Polycystic ovarian syndrome (PCOS)
PCOS is an important medical condition in women that causes irregular or absent periods. It occurs when monthly release of an egg from the ovaries (ovulation) is not occurring and there are higher levels of male-type hormones (androgens). Excess androgens may also cause problems with excessive hair growth (such as facial or on chest), acne, or male-pattern hair thinning. PCOS is common, affecting 1 in 10 women, although most women go undiagnosed. This is an important issue for women's health, as PCOS may have short- and long-term health implications, such as period problems, difficulty falling pregnant (infertility), diabetes and, possibly, and increased risk of uterine cancer in later life.
The cause of PCOS is not fully understood, although there seems to be some inherited tendency towards its development. The fundamental problem is an excess of androgen ("male" hormones - although androgens are always present in females at some level), but the underlying cause of this is debated. It may be related to high levels of insulin commonly seen in overweight women or, alternatively, there may be primarily a problem with the levels of hormone production in the ovaries or the pituitary gland. Whatever the cause, these androgen levels prevent normal development of "eggs" in the ovaries, so that they form lots of immature or small cysts only (giving the ovary the "polycystic" appearance) rather than one egg becoming dominant and ovulating, as is the usual case. Because ovulation doesn't occur, the ovaries produce even more androgens, and a "vicious cycle" develops. The lack of ovulation leads to irregular periods, often months apart and very heavy, and the excess androgens also produce acne and excess hair growth.
Importantly, PCOS does not cause ovarian pain. Periods are often heavy and may be painful, but non-menstrual pain should prompt further investigation for an alternative cause. Women commonly present with:
PCOS is diagnosed following a thorough medical history, examination, and after some investigations of hormone levels and an ultrasound to assess the appearance of the ovaries. There is no single test that confirms PCOS, and the diagnosis is usually made by a General Practitioner or Gynaecologist after considering the presence or absence of the following:
Often the most effective treatment for PCOS is modest weight loss (5-10kg) in women with PCOS who are overweight. With this, many women will begin ovulating regularly and, in turn, will notice the resumption of a regular monthly period pattern. Referral to a Dietitian can be very useful. Other treatments depend on the woman's age and current intentions for pregnancy, and often require advice from a Gynaecologist.
Treatments for women not trying to conceive may include progesterone therapy to help regulate her periods. This is often given in the form of a combined oral contraceptive pill, and some pills have "anti-androgen" components that help alleviate symptoms such as acne and excess hair, and are particularly useful in PCOS. Women trying to conceive may require medications to help her ovulate, although these are safest when used in conjunction with weight reduction in overweight women. There are also surgical options that can help restore ovulation. As PCOS has further-reaching implications, ongoing management through a General Practitioner or Specialist Gynaecologist is important to screen for secondary complications of PCOS such as type 2 diabetes.
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David is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and undertook his specialist training in Queensland. He is highly skilled in the management of complex and high-risk pregnancies, and has special training in minimally-invasive surgery, endometriosis, pelvic floor and incontinence surgery. David has completed a Master of Reproductive Medicine and is skilled in the assessment and management of fertility problems, and can offer the full range of assisted reproductive treatments. He is a Senior Lecturer with The University of Queensland Medical School, and has published both medical journal and textbook contributions.
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