • Acne
  • Polycystic ovaries (seen on ultrasound)
  • Obesity, particularly central obesity (being apple-shaped)
  • Infertility or reduced fertility
  • Irregular or absent menstrual periods

In addition, women with PCOS appear to be at increased risk of developing the following health problems during their lives:

  • Insulin Resistance
  • Diabetes
  • Lipid abnormalities
  • Cardiovascular Disease
  • Endometrial Cancer

Although polycystic ovaries can be one of the symptoms, they aren't present in all sufferers, making the most common name of the syndrome confusing. In addition many women without PCOS have polycystic ovaries but none of the other symptoms and there for it is important to understand the difference between the syndrome and having only polycystic ovaries.

Who's at risk?

It affects between 5 and 10% of all women of childbearing age regardless of race or nationality. Symptoms usually present themselves during puberty, since many of the metabolic and endocrine features of the disorder mimic puberty, but may also begin in the early to mid 20s. Certain symptoms are life long, the others will cease at menopause. Insulin resistance increases dramatically at the onset of puberty and then declines in early adulthood.

There is some evidence of that PCOS runs in families. Potentially, a gene or series of genes renders the ovaries susceptible to insulin stimulation of androgen secretion while blocking follicular maturation This genetic predisposition may be expressed as premature balding in men.

A great deal of ethnic variability exists for some of the symptoms of PCOS. For example in hirsutism; Asian women have less hirsutism given the same serum androgen values as white women. On the other hand, southern Mediterranean women more often are hirsute.

How is it diagnosed?

Elevated free testosterone activity, defined by the free androgen index, represents the most sensitive biochemical marker supporting the diagnosis. A raised luteinising hormone concentration, although a useful marker of the syndrome, is now less favoured as a diagnostic tool. Most, but not all, subjects show a characteristic ultrasound appearance of enlarged ovaries and an increased echo dense stroma surrounded by multiple, small, peripherally situated follicles.

Clinical features

  • Oligomenorrhoea or dysfunctional uterine bleeding
  • Anovulatory infertility
  • Hirsutism or acne, or both
  • Central obesity

Endocrine abnormalities

  • Increased testosterone activity (often expressed as raised free androgen index)
  • Elevated luteinising hormone concentration with normal follicle stimulating hormone concentration
  • Insulin resistance with compensatory hyperinsulinaemia.

How is PCOS treated?

Control your blood sugar levels

While low-carb diets are an effective way to do this, we recommend that you consult with your doctor before starting such a plan. Limit refined carbohydrates and sugary foods and choose high fibre lower Gi varieties of carb foods like wholemeal bread and wholemeal cereals.

High fibre foods release their energy more gradually than refined foods so blood sugar levels do not fluctuate so rapidly. They are also more satisfying and can help you avoid those dreaded food cravings.

Stay within the healthy weight range

Following either a low-carb plan or a traditional calorie-controlled diet will help.

Combine food groups

Instead of a large banana, choose a small one with some peanut butter. Top crackers with a slice of ham or a piece of cheese. This will help limit the effect of the carbs on glucose levels.

Eat little and often

This will stabilise your blood sugars and help avoid cravings.

Get your 5 a Day

Aim for at least five portions a day (the majority of these should come from vegetables, not fruit or juice) to provide you with vitamins and fibre as well as to help you balance your overall diet.

Reduce bad fats

Saturated fat can raise your cholesterol level and may contribute to the development of heart disease. Choose monounsaturated fats such as olive oil and rapeseed oil when you can.

Cut down on sugar

This doesn't mean you have to eat a completely sugar-free diet. Sugar can be used in small amounts as an ingredient in foods and in baking as part of a healthy diet. However, use sugar-free, low sugar or diet squashes and fizzy drinks, as sugary drinks cause blood glucose levels to rise quickly.

Reduce the salt sprinkle

A high intake of salt can raise your blood pressure. Try spicing up the flavour of your meals with herbs and spices instead of salt.

Eat enough calories

Eating too few calories can cause your metabolism to enter starvation mode and actually slow down the rate at which food is burnt off.

Drink in moderation only

The recommended maximum intake is two units of alcohol per day for women, but we would recommend only up to 7 drinks per week. A small glass of wine or half a pint of normal-strength beer is one unit.

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