Polycystic Ovary Syndrome: How Can It Affect You?

By Dr. Beh Suan Tiong
Senior Obstetrician and Gynaecologist
MBBS (S'pore), MRCOG (UK), FAMS

Polycystic ovary syndrome (PCOS) is a relatively common hormonal disorder and is estimated to affect about 5% of females in the reproductive age group. It is associated with three important characteristics:


1.      Problem with ovulation (releasing eggs from the ovaries), as a result, menstrual disorder.

2.      Evidence of the effect of excessive androgen (male hormones)

3.      Ultrasound features of polycystic ovarian disease

The presence of any two of the above characteristics suggest the diagnosis.

This problem is usually associated with many hidden abnormal, hormonal and metabolic changes in the body that are not yet fully understood.

Symptoms

The presence of the following is suggestive that you may have PCOS:

1.      Infrequent and irregular periods

2.      Difficulty in conceiving

3.      Excessive oily skin, acne and hair growth

4.      Weight gain

The first two symptoms are the typical reasons why patients turn up to visit a gynaecologist while the last two may lead them to consult a dermatologist, family doctor or even an endocrinologist.

Who can be affected?

This disease can strike early, starting from one’s teenage years or later in life. A typical patient tends to be heavier in weight with infrequent menses with or without acne. It is not unusual for an adolescent or teenager who just started menstruate, to have rather infrequent (once every few months) periods. However, this should become more regular after 2 to 3 years. If the infrequent periods persist, it is advisable to seek medical opinion. If a patient is trying to conceive, it may take a longer time to succeed or even not at all, hence, leading many women to visit a gynaecologist for the first time in their lives.

Although the above describes the usual manifestation, there is a group of patients who are of normal weight with only mildly disturbed menses. This latter group usually needs blood test and/or ultrasound scans to help in the diagnosis.

The Hidden Risk

This seemingly ‘quiet’ disease may be associated with a host of medical problems that affect a woman’s entire life. Firstly the menses is less frequent, with intervals of 6 weeks or more, but some may take a few months or even a years. This is due to the fact that ovulation does not take place regularly. It is because of the infrequent ovulation, infertility or problems in conceiving become another issue for women who wish to start a family. There may also be an increased risk of miscarriage. Due to the metabolic problems associated with this hormonal disorder, the patient is more prone to develop diabetes, high cholesterol or lipids and together predispose her to higher risk of cardiovascular diseases like coronary artery disease. It is exacerbated if obesity is present as well. A further hidden danger is the risk of developing endometrial cancer in patients who do not menstruate regularly for a long period of time. Endometrium refers to the inner lining of the womb which normally sheds off during menses. When menstruation fails to happen, this lining will continue to grow and if the situation is allowed to continue for long periods of times, the cells in the lining have a higher chance of turning into cancer.

What can be done?

Understanding the existing and potential problems is important to both the patient and doctor so that appropriate treatments and/or preventive measures can be advised.

Lifestyle changes

Many patients are overweight and both exercise and dietary control are important lifestyle changes that they should adopt to lose weight effectively and to sustain it. Losing sufficient weight helps in their ovulation problems and leads to better menstrual control, which indirectly tackles fertility issues. Weight loss, as commonly known, helps in combating diabetes and heart diseases as well.

Regulation of menses

If one’s menses is very irregular, it is better to take some medication to help due to the danger of developing cancer. This is commonly in the form of oral contraceptive pills or progestins. Oral contraceptive pills that contain cyprosterone acetate or disperidone are particularly helpful as they may reduce the excessive androgen effect, eg, improve acne.

Fertility enhancement

Patients who have trouble conceiving may need medication to help them to ovulate. The treatments can range from simple weight loss programs and oral medications to expensive injections and surgery, eg, laparoscopic ovarian drilling. In-vitro fertilisation may be needed as well in some situations.

Preventive measures

As there is a greater risk of developing diabetes, patients should be tested for it, e.g. going through an oral glucose tolerance test when they are older, especially if weight is also an issue. There are some suggestions of the use of metformin, an old but useful medication for diabetes, and in cases of PCOS, it helps the body to increase its sensitivity to insulin. It may help in ovulation as well, although that remains controversial.

Conclusion

It is important to recognise PCOS and seek early diagnosis and treatment. Because of its long-term health risks, attention should be also paid on preventive management to minimize the potential harm. This will benefit the patient’s reproductive health.