What are the symptoms and problems of PCOS?

Symptoms that occur if you do not ovulate

  • Period problems occur in about 7 in 10 women with PCOS. You may have irregular or light periods, or no periods at all.
  • Fertility problems – you need to ovulate to become pregnant. You may not ovulate each month, and some women with PCOS do not ovulate at all. PCOS is one of the commonest causes of infertility.

Symptoms if you make too much testosterone

  • Hair growth (hirsutes) occurs in more than half of women with PCOS. It is mainly on the face, lower abdomen, and chest. This is the only symptom in some cases.
  • Acne may persist beyond the normal teenage years.
  • Thinning of scalp hair (similar to ‘male pattern baldness’) occurs in some cases .

Other symptoms

  • Weight gain – about 4 in 10 women with PCOS are overweight or obese.
  • Depression or poor self esteem may develop as a result of the other symptoms.

Treatment of Infertility

Clomiphene citrate and metformin are the principal treatments used to help infertility. Both have been shown to be effective, but in the largest trial to date clomiphene appeared to be most effective. In this trial, 626 women were randomized to three groups: metformin alone, clomiphene alone, or both. The live birth rates after 6 months were 7.2% (metformin), 22.5% (clomiphene), and 26.8% (both). The major complication of clomiphene was multiple pregancy, affecting 0%, 6% and 3.1% of women respectively. The overall success rates for live birth remained disappointing, even in women receiving combined therapy, but it is important to consider that the women in this trial had already been attempting to conceive for an average of 3.5 years, and over half had received previous treatment for infertility. Thus, these were women with significant fertility problems, and the live birth rates are probably not representative of the ‘average’ PCOS woman.
However, many specialists continue to recommend metformin which has, separately, been shown to increase ovulation rates and reduce miscarriage rates. Metformin may be a rational choice in women in whom significant insulin resistance is diagnosed or suspected, as clomiphene works through a different mechanism and does not affect insulin resistance.
Diet adjustments and weight loss also increase rates of pregnancy. The most drastic increase in ovulation rate occurs with a combination of diet modification, weight loss, and treatment with metformin and clomiphene citrate. It is currently unknown if diet change and weight loss alone have an effect on live birth rates comparable to those reported with clomiphene and metformin.
Though the use of basal body temperature or BBT charts is sometimes advised to predict ovulation, clinical trials have not supported a useful role.
Ovarian stimulation has an associated risk of ovarian reproductive technology procedures such as controlled ovarian hyperstimulation hyperstimulation in women with PCOS a dangerous condition with morbidity and rare mortality. Thus recent developments have allowed the oocytes present in the multiple follicles to extracted in natural, unstimulated cycles and then matured in vitro, prior to IVF. This technique is known as IVM (in-vitro-maturation)
Though surgery is usually the treatment option of last resort, the polycystic ovaries can be treated with surgical procedures such as:

  1. laparoscopy electrocauterization or laser cauterization.
  2. ovarian wedge resection (rarely done now because it is more invasive and has a 30% risk of adhesions, sometimes very severe, which can impair fertility) was an older therapy.
  3. ovarian drilling.

Treating hair growth

Hair growth is due to the increased level of testosterone – the ‘male’ hormone.

  • Unwanted hair can be removed by shaving, waxing, hair removing creams, electrolysis, and laser treatments. These need repeating every now and then, although electrolysis and laser treatments may be more long lasting (but are expensive, and are not available on the NHS).
  • A cream called eflornithine may be prescribed to rub on affected areas of skin. It works by counteracting an enzyme (chemical) involved in making hair in the skin. Some research trials suggest that it can reduce unwanted hair growth, although this effect quickly wears off after stopping treatment.

Drugs taken by mouth can also treat hair growth. They work by reducing the amount of testosterone that you make, or by blocking the effect of testosterone.

Drugs include:

  • The combined contraceptive pill (’the pill’). There are many pills to chose from, but all have some effect of reducing hair growth.
  • Cyproterone acetate is an ‘anti-testosterone’ drug. This is commonly combined with oestrogen as a special contraceptive pill called Dianette. Dianette is commonly prescribed to regulate periods, to help reduce hair growth, to reduce acne, and is a good contraceptive.
  • Other anti-testosterone drugs are sometimes advised by a specialist if ‘the pill’ or Dianette do not help, or are not suitable.
  • Drugs taken by mouth to treat hair growth take 3-9 months to work fully, and for their effect to be noticed. You need then to carry on taking them otherwise hair growth will recur. Removing hair by the methods above (shaving etc) may be advised whilst waiting for a drug to work.

Treating acne

The treatments used for acne in women with PCOS are no different to the usual treatments for acne. Another leaflet discusses acne and its treatment in more detail. Treatment for acne usually works well.

Treating period problems

Some women who have no periods, or infrequent periods, do not want any treatment for this. However, your risk of developing cancer of the uterus may be increased if you have no periods for a long time. Regular periods will prevent this possible increased risk to the uterus.
Therefore, some women with PCOS are advised to take the contraceptive pill as it causes regular ‘withdrawal bleeds’ similar to periods. If this is not suitable, another option is to take progestogen hormone for several days every month which will cause a monthly bleed like a period. If neither of these is suitable, your doctor may advise a regular ultrasound scan of your uterus to detect any problems early.

Lose weight if you are overweight

Losing weight helps to reduce the high insulin level that occurs in PCOS. This has a knock-on effect of reducing testosterone. This then improves the chance of you ovulating, which improves any period problems, fertility, and may also help to reduce hair growth and acne. The increased risk of long-term problems such as diabetes, high blood pressure, etc, are also reduced.
Losing weight can be difficult. A combination of eating less and exercising more is best. Advice from a dietitian, and help and support from a practice nurse, may increase your chance of losing weight. Even a moderate amount of weight loss can help.

Sources: Emedicine Health, Patient

Related Posts