Polycystic Ovary Syndrome (PCOS)

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Polycystic ovary syndrome (PCOS) is a condition which prevents the ovaries from working properly, affecting periods, hormone levels, fertility and physical appearance.

Overview

Typically, women affected by PCOS have larger than normal ovaries (the organs in a female body which produce eggs), the outer surface of which are covered by a large number of cysts. In women without PCOS, the ovarian cysts would usually be follicles, which are small swellings in which the egg should develop before ovulation. However, when the follicles stop growing too early instead of releasing the egg, they form fluid filled sacks otherwise known as cysts.

Polycystic ovaries generally have around 12 or more cysts which will rarely fully develop or ovulate to produce an egg which could be fertilised.

Ovulation among women with PCOS is rare meaning that they are less fertile and their periods are irregular. Additional side effects include excess weight and unwanted body hair.

The condition affects up to 10 per cent of 15 to 50 year olds and there is a high incidence rate of approximately 75 per cent in women who have ovulation problems.

What causes PCOS?

Ongoing research endeavours to establish the cause of PCOS though currently a number of unproven theories exist. As it stands, one of the most popular explanations is that the condition runs in families and is down to the influence of genes.

Some individuals favour the explanation that the condition can be attributed to one particular gene, whilst others reckon that it is the role of several. Whatever the explanation ,if you have a family history of Type 2 diabetes or another diabetes, or if there is a history of baldness in the family then these can be indicators.

Similarly, though it is not necessarily the cause, excess weight has been highlighted by numerous medical professionals as a major contributing factor in PCOS. Women who weigh above the healthy body mass index limit (BMI) stand an increased risk of hormonal abnormalities and have a lower rate of ovulation. Research has shown that both of these factors would see an improvement after just a modest amount of weight loss.

The final key theory as to the cause of PCOS is higher than normal levels of specific hormones. For example, someone who is resistant to insulin (the hormone that controls your blood sugar level), will need the level of insulin in the blood to be higher than normal in order to keep blood sugar levels under control. Though this is an intelligent reaction within the body, the additional insulin may result in the ovaries producing too much testosterone which can stop ovulation.

What are the symptoms?

PCOS sufferers commonly begin to notice symptoms between their late teens and early 20s. Not all of the symptoms will occur in all sufferers, for example some women may be effected by extremely irregular periods where as others may have normal periods but excess body hair.

Similarly, symptoms can be severe in some cases and mild in others and may include one or more of the following:

• absent or infrequent periods
• acne, usually on the face
• excess body hair on the face (chin, upper lip), forearms, lower legs and around the nipples and lower abdomen (this is known as hirsutism).
• infertility - Infrequent or absent periods means rare ovulation so the chances of conception are very low.
• miscarriage -  those who suffer with PCOS usually have a raised level of a hormone know as luteinising, a hormone which is produced by the brain and affects ovary function. Women with higher levels of luteinising stand a 65 per cent increased risk of their pregnancy resorting in miscarriage compared to around 12 per cent of women who have normal luteinising levels.
• obesity and overweight – This is a common finding in women with PCOS because cells are resistant to insulin which controls sugar levels. The fight against insulin means that the cells are unable to use the sugar in the blood normally so it is stored as fat instead.
• thinning hair.

How is PCOS diagnosed?

PCOS is usually diagnosed by your GP or healthcare provider who will carry out blood tests at the correct time of cycle in order to determine whether or not you are affected.

Once the diagnosis has been made a treatment plan can then be decided upon. For some women with PCOS treatment is not actually required, for example if fertility, weight and excess body hair are not an issue. Those who do require treatment will often be offered the appropriate medication or possibly referral to a specialist doctor such as a gynaecologist who specialises in female reproductive health.

Treatment options

Despite there being no known cure for PCOS, there are a variety of treatments available which can effectively control the symptoms.

Hormone treatment:

Hormone therapy is often used by PCOS sufferers as a way of alleviating certain symptoms. In some cases, anti-male hormone drugs cyproterone acetate, spironolactone, flutamide and finasteride are used in order to block any masculine effects such as growth of unwanted hair, acne and high testosterone levels.

Hormone treatments will also help to control irregular or absent periods and the contraceptive pill or progestogen only pill may be suggested as a way of inducing regular periods.

Diabetes drugs:

Metformin, a drug commonly used by diabetes sufferers has been found to effectively increase ovulation within some women who suffer from PCOS. Additionally, experts also believe it may reduce health risks linked to insulin resistance and the effect of abnormal hormone levels.

Vaniqa cream:

This cream slows down the growth of unwanted facial hair by blocking the action of an enzyme found in hair follicles which is needed for it to grow.

This product does not remove hair or cure unwanted facial hair, so it is most effective when used alongside a hair-removal product.

Clomifene:

This is a fertility drug which is capable of stimulating the ovaries if you are not ovulating.

Surgery:

If the suggested medications have been unsuccessful in alleviating some of the symptoms then sufferers can undergo a minor surgical procedure known as laparoscopic ovarian drilling (LOD). Whilst the patient is under general anaesthetic,a small incision will be made in the lower abdomen so that a long telescope called a laparoscope can be passed through the abdomen. The ovaries will then be treated using either heat or a laser, both of which are intended to destroy the tissue which is producing the male hormones.

Nutrition:

Weight gain is one of the most common side effects of PCOS, and as generally accepted science shows, one of the safest and most successful options for weight-loss is to adapt our diet and eating patterns.

Whilst it is essential that PCOS sufferers seek professional medical advice and treatment for the condition, a nutritionist could provide individuals with additional support if they are struggling to manage their diet independently.

As well as possibly contributing to the alleviation of certain symptoms which are worsened by excess weight, weight-loss and a healthy and nutritious diet will also help to reduce a women’s risk of developing diabetes and heart disease as well as boosting overall health and well-being.

A nutritionist certainly won’t be able to cure PCOS, but what they may be able to do is provide you with advice about simple changes to eating and exercise patterns, which if implemented may contribute to the alleviation of certain symptoms and overall management of the condition.

Past nutritional approaches to treating the condition have involved the implementation of specific diets – though concrete evidence to support their efficacy is currently lacking. However, in some cases women have found success in replacing carbohydrates with whole grains, fruit and vegetables in a bid to reduce insulin response.

In addition to making dietary adjustments, an additional essential factor in weight management is physical activity. Whilst exercising does support weight-loss, it also brings about additional benefits such as improving the body's use of insulin and is an important component of any balanced nutrition programme.

If you are considering integrating nutrition as part of your PCOS management then before you do so it is important that you consult your healthcare provider, who will provide you with professional advice about the best treatment options for your particular circumstances.

Whilst some individuals will feel comfortable devising their own nutrition and fitness programme, those who feel they don't possess the necessary knowledge and experience to do so may benefit from consulting a qualified nutritionist.

If you do decide to seek professional support then you can usually expect your practitioner to begin by gathering information about your current diet and lifestyle so that they can build a realistic nutrition programme which is unique to you and your circumstances. This may involve you providing a food diary, which is essentially a record of everything you have eaten and drunk over a certain time period with details of yours moods and menstrual cycle included.

At this early stage you will also have the opportunity to discuss any dietary requirements or additional health conditions which your practitioner will need to take into consideration when formulating your PCOS diet.

After overviewing the information a nutritionist will usually put together an achievable nutrition programme which may include food plans, food and supplement suggestions, lifestyle changes and an exercise regime.

Bear in mind that a nutritionist is not just there to give you a kickstart to weight loss, but also to monitor your progress and to provide ongoing motivation, support and advice. In addition to this, a nutrition programme is intended to be indefinite, and the changes made should be able to be integrated into daily life so that they become 'normal'.

All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional. Whilst some people have benefited from nutritional therapy, no claims can be made to treat, cure or heal specific conditions, and we strongly advise individuals with any health problem to seek independent medical advice from their GP before considering nutritional therapy.