Polycystic Ovaries: an owner’s manual
Hands up if you have polycystic ovaries!
At least 10% of you (including me!) should have your hands up as this is the proportion of women who have polycystic ovaries on ultrasound scan. About half of us women may have Poly Cystic Ovarian Syndrome (PCOS), which is recognised to present with the triad of symptoms of irregular/ infrequent periods, elevated ‘male’ hormone levels causing skin problems and excessive unwanted hair growth and the characteristic ultrasound pattern of multiple small follicles around the edge of the ovaries.
For a medical condition which is so common and which causes such distress to women of all ages, it is surprising that it is so poorly recognised and understood. All the things that worry young women as they move from puberty through their college years and into relationships can be affected by PCOS. Their periods may be late arriving and then be irregular, infrequent or unpredictably heavy; they may be troubled by ‘teenage’ acne that gets worse rather than better as they get older; they may be bothered by unwanted hair growth on their face and body; and they may find that they gain weight even though they eat no more, and often much less, than their peer group.
Some women with PCOS don’t have weight problems and they are called ‘lean’ PCOS. However they still can suffer with many PCOS problems and may find it even harder to get a diagnosis.
Anxiety about body image, worries about future fertility and generalised low mood can rapidly transform into ‘comfort’ eating, bulimia, the avoidance of exercise and sometimes even depression.
So what is going on? How can this problem be so common and yet so overlooked?
How can the diagnosis often not be made until the young woman has struggled with major weight problems and subfertility for years? Years of being told ‘Its only ‘puppy fat’ or being advised to ‘go on the pill and that will sort your periods out’….
Let’s follow the science
PCOS is a hormone problem and a metabolic problem. Women with PCOS usually have higher than average levels of testosterone (hence the problem with skin and unwanted hair growth) and increased ‘insulin resistance’ which is a condition in which the body’s cells fail to respond to the normal actions of insulin. Insulin is what turns the calories we eat into energy stores and regulates the level of glucose in the blood. It seems that in PCOS, calories are more likely to be stored as fat rather than used as fuel and so even a normal calorie intake (2000 kilocalories per day: especially if the diet is high in carbohydrates) may result in excessive weight gain. It is very unfair that most of the delicious things in life such as pizza, pasta, bread, potatoes and biscuits are carbohydrates. If you have PCOS, consuming carbs will increase the problem of insulin resistance and increase the risk of developing Type 2 diabetes at an early age. Women with PCOS and a BMI greater than 30 (about 13 stone if you are 5ft 6in) have a five-fold increased risk of developing Type 2 diabetes by the age of 50.
Metformin, an anti-diabetic drug has been widely used in PCOS but the evidence for its efficacy is limited. Myoinositol (Inofolic alpha) has been shown to improve glucose metabolism in women with PCOS and research is on-going with this food supplement.
Have your 5 a day!
A diet that is low in carbs and high in leafy green vegetables, lean protein and fruit is ideal for women with PCOS and will lead to significant, sustained and healthy weight loss. NB Unforunately, the grapes in wine do not count as one of your five a day!
Apples and pears
While we are talking about fruit, this diagram explains why it is the distribution of body fat that matters rather than the actual amount. The ‘apple’ shape is generally the PCOS shape whereas the ‘pear’ is associated with fewer problems. Your waist measurement should be no more than half your height in inches or centimetres.
What does the future hold for PCOS patients?
Researchers have always assumed that PCOS must be ‘genetic’, that is inherited like eye colour, because women with first degree relatives (sister or mother) with PCOS are 3-4 times more likely to develop PCOS themselves. But a ‘polycystic gene’ has not been found and it is likely that PCOS is a complex mixture of factors.
Some ethnic groups (particularly women from South East Asia) are more likely to develop PCOS, especially if they move to the West and change their diet.
Excellent Australian studies have shown that a weight loss of 10% of BMI combined with an exercise programme can induce ovulation and spontaneous pregnancy in the majority of women with PCOS.
Some very exciting work by Prof Roy Homburg from London has shown that it may be exposure in the womb to slightly higher levels of maternal testosterone found in pregnant women with PCOS that converts a genetic pre-disposition of the baby girl to have PCOS into actually developing it. He tested the skin of newborn baby girls and found that those born to mothers with PCOS had higher levels of sebum (oil) than those of mothers without. Safely reducing testosterone levels in pregnant PCOS women may offer a promising therapy.
Is there an upside to PCOS?
Women with PCOS have high levels of AMH and therefore tend to respond very well to fertility treatments such as IVF.
Our naturally greasy skin means we don’t get wrinkles!
Our hormone levels mean we tend to be brave and adventurous. Boadicea probably had PCOS (and had two feisty daughters!)
How CARE can help
In order to optimise your chances of a pregnancy with PCOS, CARE will help you to reduce particular risks that are related to IVF and PCOS. To do this we can:
- Help you to optimise your weight
- Prescribe specific medication that can help reduce the risk of over response
- Reduce your chances of over stimulation
Your safety is the most important aspect of any treatment which is why we will always offer you individualised treatment plans and help you every step of the way. To ensure your safety we will:
- Provide individualised stimulation
- Plan a treatment to suit your needs
- Closely monitor you at every stage of your treatment
If you would like to learn more about your treatment options, please feel free to contact your nearest CARE clinic. Our teams are always more than happy to help.