What Is Polycystic Ovary Syndrome (PCOS) And How Is It Managed? 

During ovulation, an egg is released from the ovaries to travel down the fallopian tubes to the uterus, in preparation for fertilisation. The eggs are released from the ovaries through small fluid-filled sacs, called follicles. 

As the egg matures, the follicles grow and eventually burst open, releasing the egg. Sometimes, given a hormonal imbalance, the follicles do not open. They keep growing to form a fluid-filled cyst. 

There can be multiple cysts on the ovaries at the same time and cysts can grow large and become painful. 

Polycystic ovary syndrome (PCOS) is when there are multiple fluid filled cysts present on the ovaries, and ovulation is not happening as it normally would. The condition is often accompanied by irregular menstrual periods, fertility issues, excessive hair growth, acne, and weight gain.

An estimated 1 in 10 women will experience PCOS.

The Hormones Associated With Ovulation

The release of an egg is mediated by a delicate balance of hormones, namely:  follicle-stimulating hormone (FSH), luteinizing hormone (LH) (which are both produced by the pituitary gland in the brain) and estrogen.  

During the menstrual cycle, FSH stimulates the growth and development of the follicles. As the follicles mature, they produce increasing levels of estrogen. Estrogen prepares the uterus for a potential pregnancy.   

As estrogen levels rise, it triggers a surge of luteinizing hormone (LH), which usually occurs around the middle of the menstrual cycle. The LH surge triggers the final maturation of the dominant follicle and the release of a mature egg from the ovary. This is ovulation.

What Causes Polycystic Ovary Syndrome?

The causes of polycystic ovary syndrome are still being researched, but studies have shown that genetics, health conditions and hormonal imbalances might play a role. 

Women with PCOS often have higher levels of androgen hormones. Higher than normal levels of androgens in women can prevent ovulation.

What Are The Symptoms Of PCOS?

Women with PCOS have dysfunctional menstrual cycles which can result in problems with their overall health and appearance, especially when left untreated. Symptoms associated with PCOS can include:

• Irregular menstrual cycle
• Menorrhagia (heavy periods)
• Infertility - due to anovulation
• Development of cysts in the ovaries that are visible on an ultrasound
• Hirsutism - too much hair on the face, chin, or parts of the body. 
• Acne on the face, chest, and upper back
• Hair loss
• Weight gain or difficulty losing weight
• Darkening of skin
• Skin tags in the armpits or neck area 

How Is PCOS Diagnosed?

To help diagnose PCOS your doctor may discuss your medical history, do a physical exam and conduct a series of tests.

During a physical exam your doctor will measure your blood pressure, body mass index (BMI), and waist size. They will also look for acne and extra hair on your face, chest or back. Other problems such as hair loss and an enlarged thyroid gland will be noted.

During a pelvic exam your doctor may look for signs of extra male hormones such as an enlarged clitoris. Your ovaries will be checked to see if they are enlarged or swollen.

A pelvic ultrasound test is a very effective diagnostic tool. It can be used to examine your ovaries for cysts and check the lining of your uterus (your endometrium). Multiple cysts on one or both ovaries is a common sign of PCOS.

Blood tests can check your androgen hormone levels. Your doctor might also check for other common health problems such as diabetes or thyroid disease.

Health Problems Associated with PCOS

Hormone imbalances can affect a woman's health in many ways. Women with PCOS are more likely to develop certain serious health problems, including:

• High blood pressure
• Unhealthy cholesterol
• Sleep apnea
• Depression and anxiety
• Endometrial cancer
• High Insulin levels

How Is PCOS Treated?

There is no cure for PCOS, but the symptoms can be managed. 

Losing weight and eating a healthy, balanced diet can improve some of the symptoms of PCOS. 

Excessive hair growth can be treated with medication or manual management. Contraceptives, including the pill, patch, injection, vaginal ring, and hormone intrauterine device (IUD), can make your menstrual cycle more regular, improve acne and reduce extra facial hair. Most women with PCOS can conceive, given timely and appropriate fertility treatment.