By Dr Victoria Nisenblat, Gynaecologist, Fertility Specialist, Surgeon at Fertility SA
Could your hairiness be more than just inheriting your Dad’s Mediterranean genes?
Polycystic Ovarian Syndrome (PCOS) is a common hormonal condition that affects 12-18 percent of young women. The name ‘polycystic’ suggests you may have multiple ‘cysts’ on your ovaries. The term ‘cyst’ is a bit misleading because the ‘cysts’ are actually not cysts but partially formed follicles which contain an egg. This results in special appearance of ovaries on ultrasound when multiple small follicles are seen, but not all women who have PCOS have such ovaries and not all women who have such looking ovaries have PCOS. With significant general and mental health consequences, PCOS impacts quality of life and is a major health and economic issue. PCOS symptoms present in many different ways, and some women will have only some, or mild symptoms, whereas others will have severe symptoms. PCOS can cause problems with a women’s menstrual cycle, fertility, hair and skin, sleep, mental and emotional health as well diabetes or heart disease later in life if left untreated.
We can partly blame Mum for this one…
While the exact cause of Polycystic Ovarian Syndrome is not known, hormonal imbalances and genetics play a large role. Women are more likely to develop PCOS if their mother or sister also has the condition. Many symptoms of Polycystic Ovarian Syndrome are caused by high levels of the ‘male’ sex hormones or androgens circulating through the body, testosterone being the most common. All women produce small amounts of androgen, but women with it often produce higher-than-normal levels, affecting the menstrual cycle and lead to excess hair growth and acne. High androgen levels also can affect the development and release of eggs during ovulation and cause difficulty in ovulating. Increased production of androgens in PCOS is commonly caused by excess insulin due to insulin resistance. One of the roles of insulin is to keep the levels of glucose in the blood from rising after eating. With insulin resistance, the body doesn’t use available insulin effectively to help keep the glucose levels stable. Because the insulin is not working effectively, the body produces more insulin and these high levels can increase the production of androgens in the ovaries. Insulin resistance is present in up to 80% of women with PCOS.
Insulin resistance is caused in part by lifestyle factors including being overweight because of a diet or physical inactivity. While women without PCOS who are overweight can have this form of insulin resistance, women with it are more likely to have insulin resistance caused by genetic factors and, even slim women can have this condition.
Image credit: womenshealth.gov
What symptoms should you be looking for if you suspect PCOS?
Symptoms of PCOS show as early as puberty and symptoms can vary in type and severity from person to person. Very few women have the same set of symptoms. The most common characteristic of PCOS is irregular menstrual periods. PCOS is manifests from a decrease in female sex hormones and an excess of male hormones, so women may develop certain male characteristics such as:
:: Excess hair on the face, chest, stomach, thumbs, or toes
:: Deeper voice
:: Thin hair
Other symptoms can include
:: Acne, oily skin, hair loss
:: Weight gain or difficulty losing weight
:: Anxiety or depression
Whilst not symptoms of the disease, many women with PCOS have other simultaneous health problems, such as diabetes, hypertension, and high cholesterol. These are mainly associated with weight gain often seen in PCOS patients.
How do you know for sure that you’re not just a naturally hairy woman?
There is no single conclusive test for Polycystic Ovarian Syndrome. It can be a complex condition to identify because women don’t have to have all the symptoms and features to be diagnosed. To make a diagnosis your doctor will review your medical history and symptoms, and perform tests such as a physical and pelvic examination to exclude other possible conditions. Blood tests may also be performed to measure hormone levels, including:
:: Reproductive hormones including androgens, oestrogen and progesterone produced by the ovaries and some hormones produced by brain to control the ovaries.
:: Thyroid function tests to determine how much of the thyroid hormone your body produces.
:: Additional hormonal tests may be indicated depending on the presenting symptoms
:: Tests to measure your blood sugar levels
:: Lipid level tests to assess the amount of cholesterol in your blood
If your doctor suspects Polycystic Ovarian Syndrome you may be referred for a pelvic ultrasound. Advice from a specialist gynaecologist should be considered to make an accurate and timely diagnosis. Both the GP and specialist can, together with you, develop a long term follow up plan with an emphasis on fertility, or other concerns that woman may have.
What if these tests point to actually having PCOS?
We can treatPolycystic Ovarian Syndrome but, unfortunately, we can’t cure it completely. Treatment focuses on managing symptoms to help prevent complications and varies from woman to woman.
A healthy diet and regular exercise to lower blood sugar levels and regulate the menstrual cycle is recommended for women with Polycystic Ovarian Syndrome, especially those who are overweight. The oral contraceptive pill can help treat acne, regulate the menstrual cycle, and lower levels of male hormones, such as testosterone, in woman who don’t want to become pregnant. If a woman with PCOS does want to have a baby and has difficulty, fertility drugs may be administered to help her in ovulation.
Anti-androgens drugs to reduce male hormone levels and help stop excess hair growth and reduce acne can be considered, as may diabetes medications such as metformin to lower blood glucose and testosterone levels.
There are some surgical solutions such as ovarian drilling and bariatric surgery that can help, but lifestyle management is the first and best option, according to most studies.
We don’t want to be scaremongers but…Women with untreated PCOS have a higher risk of developing:
:: High blood pressure
:: High cholesterol
:: Depression and anxiety
:: Sleep apnoea
:: Endometrial cancer
Women with PCOS also have a higher rate of miscarriage, gestational diabetes, and premature delivery and may need extra monitoring during pregnancy. The earlier PCOS is diagnosed and treated, the lower the risk of developing these complications.
If you think that you may have Polycystic Ovarian Syndrome, please follow up with your GP. If you do have PCOS, the sooner you are diagnosed and treated, the less destructive this disease will be.
By Dr Victoria Nisenblat
Dr Victoria Nisenblat is a gynaecologist with a special interest in pelvic pain, infertility and reproductive health. She obtained her medical degree in Israel followed by specialist training in Obstetrics and Gynaecology in both Israel and Australia. She completed her PhD in Medicine in 2013 at the University of Adelaide and holds academic appointment of Researcher and Lecturer at the University. Her research is focused on diagnosis and management of endometriosis. Dr Nisenblat is undertaking subspecialty training in reproductive endocrinology and infertility. Dr Nisenblat consults at Pelvic Pain SA, Royal Adelaide Hospital and The Queen Elizabeth Hospital as well as Fertility SA.
Victoria is an avid skier who would love to have more time to travel and follow the snow. She loves spending time with her family, including her two fur kids- cats Victor and Isabella.