Polycystic Ovary Syndrome
Polycystic Ovary Syndrome (PCOS) is a condition affecting women caused by an underlying hormone imbalance.
It was first noted in 1935 by two doctors, Stein and Leventhal (this explains why it was originally called the Stein-Leventhal syndrome). The three main things you may experience if you have PCOS are irregular periods (or complete lack of periods), high levels of androgens (‘male’ hormones) and polycystic ovaries.
Polycystic ovaries are very common and thought to affect around 20 per cent of women. If you have polycystic ovaries, you have many small cysts on your ovaries (around twice as many as in normal ovaries) with the cysts usually being around 8mm in size. The cysts are follicles that contain eggs. But because they haven’t developed properly owing to a hormone imbalance, the follicles cannot release an egg –which means ovulation doesn’t take place.
However, you may be diagnosed with PCOS even if you don’t have polycystic ovaries, as – despite the name of the syndrome – polycystic ovaries are just one of the symptoms you may experience. To be diagnosed with PCOS you have to be affected by two out of three of the main symptoms, which could be irregular periods and excess androgens but not polycystic ovaries.
According to the PCOS charity Verity, PCOS is also very common. And while it was originally thought to affect 10 per cent of women, recently it’s been found to affect about twice that number.
In addition to the three main features of PCOS, you may experience any of the following:
Difficulties getting pregnant
Excess facial or body hair
Alopecia (thinning hair or hair loss)
Oily skin or acne
Depression and mood changes
What causes PCOS?
Experts don’t know exactly why some women have PCOS or why they have the hormone imbalances thought to cause it.
Many women with PCOS also have a condition known as insulin resistance, where they produce excess levels of insulin because their bodies are resistant to its effects. Because they produce too much insulin, it makes their ovaries produce high levels of testosterone (a ‘male’ hormone). High levels of insulin can also lead to weight gain. High levels of testosterone produced by the ovaries, on the other hand, can lead to some of the other symptoms such as alopecia, excess/thinning hair and acne.
Meanwhile, some women have abnormal levels of hormones that control the menstrual cycle, including high levels of luteinising hormone (the hormone that stimulates ovulation) and low levels of other hormones such as follicle stimulating hormone (which develops the follicles that release eggs), progesterone and sex-binding hormone globulin (SHGB, a protein in the blood that regulates the body’s testosterone levels).
Some women with PCOS also have raised levels of a hormone called prolactin, which stimulates the production of breast milk during pregnancy.
What causes these hormonal imbalances isn’t clear, but researchers are looking at a possible genetic link, since PCOS sometimes runs in families (though it’s not usually inherited from parents). According to the PCOS charity Verity, other possible triggers for the condition are also being investigated, including diet and lifestyle.
PCOS and health risks
If you have PCOS, your risk for developing other health problems later on may also be higher than normal.
For instance, if you have PCOS with insulin resistance, your risk of developing type 2 diabetes may be increased and you may also have a higher risk of developing diabetes in pregnancy (gestational diabetes). The PCOS charity Verity claims women with PCOS who are overweight are more likely to develop type 2 diabetes, though the condition can also sometimes affect women who don’t have weight problems.
Other pregnancy complications linked with PCOS include a higher chance of having a premature baby and developing high blood pressure in pregnancy (pre-eclampsia). If you have PCOS and are pregnant, your GP or midwife should check you regularly for both gestational diabetes and pre-eclampsia.
If you’re affected by insulin resistance, it may also increase your risk of developing heart disease or stroke in later life. That’s thought to be because PCOS is linked to problems with high cholesterol and high blood pressure.
However, while having PCOS may increase your likelihood of developing heart disease and stroke risk factors, there isn’t any real evidence to suggest women with PCOS have more heart attacks than those who don’t have PCOS.
If you have PCOS and are overweight or have a family history of heart disease or stroke, your GP should advise you about reducing your risk by eating healthily and taking regular exercise to help prevent problems later on.
Meanwhile, if you have very infrequent periods (fewer than four a year) or no periods at all, your risk for developing endometrial cancer (cancer of the lining of the uterus) may also be higher than average – though this risk is thought to be small and many believe it can be reduced or even prevented by using treatments such as the contraceptive pill, progestogen tablets or a progestogen-releasing coil (IUS).
There’s also evidence that sleep apnoea – where you stop breathing for short spells while you’re asleep – is more common in women with PCOS.
Treatments for PCOS
While there’s no cure for PCOS, several treatments are available that may help treat the individual symptoms. If you have weight problems, for instance, you may be prescribed weight-loss medication such as orlistat. Or if you have high cholesterol, your GP may recommend you to take cholesterol-lowering medicines called statins.
If you have few or no periods, you may be advised to use hormone treatments such as the contraceptive pill or to take occasional progestogen tablets to help make your periods more normal. These will also help to reduce your risk of developing endometrial cancer.
Alternatively you may be advised to have an IUS (intrauterine system) fitted. This is also a hormone-based contraception method that can help reduce your risk of developing endometrial cancer in later life, but it’s less likely to induce regular periods.
According to the NHS, most women with PCOS can get pregnant with treatment. This may include taking clomifene tablets that help make you ovulate, or a medication used to treat type 2 diabetes called metformin. This also helps to stimulate ovulation and regulate the menstrual cycle, while lowering the risk of miscarriage.
However, metformin isn’t currently a licensed treatment for PCOS in the UK. But as it helps make the body more sensitive to insulin, specialists sometimes sometimes prescribe for women with PCOS who are also affected by insulin resistance.
Another medicine that’s sometimes used to stimulate ovulation – but, like metformin, isn’t officially licensed as a treatment for PCOS – is letrozole, which is more commonly used for treating breast cancer.
If medication doesn’t help, you may be offered IVF treatment or injections of gonadotrophins, which stimulate the ovaries. However, there’s a risk with both of these treatments that you may have a multiple pregnancy (usually twins).
Surgery can also be an option for PCOS-related fertility problems. The operation in question is a minor procedure called laparoscopic ovarian drilling, where tissues that produces androgens on your ovaries are destroyed by heat or a laser.
Excess or thinning hair
There are various types of medicines used to treat excessive hair growth as well as alopecia (hair loss). You may, for instance, be prescribed an oral contraceptive or another drug that blocks the effects of androgens or stops your ovaries from producing androgens (these drugs may also used to treat acne). According to the NHS, laser removal of facial hair may also be available in some parts of the country.
PCOS and lifestyle
Women with PCOS are often advised to make lifestyle changes to help relieve their symptoms and to reduce their risk of developing long-term health problems – especially if they’re overweight (according to the NHS, a loss of just five per cent of body weight can lead to a significant improvement in PCOS symptoms). Giving up smoking is also a priority, as smoking increases your risk for heart disease and stroke.
Eating a healthy diet and taking part in regular physical activity are both essential if you have PCOS, mostly because they help with weight loss, weight maintenance and insulin resistance. There is also some evidence that a healthy lifestyle – which includes diet, exercise and weight maintenance – reduces testosterone levels and improves hair growth in women with PCOS (i).
The current physical activity recommendation for adults is to take part in at least 150 minutes of moderate aerobic activity such as cycling or fast walking each week, plus strength exercises on two or more days a week that work all the major muscles. As for a healthy diet, here are some tips that may help:
Eat plenty of fibre
Aim for a minimum of five portions of fruit and veg each day plus beans and pulses such as chickpeas and lentils, all of which contain lots of fibre. If you’re not used to much fibre in your diet, introduce high-fibre foods gradually to avoid digestive problems.
Eat the right carbs
Eating lots of foods rich in refined carbohydrates and sugars puts extra pressure on your body to produce more insulin. So try to choose complex carbohydrates instead (for instance, wholemeal or whole grain versions of bread, pasta, rice and cereals rather than white versions). Eating little and often can also help keep your blood sugar levels stable, which means your body doesn’t have to produce so much insulin.
Cut down on saturated fats
Since PCOS is linked with an increased risk of high cholesterol, it may be a good idea to limit the amount of saturated fat in your diet. Instead, choose monounsaturated fats (such as olive oil) and polyunsaturated fats (including the omega-3 fatty acids found in oily fish).
Reduce your salt intake
PCOS is also linked with an increased risk of high blood pressure. A high-salt diet is known to raise blood pressure, so try to eat fewer foods with lots of salt (check food labels for salt or sodium levels, as most of the salt in our diet is found in processed foods and smoked or cured meats rather than the salt you add to food at the table). Aim for less than 6g salt a day (about one teaspoon).
Add protein to each meal
Protein has a stabilising effect on sugars released from carbohydrates into the bloodstream, so try to have some with each meal and snack. Healthy protein sources include lean meats, fish, poultry, low-fat dairy foods, beans, nuts and seeds.
Drink in moderation
Alcohol contains sugar, so stick to the recommended limit, which is 14 units a week (one unit is a small glass of wine, a single measure of spirits or half a pint of normal-strength beer).
Natural support for PCOS
Switching to a healthier lifestyle may be the most important thing you can do to help yourself if you have PCOS. But there are some natural remedies that may help too, including the following nutritional supplements:
Evening primrose oil
The seeds of the evening primrose are rich in an omega-6 fatty acid called GLA (gamma-linolenic acid). Many natural health practitioners believe GLA and other omega fatty acids support a healthy hormone balance, with some recommending it for PCOS as well as premenstrual syndrome (PMS).
Though it’s not always listed as a PCOS symptom, many women with the condition have reported they suffer from water retention (or bloating). Magnesium helps control and balance other minerals (or electrolytes) in the body, including potassium and sodium (an imbalance of potassium and sodium may lead to bloating – too much sodium and not enough potassium can make your body hold on to too much water).
Some experts – including Dr Robert Atkins (promoter of the Atkins diet) – also believe magnesium may be needed for blood sugar control, and that eating too many refined carbohydrates and sugars can make you excrete magnesium when you urinate.
Some health professionals believe PCOS may be linked with low-grade inflammation in the body (ii). This suggests taking a supplement containing plant compounds called anthocyanidins could be useful for PCOS, since anthocyanidins are thought to help block the release of prostaglandins, substances that play a key role in the generation of the inflammatory response.
Anthocyanidins are found in dark-skinned fruits including blueberries, cranberries, raspberries, blackberries and red grapes, plus some vegetables (red cabbage, red onions, aubergines etc.) and other plant extracts such as grapeseed extract.
A vitamin-like substance (also sometimes called a pseudovitamin) found in many natural sources, myo-inositol– often called simply inositol – is a carbohydrate with a molecular structure similar to that of glucose. Studies suggest taking myo-inositol and the B vitamin folic acid in therapeutic doses may help with menstrual regularity, ovulation and higher quality eggs in women with PCOS (iii).
There is also evidence to suggest myo-inositol may not only help increase fertility in women with PCOS, but it may improve insulin sensitivity too (iv).
Moran. LJ, Hutchinson. SK, Norman. RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD007506.
Deluba. AJ, Dokras. A. Is PCOS an inflammatory process? Fertil Steril. 2012 Jan;97(1):7-12.
Gerli. S, et al. Randomized, double-blind placebo-controlled trial: Effects of Myo-inositol on Ovarian Function and Metabolic Factors in Women with PCOS Eur Rev Med Pharmacol Sci. 2007 Sep-Oct;11(5):347-54.
Ciotta. L, et al. Effects of myo-inositol supplementation on oocyte's quality in PCOS patients: a double blind trial. Eur Rev Med Pharmacol Sci. 2011 May;15(5):509-14.
Constantino. D, et al. Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):105-10.
Laboureau-Soares Barbosa. S, et al. Polycystic Ovary Syndrome: Treatment With Insulin-Sensitizing Agents. 2002:63 (1), 31-35. 2.
Disclaimer: The information presented by Nature's Best The Pharmacy is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.