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By Dr J Kabyemela, MD

What is Polycystic Ovarian Syndrome (PCOS)?

Polycystic ovarian syndrome or ‘Polycystic Ovaries’ is the commonest endocrine disorder to affect women. It is commonly shortened as PCOS or even simply as PCO. Estimates range from 5 – 10% of all women being affected to some degree.  Some estimate put the prevalence significantly higher than that. What is not in dispute is that at least 1 in 20 women are affected by this condition. It affects women of all races roughly equally.

Endocrine disorders

It is important to understand what we mean by endocrine disorders to really understand Polycystic Ovarian Syndrome. These are disorders where there is an abnormality of production of certain natural hormones and chemicals. The abnormality could be either in increased or reduced production. Examples would include an underactive thyroid where there is reduced thyroxine hormone production or Type 1 diabetes where the production of insulin hormone is severely reduced. There are several endocrine disorders, some not as common or well known. Let’s go back to Polycystic Ovarian Syndrome.

Causes of polycystic ovaries

It is wrong to talk about causes when it comes to ‘polycystic ovaries’. It is a condition that one inherently has. Unlike the examples of endocrine disorders mentioned above, polycystic ovarian syndrome is not acquired. It does not suddenly develop at some point in life. It is a condition that an individual always has and, crucially, will always have. Because it is a condition that is reproductive hormone related, it starts manifesting itself in the mid to late teens.

The name Polycystic Ovarian Syndrome (PCOS)

In clinical practice, one always encounters this inevitable question once the diagnosis has been made: “Why don’t you just remove the cysts?” It is an understandable question but completely misguided as far as the nature of the condition is concerned. When an ultrasound scan is performed to look at the ovaries in a woman with this condition, the ovaries are typically found to have multiple very small cysts all around the periphery. This finding has been dubbed ‘the necklace sign’ due to the small cysts being evenly spaced all around the periphery. The cysts are a manifestation and not a cause of the condition. Removing them is neither feasible nor beneficial.

Clinical features of Polycystic Ovarian Syndrome

A typical presentation of polycystic ovarian syndrome is:

§ Obesity: There is a tendency to be overweight or obese but this is by no means universal. Some women with polycystic ovaries will be of normal weight.

§ Irregular menstruation: This is very common in polycystic ovaries. Periods tend to be erratic, typically going for several weeks, even months without one. This is caused by the derangement of the hormone profile in the body.

§ Hirsutism: There is a tendency to increased body hair, including the very distressing facial hair

§ Skin changes: Acne and greasy skin can be quite prominent; again, that is an effect of high androgen activity.

§ Sub-fertility: Because of erratic ovulation, a woman with polycystic ovaries may have a great deal of difficulty conceiving. There is also a slightly higher tendency to miscarry.

Underlying problem in polycystic ovaries

So what are the hormone problems in Polycystic Ovarian Syndrome (PCOS)? For one, the ovaries, for some obscure reasons, produce excessive amounts of the so-called male sex hormones. These are more appropriately called ‘androgens’. It is important to understand that ovaries do normally produce these androgens, alongside the other ‘female sex hormones’ such as estrogen and progesterone. The difference is that, in polycystic ovaries, the production is higher. This, apart from the masculinising effect, tends to mess up the balance of other hormones. This is one of the main causes of the features mentioned above including hirsutism, skin problems, erratic menstruation and sub-fertility.

The other major problem in polycystic ovaries is insulin resistance. Insulin is a crucial hormone for metabolism of carbohydrates. While production of insulin is normal in polycystic ovaries, there is resistance to the effect of the hormone. In fact, women with polycystic ovaries are at a significantly higher risk of Type 2 diabetes in middle age and later.

Next Page: Long term issues in Polycystic Ovaries

Polycystic ovaries

A classic scan image of an ovary in a case of Polycystic Ovarian Syndrome (PCOS). The small dark rings around the periphery are the ‘cysts’ which constitute the diagnostic feature of this condition. They are a manifestation and not the cause of PCOS.

Hirsutism in polycystic ovaries

The over-production of androgen hormones and/or their increased activity in women with Polycystic Ovarian Syndrome (PCOS) could mean masculinising effects including development of f acial hair.

Polycystic Ovarian Syndrome (PCOS)