The term ‘polycystic ovaries’ describes the ovaries, as seen on the ultrasound scan above. Many women have ovaries that are polycystic, but do not have any of the other symptoms or hormone findings as described previously. Overall, around 20% of women of the general population have ovaries with this appearance, and what isn’t known yet from current research is whether this is one end of a long scale including the full polycystic ovary syndrome or a sign that symptoms are more likely to develop in the future.
Diabetes, insulin & long-term risks
In recent years it has become clear that PCOS is closely related to a problem with insulin. Insulin is a hormone released from the pancreas after a meal and it allows the organs of the body to take up energy in the form of glucose. In PCOS there is a ‘resistance’ of cells in the body to insulin, so the pancreas makes more insulin to try and compensate. The excessively high levels of insulin have an effect on the ovary, preventing ovulation and causing a rise in androgen (testosterone) levels.
One study found that 30% of slim women with PCOS have insulin resistance, however it affects as many as 75% of those who are overweight. This explains why overweight women with PCOS are more likely to suffer with excessive hairiness and infertility related to not ovulating.
Longer-term risks of PCOS
The long-term risks of PCOS are related to both the insulin problem and the high androgen levels. High levels of insulin are associated with an increased risk of developing type II diabetes which, if it develops, generally means strict diet control or possibly tablet medication. 25-35% of overweight PCOS women show signs of this by their 30′s and it probably becomes more common in the 40′s and beyond.
The hormone changes described increase the chance of developing high blood pressure and high cholesterol levels, both of which can lead to a greater risk of heart disease.
Irregular or infrequent periods over a long period of time lead to an increased risk of cancer of the lining of the uterus (endometrial cancer). This is, in part, due to high levels of the hormone oestrogen, which over-stimulates the lining of the uterus. Absence of ovulation, and the resulting progesterone deficiency, also contributes to this risk.
Control of irregular periods
As mentioned previously, irregular and heavy periods can occur due to problems with ovulation. Whilst it would seem that restarting ovulation would be the best treatment, this is generally reserved for when a pregnancy is desired. The ovarian stimulation drugs to do this have other side effects, making their long-term use inappropriate.
Excess weight is a cause of menstrual problems in both women with and those without PCOS. Extra oestrogen is made in fat tissues and this interferes with ovulation and leads to over-stimulation of the lining of the uterus and heavier periods. Weight reduction will improve cycle control and reduce the heaviness of menstrual flow.
Periods may be controlled by the use of the contraceptive pill, which is most suitable for women under the age of 35 who also require a good form of contraception. The other type of drug used is a progesterone-like hormone. Progesterone is the main hormone of the second half of the menstrual cycle, maintaining its length and helping reduce the heaviness. Progestagens are taken as tablets in a cyclical way, for example between days 12-26, the exact type and timing depending upon the woman’s individual cycle problem.
Some women have no periods at all, and either the contraceptive pill or cyclical progestagens are advisable to avoid the risk of endometrial cancer. Around 6 periods per year is adequate to protect against this.