Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (POS) is a common condition that often affects women with bulimia. It can cause hirsutism (growth of ‘male’ body hair), prevent a normal menstrual cycle and affect fertility. The syndrome is named after the appearance of the ovary which contains an increased number of small fluid-filled structures called follicles or cysts. POS can be treated with hormones.

Polycystic Ovary Syndrome sometimes called Polycystic Ovarian Syndrome is a common condition that effects between 5 and 10% of women. The syndrome is named after the appearance of the ovary which contains an increased number of small fluid-filled structures called follicles or cysts.

People who suffer from bulimia nervosa, binge eating disorder, compulsive overeating or other problems resulting in weight gain have a slightly higher risk of developing PCOS than other people.

‘What is the difference between polycystic ovaries (PCO) and polycystic ovary syndrome (PCOS)?’

Although the two terms are sometimes used interchangeably, when health professionals say that a woman has polycystic ovaries (PCO) it means that polycystic ovaries have been found on an ultrasound scan, but that she has none of the other signs or symptoms that make up the syndrome. About one in five females have PCO and some will never be aware of it.

If you have been diagnosed with polycystic ovary syndrome this means that in addition to the findings of PCO on a scan, you also have one or more of the associated problems. The actual symptoms will vary from woman to woman and can be present in any combination, but the most common ones are hirsutism (inappropriate or ‘male’ hair growth), male-pattern baldness, dandruff, acne, pelvic pain, type 2 diabetes, or irregular menstrual cycles which may lead to infertility or miscarriages.

It is not entirely clear why some women with PCO manage to stay symptom-free while others seem to have every symptom or are badly affected by one in particular. It is possible that PCOS is an inherited condition. However the factors that influences the development of the symptoms include diet and weight as well as lifestyle.

What happens during the menstrual cycle and how does PCOS affect it?

The ovaries are two small organs, one on each side of a woman's uterus. A woman's ovaries have follicles, which are tiny sacs filled with liquid that hold the eggs. These sacs are also called cysts. Each month a number of eggs start to mature, but usually only one becomes dominant. As the one egg grows, the follicle accumulates fluid in it. When that egg matures, the follicle breaks open to release the egg so it can travel through the fallopian tube for fertilization. When the egg leaves the follicle, ovulation takes place.

In women with PCOS, the ovary doesn't make all of the hormones it needs for any of the eggs to fully mature. They may start to grow and accumulate fluid. But no one egg becomes large enough. Instead, some may remain as cysts. Since no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent. At the same time the cysts produce male hormones, which continue to prevent ovulation and lead to the 'male' characteristics appearing.

What is the treatment for PCOS?

Tablets or injections that stimulate the correct release of your body’s normal hormones are usually used especially where restoring fertility is important. In some cases the combined oral contraceptive or ‘pill’ is given. This, in effect, overrides the natural cycle, but has the advantage of preventing the endometrium from becoming too thick and causing other problems such as heavy bleeding. The pill may also help to prevent some of the symptoms caused by the male hormones, however the ‘pill’ will not cure PCOS. In complex or serious cases surgery on the ovaries may be suggested.

How can my weight affect my skin?

The majority of ‘male’ hormone is carried in the blood attached to a protein which stops it from having any action. If you are over-weight then you will make less of the protein and this will mean that there is more ‘free’ hormone to work on the skin. However even a small amount of weight loss will increase the level of the protein and ‘mop up’ some of the testosterone.

A second way that your weight has an effect is through the hormone insulin. Insulin is the hormone that controls the level of glucose in the blood. For reasons we don’t yet completely understand in some women with PCOS the insulin does not pass on its message very well and so more insulin is made to try to compensate. The more overweight you are the less the message is passed on. This is known as insulin resistance.

One of the side-effects of high levels of insulin is that it drives the production of male hormone by the ovaries and increases the levels in the blood. Another side-effect is that it increases your chance of having diabetes later in life. As the gland that makes insulin, the pancreas, is working very hard to try to keep the insulin high, it eventually becomes tired and fails. At this point the glucose level is no longer controlled and diabetes will occur.

This can be avoided or delayed by keeping fit and keeping your weight within the normal range. Increasing the amount of muscle will help to remove glucose from the blood and will give the pancreas a rest. However excessive exercise can have the opposite effect and stop the menstrual cycle altogether.

Does it matter if I don’t have any periods?

If you do not wish to become pregnant and you are not having treatment for your skin then you may decide not to take the oral contraceptive just to make your periods regular. This is fine as long as you do not have very heavy periods when they eventually do come. If you have heavy, very irregular periods you may increase the chances of developing abnormal endometrium. This can be avoided by regular shedding of this tissue and the oral contraceptive will cause this to happen.

What else should I do to help recovery?

Well balanced nutrition is important as is working towards a normal range of weight. Nevertheless weight loss should be gradual as rapid loss of weight almost always results in regaining or even increasing weight. About 0.5 Kg a week is ideal. Slow and boring, but realistic. You should work with experienced health professionals to achieve a healthy and sustainable weight.

Where can I learn more about PCOS?

For more information Verity is a self help organisation for women whose lives are affected by PCOS. They have a useful website at www.verity-pcos.org.uk or write to them at…
Verity, The Aberdeen Centre, 22-24 Highbury Grove, London N5 2EA

The information in this leaflet came from a number of sources but special thanks is due to Helen Mason, Senior Lecturer in Reproductive Endocrinology St Georges Hospital and Verity.