POLYCYSTIC Ovary Syndrome, usually abbreviated to PCOS, is one of the most common hormonal problems among women, with some estimating it to affect one in five females in the UK. However this figure may be as high as one in two women of South Asian origin.

It is a condition which not only impacts on fertility, but also has implications for your physical health, specifically diabetes and heart disease, as well as affecting mood and psychological wellbeing.

Most women have two ovaries. Within these, follicles contain immature eggs, one or more of which are released every month during ovulation. In PCOS, there are excess follicles, but the eggs aren’t released as regularly, or sometimes not at all. This is noticed as irregular periods, or no periods at all.

Sufferers may also notice increased facial hair, acne and male pattern hair thinning. This is due to increased levels of the male hormone testosterone.

Many women with PCOS will struggle to lose weight. In obesity, insulin; the hormone needed to control blood sugars, is less effective. Rising levels of blood sugar therefore stimulate the pancreas to produce even more insulin. This unfortunately promotes appetite and weight gain, higher levels of testosterone, and irregular periods. If your sugars remain uncontrolled, you will become diabetic.

We know that genetically South Asians are more likely to become insulin resistant; this being the stage before actual diabetes. Furthermore this happens at a lower body mass index than in the Caucasian population. Hence the polycystic ovary syndrome may be more severe in South Asians both in terms of struggling to conceive, as well as the distressing issue of excess facial and body hair.

Obesity and struggling to conceive are both strongly linked with low mood and depression.

If you recognise any of these symptoms in yourself, the first thing to do is to see your routine GP. The gold standard for diagnosis is an ultrasound of the abdomen and pelvis, which will show the appearance of your ovaries. Even if you have polycystic ovaries, the diagnosis of PCOS is only made if you have this plus the physical issues described above.

Although this may sound bleak, PCOS is not an absolute bar to becoming pregnant, and both your fertility and sensitivity to insulin will improve with weight loss. This means long term dietary changes as well as regular exercise 3-5 times a week, aiming to get your Body Mass Index (BMI) into the normal range.

Women struggling to conceive will be referred to a fertility specialist and the options available range from hormonal tablets through to a procedure called ovarian drilling, which damages the tissue in the ovaries producing testosterone.

If your sugars remain high, it is likely that you will be put on medications for diabetes, as well as being advised on lifestyle measures.

If you have less than three periods a year, the lining of the womb, the endometrium, does not shed and may thicken, with a small increase in the risk of endometrial cancer. If you are not trying to conceive, you may be offered hormonal contraceptives to try and increase the number of periods you have. PCOS is not linked with an increased risk of breast or ovarian cancer.

Finally, research shows that “medication alone is not superior to weight loss and exercise”. The expert body on these matters, the Royal College of Obstetricians & Gynaecologists advises; “Many women with PCOS successfully manage their symptoms and long-term health risks without medical intervention… by eating a healthy diet, exercising regularly and maintaining a healthy lifestyle.

“Polycystic Ovary Syndrome is not an absolute bar to becoming pregnant, and both your fertility and sensitivity to insulin will improve with weight loss.”

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Dr Z Uddin


General Practitioner