Understanding polycystic ovary syndrome

Polycystic ovary syndrome affects between five and 10 percent of women in their reproductive years.

11 August 2014
by Wendy Maritz

Polycystic ovary syndrome (PCOS) is one of the most common female hormonal disorders, and one of the leading causes of infertility in women. Left untreated, it may lead to metabolic complications and diabetes.

“The symptoms of PCOS include irregular or absent menstrual cycles, infertility, recurrent pregnancy loss (three of more consecutive miscarriages) and obesity,” explains fertility specialist Dr Sascha Edelstein of HART (Holistic Assisted Reproduction Treatment) in Cape Town. There are also a number of associated features related to an increase in production of the male hormone androgen, such as acne, hirsutism (excessive body or facial hair) and alopecia (male-pattern balding).

There appears to be a strong familial connection between women who develop PCOS, so its causes are mainly related to genetics. (A 2010 study conducted at Groote Schuur Hospital determined that 20 percent of mothers, 45 percent of sisters and 55 percent of daughters of women with PCOS had the disorder themselves.) Weight gain beyond a certain threshold in women who have this genetic predisposition can cause the disorder to manifest.

“Fertility is affected by increased androgen production and a decrease in the amount of the sex-hormone binding globulin (SHBG), a glycoprotein that essentially ‘mops up’ excessive androgens,” explains Dr Edelstein. “Androgens interfere with normal ovulation, causing infertility.” Insulin resistance is another factor – higher than normal insulin levels are required to control the glucose levels in the blood. The excess insulin stimulates the ovaries to produce large amounts of androgens that cause cysts on the ovaries.

A rise in insulin levels can also cause increased appetite and decreased fat burning which leads to weight gain, a precursor for type-2 diabetes, hypertension and dyslipidaemia (an unfavourable ratio of good to bad cholesterol, which if left untreated can lead to cardiovascular disease).

Once a diagnosis has been made (with a blood test to determine androgen levels and an ultrasound that can detect the presence of polycystic ovaries), management of PCOS will depend on family planning and metabolic issues.

Your gynaecologist can help you manage irregular periods and the symptoms of PCOS by prescribing an anti-androgen combined contraceptive pill. If you are planning a family, and PCOS has been determined to be a sole cause of your inability to conceive, then a fertility specialist can assist with various ovulation induction therapies. There are a variety of options, says Dr Edelstein. “Apart from taking medication, management of PCOS must include ways to reduce obesity,” he adds. “A 10 percent weight loss in obese women will dramatically improve their chances for resuming ovulation. There also has to be adequate monitoring and screening to see if metabolic complications develop, since these carry the real long-term health risks for patients. As with many other medical conditions, early intervention can prevent long-term complications.”