POLYCYSTIC OVARIAN SYNDROME What is polycystic ovary syndrome (PCOS)? Polycystic ovary syndrome is when you have polycystic ovaries as well as certain symptoms. In a normal ovary, around five follicles (small sacs) develop each month, at the beginning of the menstrual cycle. These follicles contain eggs. Usually one follicle each month continues to develop until it releases an egg into the fallopian tube. This is known as ovulation. If the egg is fertilised by sperm, it travels down to the womb, implants in the lining and a pregnancy begins. If the egg is not fertilised, the lining of the womb is shed at the end of the monthly cycle, when you have your period, and the egg is absorbed naturally back into your body. Polycystic ovaries have at least twice as many developing follicles as normal ovaries. However, many of these follicles do not mature to the point of releasing an egg (ovulation). Because they have more follicles than is usual, polycystic ovaries are slightly larger than normal ovaries. The term polycystic is a bit misleading. Early researchers thought that they could see cysts (small fluid-filled sacs) on the ovaries. In fact, what they saw were enlarged follicles. Around 20 out of every 100 women have polycystic ovaries. Most women with polycystic ovaries have no symptoms. A syndrome is a collection of different signs and symptoms that are all part of the same underlying medical condition. Women with polycystic ovary syndrome (PCOS) rarely have all of the possible signs and symptoms. PCOS is therefore difficult to diagnose. The doctor will take account of your symptoms and will usually check your hormone levels (through a blood test) and your ovaries (through an ultrasound scan). PCOS runs in families. What could PCOS mean for me? If you have polycystic ovary syndrome (PCOS), you may become aware of some or all of the following symptoms. You may: • have more body hair than is usual for you • have irregular periods or no periods at all • have difficulty in getting pregnant • be overweight • have acne • lose hair on your head. These symptoms can vary from mild to severe. They can be caused by other conditions, too. If you have PCOS symptoms, you have a greater risk of developing long-term health problems such as: • heart problems • diabetes • high blood pressure • cancer of the lining of the womb (known as endometrial cancer). This information tells you about these long-term problems What can help reduce long-term health risks? Following a balanced diet is one of the main ways in which you can help yourself. Taking regular exercise is another way in which you can help yourself. Both can help reduce the long-term health risks associated with PCOS. If you are overweight, losing weight will help you. If your periods are irregular or nonexistent they may become more normal. Follow advice from your doctor or nurse on reducing your calorie intake and taking more exercise. Even if you are not overweight, you should take care to keep your weight within the normal range for your height. Your doctor or nurse should give you more information on what you need to do. To monitor your health, your doctor may offer you tests on the levels of cholesterol and certain fats (known as lipids) in your blood. These may be done regularly (usually once a year), especially if you are overweight and you have a family history of heart disease. They should be available either at your GP clinic or a hospital outpatient department. Your doctor or nurse can then advise you on what you can do to help reduce your cholesterol and lipid levels. Women with PCOS are more likely than normal to develop a form of diabetes known as type 2 diabetes. One or two in every ten women with PCOS go on to develop this form of diabetes. It can be treated by diet and exercise, and sometimes also with tablets or insulin injections, depending on your circumstances. If you are overweight and you have a family history of diabetes, you may be offered regular tests on the levels of sugar in your urine or the levels of glucose in your blood, to check for signs of type 2 diabetes. These tests may be done about once a year through your GP or at a hospital outpatient clinic. If you have few periods or no periods at all, the lining (known as the endometrium) of your womb may be more likely to thicken. Having regular periods usually prevents this. If the endometrium thickens, it can sometimes lead to cancer. To reduce this risk, your doctor may offer you treatment with progestogen hormones to ensure that you have a period at least every three to four months. How much do we know about the links between PCOS and other conditions? Insulin resistance and diabetes Insulin is a hormone that regulates the amount of glucose (a form of sugar) in your blood. If the levels of glucose in your blood do not stay normal this leads to diabetes. Some people need a lot of insulin in order to keep their blood glucose at the normal level. This is known as being insulin resistant. Some women with PCOS are insulin resistant and therefore more likely to develop diabetes. Drugs known as ‘insulin sensitising agents' (such as metformin) act by making the body more sensitive to insulin. These drugs can be used for short periods of time to help non• diabetic women who have PCOS (especially women who do not ovulate). There is not enough evidence to tell us how safe or effective they are for long-term use by people who do not have diabetes. More research is needed on this. If you become pregnant when you have PCOS, and especially if you are very overweight, you may develop diabetes during your pregnancy. This is known as gestational diabetes. You should be tested for it early in your pregnancy. It usually goes away once your baby is born, but you may be more likely to develop type 2 diabetes later in life. If you have diabetes while you are pregnant your doctor or midwife should refer you to a specialised obstetric diabetic service. Heart disease If you have diabetes and/or high blood pressure you may be more likely to develop heart disease in later life. However, there is no clear evidence that, just because you have PCOS, you are any more likely to die from heart disease than women who do not have PCOS. Breast cancer If you have PCOS and you have been through the menopause, evidence shows that your risk of developing breast cancer is the same as women who do not have PCOS.