POLYCYSTIC OVARY SYNDROME

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1 POLYCYSTIC OVARY SYNDROME Information Leaflet Your Health. Our Priority.

2 Page 2 of 6 What is polycystic ovary syndrome? (PCOS) Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. In women with PCOS, the ovaries contain more developing follicles (small fluid filled sacs) than normal. The eggs in these follicles do not mature and cannot therefore be released from the ovaries leading to the formation of cysts. How common is PCOS One in ten women of child bearing age has PCOS. Although it has been reported in very young girls, it is generally diagnosed when women are in their 20s and 30s. What could PCOS mean for me? Some women with PCOS have no symptoms and not all women with PCOS have the same symptoms. Below are some symptoms of PCOS: The commonest is infrequent menstrual periods, no menstrual periods, and or irregular bleeding (occurs in 7 in 10 women with PCOS) Difficulty in getting pregnant (infertility) because of not ovulating. You may not ovulate every month and some women with PCOS will not ovulate at all Have more bodily hair (face, chest and lower abdomen) than normal called hirsutism Acne, oily skin or dandruff Hair loss appears as thinning of hair on the top of the head Weight gain or obesity 4 in 10 women with PCOS become overweight or obese Anxiety or depression - due to poor self-esteem as a result of other symptoms such as infertility If you have PCOS symptoms you may be at risk of developing long-term health problems such as: o Insulin resistance or type 2 diabetes o High blood pressure o Heart problems due to high cholesterol o Cancer of the lining of the womb (endometrial cancer) What causes PCOS? The exact cause is not clear but polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens) particularly testosterones either through the release of excess luteinizing hormone (LH) by the anterior pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus. At the beginning of each menstrual cycle, about 5 follicles (small sacs) develop in a normal ovary. These follicles contain eggs but usually only one follicle continues to develop until it releases an egg. This is called ovulation. In polycystic ovaries there are at least twice as many developing follicles as normal ovaries. Most of these follicles do not mature to the point of releasing an egg (ovulation). Ultrasound scan will show at least 12 follicles (tiny cysts) developing on each of your ovaries. (Polycystic means many small cysts).

3 Page 3 of 6 Polycystic ovary syndrome is not strictly inherited from parents but may run in some families because women with this disorder tend to have a mother or sister who has symptoms similar to PCOS disease. How is the diagnosis for PCOS made? Medical history and physical/examination: Your doctor will take a medical history specifically for menstrual pattern, weight and abnormal hair growth. During physical examination your doctor will measure your blood pressure, body mass index (BMI) and check areas of increased hair growth. Ultrasound scan: Ultrasound scan of the pelvis usually performed vaginally will be recommended to check the ovaries for small ovarian follicles (cysts) and check out the endometrium (lining of the uterus) which may become thicker if your periods are not regular. Blood tests: Blood will be taken to measure the level of testosterone and LH (luteinizing hormone) as they tend to be high in women with PCOS. You may be advised to have regular blood tests for sugar and cholesterol to detect early changes. How is PCOS treated? There is no cure for PCOS but symptoms can be treated, and the chance of getting diabetes or heart disease can be lowered. Treatment goals are based on your symptoms and some women will require a combination of treatments. Treatment of menstrual irregularity and prevention of endometrial hyperplasia (thickening of lining of the womb with risk of cancer) If you do not wish to become pregnant, menstruation can usually be regulated with a contraceptive pill. Most contraceptive pills will regularise periods but Dianette is also beneficial for hirsutism, and is often prescribed in PCOS. Some women with no periods or infrequent periods may not want any treatment but they run the risk of developing cancer of the uterus (womb). When a regular menstrual cycle is not required, oral progestogen taken at intervals of every three months will induce menstrual bleeding and protect the endometrium (womb lining). If the pill is not suitable, some women will prefer progestogen intrauterine coil (Mirena) to provide both contraception and protection of the lining of the womb. Treatment of fertility problems Some women with PCOS do not have problems conceiving. Lack of ovulation is the commonest cause of fertility problems in women with PCOS. Once other causes of infertility have been excluded, the first line medication to stimulate ovulation and help women with PCOS to become pregnant is clomifene citrate. Those who fail to ovulate on clomifene will be stimulated with gonadotrophins (FSH and LH). Both clomifene and gonadotrophins are associated with risk of multiple births although the risk is higher with gonadotrophins. Women who have PCOS and insulin resistance will benefit from using metformin. If it fails to induce ovulation a combination of metformin and clomifene is tried. In overweight women with

4 Page 4 of 6 PCOS and anovulation, diet adjustment and weight loss are associated with menstrual regulation and ovulation. If they fail to ovulate despite resuming regular menstruation, clomifene can be used to induce ovulation. Treatment by IVF is another treatment option available to these patients. Surgery Laparoscopic ovarian drilling (puncture of 4 small follicles with electrocautery) is sometimes used and often results in spontaneous ovulation or indeed ovulation after adjuvant treatment with clomifene or FSH. Treatment of hirsutism (excessive hair growth) and acne For women of child bearing age requiring contraception, the oral contraceptive pill may be effective in reducing excessive hair growth. Commonly used is the pill Dianette which contains the progestogen cyproterone acetate. This progestogen has anti-androgenic effects that blocks the action of male hormones that contribute to acne and growth of unwanted facial and body hair. Other anti-androgen drugs such a spironolactone has been shown to reduce abnormal hair growth in women. In women with insulin resistance, diabetes or obesity, metformin by reducing insulin resistance can minimise abnormal hair growth. Eflomethine (Vaniqa) is a cream which is applied to the face and acts directly on hair follicles to inhibit hair growth. Electrolysis or laser treatments are faster and more efficient alternatives than medical therapy. Metformin and other insulin sensitizing drugs Metformin hydrochloride (Glucophage) used to treat type 2 diabetes, makes the body cells more sensitive to insulin and lowers testosterone production. In women with PCOS, abnormal hair growth will slow down, and ovulation may return after a few months of use. Other insulin sensitizing drugs that can be used include pioglitazone hydrochloride (Actos) and rosiglitazione maleate (Avandia). In addition to the positive effect on insulin resistance, metformin treatment has been shown to improve hirsutism, acne, and menstrual irregularities in thin PCOS women. Dietary therapy If you have PCOS and you are overweight, weight loss is the most effective method of restoring normal ovulation and menstruation. Weight loss reduces the high insulin levels that occur and the knock-on effect is reduction in testosterone levels. In addition to improving the chance of regular ovulatory cycles, it may help reduce hair growth and acne. The increased risk of longterm problems such as diabetes, high blood pressure and heart disease are reduced. How does PCOS affect a woman while pregnant? Patients with PCOS appear to have a higher rate of miscarriage, gestational diabetes, pregnancy induced high blood pressure (pre-eclampsia) and premature delivery. Metformin can be given to those who have insulin resistance and does not appear to cause any major birth defects or other problems during pregnancy.

5 Page 5 of 6 More information on PCOS can be obtained from the following websites

6 Page 6 of 6 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MAT152 Publication date June 2013 Review date June 2016 Department Gynaecology Department Location Women s Unit, Stepping Hill Hospital

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