Polycystic Ovarian Syndrome – PCOS
Irregular periods are often caused by Polycystic Ovarian Syndrome, or PCOS.
PCOS is the most common hormonal problem in women of childbearing age. It can affect fertility, metabolism, and later in life, increase the risk of heart attacks and stroke. Many women also struggle with depression, anxiety and low self-esteem.
PCOS develops when high levels of testosterone and insulin resistance cause the hormonal signaling between the pituitary gland in the brain and the ovaries to get muddled up.
Cysts on the ovaries – POCS
The follicles in the ovary don’t develop properly and accumulate on the surface of the ovary – hence the ‘poly’, or many, cysts on the ovaries.
High levels of insulin further muddle the hormonal messages. So, an egg is not released from the ovary as it should be each month.
An egg needs to be released from the ovary to trigger the hormonal cascade that results in a period.
It’s a bit like dominoes – one signal needs to trigger another in correct sequence for a period to occur. If the hormonal signals are not in correct sequence, the result is irregular periods, pimples and difficulty losing weight.
PCOS should be considered in any woman whose periods are shorter than 21 days, or longer than 35 days apart.
It’s OK not to have a period if you are ‘tricycling’ the pill (skipping the placebo or sugar pills each month), or using progesterone based hormonal contraception.
But, if the lining of the uterus builds up each month (your period and what would be the placenta if you were pregnant), doesn’t get the appropriate signal to come away…then it can cause problems with endometrial hyperplasia.
Endometrial hyperplasia, or excessive thickening of this lining can lead to cancer of the endometrium. Being a smoker and being overweight increases the risk further.
Diagnosis of Polycystic Ovarian Syndrome
Doctors use the ‘Rotterdam Criteria’ to diagnose PCOS. A woman should have 2 of the following 3 criteria for a diagnosis of PCOS:
- Periods < 21 days apart or > 35 days;
- Excess facial or body hair and acne (particularly around the chin and cheeks) OR elevated testosterone on blood tests;
- Multiple cysts on the ovaries as seen on a pelvic ultrasound, and;
- Other important hormonal problems (such as low thyroid hormone levels) have been excluded.
POCS and Pregnancy
But PCOS is not just about irregular periods, pimples and difficulty losing weight. Women with PCOS may need fertility treatment to become pregnant. They are also more likely to have complications in pregnancy such as pre-eclampsia (high blood pressure), premature delivery and gestational diabetes.
Later in life, women with PCOS have increased risk factors for heart disease, stroke and obstructive sleep apnoea.
But, take heart ladies! There is much that can be done.
- Weight loss and exercise improve ovulatory function, blood pressure control and reduce insulin resistance. 
- Metformin, a medication used in the treatment of diabetes can help to reduce weight gain and restore normal ovarian function by increasing insulin sensitivity.
- Anti-testosterone medications such as spironolactone and cyproterone acetate reduce the production of testosterone and block its action in the body (‘bye, ‘bye upper lip fuzz and pimples).
- For women not wanting a pregnancy, the combined oral contraceptive pill regulates periods and also reduces the amount of testosterone available for use in the body.
- For women wanting a pregnancy, there are a number of medications such as clomiphene that can stimulation ovarian function without needing to resort to IVF.
A doctor with experience in managing hormonal concerns will be able to work with you to optimise your health and wellbeing.
If you think that you might have Polycystic Ovarian Syndrome, PCOS, and want to take active steps to look after yourself, make an appointment with Dr Tonia Mezzini today.
For more information on PCOS go to: www.jeanhailes.org.au
Dr Tonia Mezzini is known for offering the best possible advice and treatment options for a person’s sexual health care needs. In particular, she cares for patients with:
• Menopause and hormonal concerns
• Breast cancer prevention strategies
• Chronic pelvic pain in men and women
• Painful periods and endometriosis
• Vulval pain syndromes and vulval skin conditions
• Low libido and pain with intercourse
• Polycystic Ovarian Syndrome
• Gender-affirming hormone therapy
• Complex contraceptive choices
• Sexually transmitted infections such as recurrent genital herpes
• Recurrent bacterial vaginosis
• Recurrent thrush
 Teede HJ, Misso ML, Deeks AA, et al. Assessment and management of of PCOS: summary of an evidence-based guideline. MJA 2011;195(6):S65-112.
 Moran LJ, Brown WJ, McNaughton SA, et al. Weight management practices associated with PCOS and their relationship with diet and physical activity. Hum Reprod 2017 Mar 1;32(3):669-678.