Polycystic ovarian syndrome (PCOS)

Diagnosis

Diagnostic criteria for Rotterdam diagnosis of polycystic ovary syndrome.
Two of the following three criteria are required:

1. Irregular Menstrual Cycles (Oligo/Anovulation)
2. High levels of androgen (male) hormones (Hyperandrogenism) Clinical (hirsutism, acne or less commonly male pattern alopecia) or Biochemical (raised FAI or free testosterone)
3. Polycystic ovaries on ultrasound

Other causes must be excluded such as congenital adrenal hyperplasia, androgen-secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinaemia.

There are several different definitions of PCOS, however, the Rotterdam consensus is the most widely accepted in Australia, Europe and Asia and was the definition used for the Evidence-based guideline for the assessment and management of polycystic ovary syndrome developed by the PCOS Australian Alliance in 2011 (and updated in 2015). The information presented here is taken directly from the guideline.

Irregular menstrual cycles (Oligo/Anovulation)

In adolescent women (<18 years), after two years of irregular cycles (>35 or <21 days) following the onset of the first period (menarche), polycystic ovary syndrome should be considered, and an appropriate assessment should be undertaken. As polycystic ovary syndrome is a diagnosis of exclusion, other causes of irregular cycles (such as thyroid dysfunction or hyperprolactinemia) need to be considered and excluded before the diagnosis of polycystic ovary syndrome.

Hyperandrogenism

High levels of androgens can cause effects seen in PCOS such as excessive hair growth, or abnormal patterns of masculine hair growth (hirsutism). To explore this, blood tests calculating the amount of testosterone in the blood can be performed however people on the combined oral contraceptive pill will have a low level of testosterone, so it may be necessary to stop the pill for 3 months to check the testosterone levels. During this time other forms of contraception need to be looked at.

Polycystic ovaries

Polycystic ovaries are checked by ultrasound. Interestingly you do not need to have multiple cysts or follicles for the diagnosis of PCOS if there are irregular periods and signs of hyperandrogenism. Performing an ultrasound on younger adolescents can also give us a false impression of PCOS as there are many more follicles in younger women.

Treatment of PCOS

All the symptoms of PCOS must be addressed and managed long-term, to avoid associated health problems. PCOS is a long-term condition and long-term management is needed.

Lifestyle modifications

Lifestyle changes – such as eating a healthy diet low in carbohydrates and introducing regular physical activity into your weekly routine can have a positive effect on your health in so many ways. For women who have PCOS, a healthy lifestyle can lead to an improvement in symptoms, particularly if your new lifestyle helps you to lose weight.

Weight reduction

You don’t even have to lose much weight to feel the benefit. Studies suggest that just 5 to 10 per cent weight loss can: restore normal hormone production – which can help regulate periods and improve fertility improve mood reduce symptoms such as:

• facial and body hair growth
• scalp hair loss
• acne

It can also reduce your risk of developing type 2 diabetes and cardiovascular disease.

Medical treatments for PCOS treatments include:

1. Combined oral contraceptive pill (COCP)
   If you are suffering from irregular, heavy periods, the oral contraceptive pill is often prescribed for contraception, to regulate the cycle, reduce excess hair growth and acne, and prevent the lining of the womb from thickening excessively
2. Anti-androgen medication (blocks hormones such as testosterone)
   E.g., spironolactone – these may be used to reduce excess hair growth or scalp hair loss and treat acne
3. Anti-acne medications
4. Fertility medications
   If fertility is a problem, clomiphene citrate (sold as Clomid) or metformin may be taken orally to bring about ovulation (egg release) and increase the chance of falling pregnant
5. Psychological counselling
   Your doctor and specialists can advise you about what treatment best suits you.
6. Medication to reduce the risk of heart attack and stroke
   E.g., cholesterol and blood pressure lowering medication
7. Medication for prediabetes and type 2 diabetes
   E.g., metformin

So, what next?

If you have been suffering from irregular periods, have hair growth or thinning hair that concerns you, or weight loss is a particular issue (or a combination of the three) then it is important to exclude PCOS as a cause. As there are great ways to manage and live a healthy life, it is important to have clarity around the diagnosis.

If you are concerned or would like to ask more questions, please book in with the doctors at GS Health for more information.