The function of ovaries in the female is to store the supply of eggs and then to release an egg to make it available for fertilisation. Ovaries also produce oestrogen, progesterone and small quantities of the male hormone testosterone. As is discussed above in detail, ovulation occurs normally on a regular cyclical basis approximately once a month. The egg matures in a follicle or cyst in the ovary before ovulation occurs. Although normally only one egg is released during each cycle, several follicles start to develop initially, with the most mature egg finally being shed at ovulation.
However, in PCOS, several follicles do start to develop but none develops enough to reach maturity. Therefore, sometimes, no eggs are released. No ovulation takes place in these cycles - anovulation. Hormonal problems also occur with raised levels of testosterone being produced. LH levels can also to elevated.
Symptoms of PCOS
Causes of PCOS
The exact cause of PCOS is still not fully understood. However, there does seem to be a genetic component to this condition as it can run in families.
The role of insulin and insulin resistance is described above. This seems to be an important factor in PCOS, particularly in women who are overweight, although thin women can also have PCOS. The lack of response to insulin causes an elevation in insulin levels. This in turn causes the ovaries to produce more testosterone. Together, the elevated levels of these two hormones interferes with the maturation process of the follicles, leading to a failure in ovulation. Many of the symptoms listed above are caused by the excess of testosterone.
The above situation is compounded by being overweight as having excess fat causes a further increase in insulin production. But, excess insulin leads to being overweight and therefore, women who are overweight and have PCOS can find that losing weight is a particular struggle.
Diagnosing PCOS
Diagnosis of PCOS is usually based on the following findings;
The symptoms of PCOS as listed above
Ultrasound scan findings: the ovaries appear enlarged, with multiple cysts
Blood tests: such as testosterone and LH levels.
The Treatment of PCOS
1. Weight loss: although this can be difficult, losing weight can greatly affect the symptoms of PCOS. As fat is lost, insulin levels start to decline as an excess is no longer required. This in turn causes the level of testosterone to fall also, thereby improving the chances of ovulation. Many of the "male" symptoms listed above will also then start to reverse as testosterone levels decline.
2. Anti-androgenic (anti-male hormone) drugs can be used to reverse the male type symptoms. Examples of these drugs include cyproterone acetate (found in Dianette or Diane 35 and other drugs) or spironolactone.
3. Combined oral contraceptive pill (COC): this can be used to induce regular (though artificial) periods and therefore reduce the risks of endometrial cancer. Sometimes, though less often, the progesterone only pill (POP) may be used but the results are usually less predictable.
4. Metformin: this drug is usually used to treat Diabetes Mellitus Type 2. It works by reducing insulin resistance in these diabetic patients. It therefore seems to have an increasing role in the treatment of PCOS for the same reason.
5. Clomiphene: for the purposes of conception, clomiphene may be used to induce ovulation by stimulating the ovaries.