Having polycystic ovaries does not necessarily mean that you have PCOS. Equally it is possible to be diagnosed with PCOS, even if you do not have cysts on your ovaries.

PCOS is thought to affect between 10 and 15 per cent ⁽¹⁾ of women, though many may not realise they have the condition, as symptoms vary enormously from one woman to another.

Up to 75 per cent of women with polycystic ovaries are thought to have PCOS, which means they may have other symptoms.

What are the main symptoms of PCOS?

If you do not ovulate then you do not have a period, so one of the classic symptoms of PCOS is light, irregular or absent periods. Period problems are a symptom in about 70 per cent ⁽²⁾ of women with PCOS.

If you do not ovulate - or if you only ovulate now and then - your fertility is also affected, which means you may not be able to get pregnant easily.

Other symptoms include:

• Oily skin or facial acne
• Increased facial or body hair (hirsuitism)
• Thinning scalp hair or hair loss (alopecia)
• Weight problems (between 40 and 50 per cent ⁽³⁾ of women with PCOS are overweight or obese)

Not all women with PCOS have all of these symptoms and some may have far more severe symptoms than others.

The symptoms of PCOS usually start around the late teens or early 20s ⁽³⁾ and change as you get older. For example middle-aged women with PCOS may have less acne but more problems with excess hair.

What causes PCOS?

Doctors are unsure what causes PCOS, but one or more hormone imbalances are thought to cause the condition.

One of the hormones in question is called luteinising hormone (LH), a hormone produced by the pituitary gland in the brain that stimulates the ovaries to produce and release an egg. Almost forty per cent ⁽⁴⁾ of women with PCOS have high levels of LH.

The hormone insulin is believed to be connected to PCOS, since many women with the condition suffer from insulin resistance. This happens when your body becomes resistant to normal amounts of insulin, so your pancreas has to produce more to keep your blood sugar levels normal.

A high amount of insulin in the blood may stimulate the ovaries to produce too much testosterone, a hormone classed as an androgen (male hormone) since men produce ten times as much of it as women. Many women with PCOS have slightly higher than normal levels of the male hormone testosterone. Along with raised insulin, this excess testosterone may interfere with the development of follicles in the ovaries.

Being overweight or obese, meanwhile, may not be a direct cause of PCOS, but carrying excess fat may increase your risk of developing the condition because it is linked to insulin resistance.

Am I at risk?

Although doctors are unsure what causes PCOS, they do think that there may be hereditary factors. You may be more at risk if a close female relative has been diagnosed with PCOS.

PCOS may be inherited from your father's rather than your mother's side of the family, however, if the men in your family have a tendency to go bald early. This could also be a sign that your risk of PCOS may be higher ⁽⁵⁾.

You may also be more likely to develop PCOS if Type 2 diabetes (non-insulin dependent diabetes) runs in your family ⁽⁵⁾.

Can the cysts lead to cancer?

The cysts in PCOS are benign, which means they are not harmful and do not lead to cancer.

What other health risks are there?

There is an increased risk of developing endometrial cancer (cancer of the lining of the womb), if you have fewer than four periods a year.

Between 10 and 20 per cent ⁽⁶⁾ of women with PCOS develop diabetes at some point in their lives.

Long-term insulin resistance may also increase your risk for stroke and heart disease later in life, and you may be more likely to suffer from high blood pressure and high cholesterol (regular blood sugar, blood pressure and cholesterol tests are recommended for women with PCOS).

How is PCOS diagnosed?

If you have one or more of the symptoms of PCOS, your doctor may recommend an ultrasound examination to check whether there are any cysts on your ovaries, as well as blood tests to check your hormone levels.

What treatments are there?

There is no treatment or cure for PCOS as such, but the symptoms can be treated and controlled:

• You may be advised to take the contraceptive pill to regulate your periods and reduce the level of testosterone in your blood. Other drugs, such as cyproterone and spironolactone, can also be used to block the production of testosterone
• If you are having fertility problems, you could take an ovary-stimulating medication called clomiphene, which triggers ovulation
• Gonadotrophin hormone injections can also help stimulate the ovaries to produce growing follicles
• Surgery called ovarian diathermy is another option, as it can help restart ovulation and reduce the production of male hormones. However, the effect may be only temporary
• Some women with PCOS are given a drug called metformin, which was developed as a treatment for Type 2 diabetes. The drug helps reduce insulin levels in the blood, which in turn could help reduce testosterone production

Can I control symptoms myself?

Losing excess weight can help reduce PCOS symptoms, as well as reduce your risk of diabetes and heart disease. Even if you lost between five and ten per cent of your body weight, it could make a big difference.

If you have PCOS, however, losing weight can be particularly difficult, so ask your doctor for advice or for a referral to a dietician. A balanced, low-fat, low-sugar diet as well as regular exercise can reduce your symptoms as well as keep your weight down.

If you smoke, giving up cigarettes will help too, since smoking may affect your fertility and increases your risk of heart disease.

Infolinks:

• Verity (PCOS self-help group)
• PCOS-UK