Polycystic Ovary Syndrome (or PCOS), is the commonest endocrine abnormality seen in reproductive aged women, with an estimated 400,000 women in Australia being affected by it. The overall prevalence in Australia is estimated between 6-9% but PCOS is more common in obese women with a prevalence of 28%, whereas only 5% of lean women suffer from it.
Untreated, PCOS may have significant or even serious health consequences. These consequences include obesity, psychological problems, (poor self-esteem, negative body image, depression, anxiety), excessive body hair, loss of scalp hair, infertility, insulin resistance, metabolic syndrome, pre-diabetes, type 2 diabetes and potentially – cardiovascular disease.
Most patients with PCOS have ovarian dysfunction, and hormonal imbalance. This leads to infrequent periods or even total lack of periods. However, it is important to note that PCOS is not the only cause of failure to menstruate, and other causes must always be excluded.
The menstrual irregularity may be abolished by use of the oral contraceptive pill, but this does not correct the underlying endocrine abnormality and does not prevent the other serious consequences arising from untreated PCOS.
The hormonal imbalance seen in PCOS may also cause heavy menstrual periods, also known as menorrhagia, and this can at times be debilitating and/or embarrassing.
Excessive male hormone production (androgen excess) is commonly seen in women with PCOS. This leads to acne, excessive body hair (hirsutism), male pattern hair loss involving the scalp (androgenic alopecia), and in some women a muscular physique.
PCOS is a common cause of hirsutism in women. Approximately 60-80% of women with PCOS have some degree of hirsutism. The variability in this percentage relates to race and the degree of obesity.
Obesity increases the production of male hormones (androgens), promotes excessive body hair growth, increases infertility and pregnancy complications. So it is essential to treat the underlying causes of the obesity.
Male pattern hair loss, while it does occur in PCOS, is not frequent, as it usually requires a familial predisposition.
Acne affects one third of patients diagnosed with PCOS.
Insulin resistance affects 60-80% of women with PCOS. This leads to a metabolic disturbance with an impaired glucose tolerance, prediabetes, and a 4-7 fold increased risk of developing type 2 diabetes mellitus. This increased risk of diabetes in PCOS, occurs in both the lean women and the obese. Insulin resistance may also result in massive weight gain and fatty infiltration of the liver (fatty liver).
Women with PCOS have an increased prevalence of the risk factors for cardiovascular disease. These include elevated blood lipids, elevated homocysteine levels, impaired fibrinolysis, (anti-bloodclotting activity), increased inflammation, increased oxidative stress and elevated white blood cell counts.
Early markers for atherosclerosis (hardening of the arteries) are also more advanced in PCOS and are associated with insulin resistance and obesity.
In view of the significant health consequences arising from untreated PCOS, it is imperative that women be correctly diagnosed when they present with menstrual irregularity, acne, obesity, infertility, male pattern baldness, or excessive body hair. Treatment must be directed at restoring normal hormonal function and this in turn results in weight loss, a regular menstrual cycle, resolution of acne and for most women, correction of the excessive body hair growth and restoration of fertility.
Cardiovascular risk factors, insulin resistance and obesity must also be addressed. This involves diet and lifestyle changes
Fortunately, more and more women are achieving normalisation of their hormonal function with restoration of their menstrual cycles and fertility, along with lowering of their risk for diabetes and cardiovascular disease.