For many women with polycystic ovary syndrome (PCOS), the condition comes with confusion and challenges. There are the symptoms of acne and excess hair, and sometimes a higher body weight. What’s more, women often face a long road to diagnosis and effective treatment, says Jean Hailes hormone specialist Dr Kate Rassie.
An estimated one in 10 women in Australia has PCOS, yet getting a diagnosis can take time. This may be because some women get help for a specific symptom like acne or excess hair without knowing that these are part of a bigger health picture. Only when a health professional investigates the symptoms – and they range from mild to severe – can a correct diagnosis be made.
“We tend to rely on a woman having at least two out of three features for a diagnosis,” explains Dr Kate Rassie, Jean Hailes Endocrinologist. “The first two are irregular or absent periods, and high levels of androgens (male-type hormones). High levels of androgens may either be measured in the blood, or cause symptoms which include acne and excess hair growth on the face or body.”
The third measure used for diagnosis is an ultrasound to check for multiple, immature follicles on the ovaries. Abnormal hormone levels stop the follicles from maturing. In some cases, a blood test, known as AMH (anti-mullerian hormone), can be used instead of the ultrasound.
PCOS can affect ovulation – when an egg is released from an ovary – so a big concern for women with PCOS is whether they will be able to have children. “A lot of women are terrified about their fertility,” says Dr Rassie.
30% of women with PCOS will have no problem in getting pregnant and 70% will have some delayed fertility."
Dr Kate Rassie, Jean Hailes Endocrinologist
“But 30% of women with PCOS will have no problem in getting pregnant and 70% will have some delayed fertility .” This means that it may take longer to become pregnant, but these women are certainly not infertile. There are a range of treatments available to them.
Regulating ovulation is a key first step. “For women who carry higher weight, losing between five to 10% of their weight can help to regulate cycles, making ovulation more predictable,” she says. “For other women, there will be medication like metformin which helps with ovary function and regular periods.
“There are other drugs available to induce ovulation, but they are usually prescribed by a fertility specialist or an obstetrician and may require ultrasound monitoring.”
To help improve their chances, women with PCOS who want to have children are encouraged to consider starting a family before the age of 35.
“The good news is that most of the fertility challenges faced by women with PCOS can be treated through lifestyle changes – increasing physical activity, losing weight – or taking medication. For others, there is surgery or IVF.”
Women with PCOS often have a higher weight and, unfortunately, often experience stigma and judgement because of their body size.
“It can be very difficult for women with PCOS to lose weight,” says Dr Rassie. “Women should be well-supported, with input from a dietitian and an exercise physiologist, if possible. For some women, an initial goal might be a case of not putting on weight before even thinking about weight loss.”
On the topic of diets, Dr Rassie says there is no one single diet that will suit all women with PCOS. It’s about working out what will work for each individual. Overall, reducing processed foods and sugar is helpful.
Physical activity is a crucial part of managing PCOS. Not only does it improve many symptoms, it also reduces the risk of long-term impacts.
“There are also some medications we can offer for weight loss, but that discussion would have to take place with an endocrinologist,” she says.
The medical world is only beginning to understand the psychological effects of the condition, explains Dr Rassie. Mental health conditions are, for example, more common in women with PCOS – think anxiety, depression and eating disorders – as well as other symptoms like mood changes, distress and low self-esteem.
“These mental aspects are part of the condition and women need to have their mental health supported and assessed as part of managing their condition,” she explains. “It’s important to get sleep and diet right. And in those cases where there is a formal diagnosis of a mental health condition, women are recommended to see a psychologist.
Women with PCOS have a higher risk of developing type 2 diabetes, high blood pressure, high cholesterol and heart disease. But the good news is these risks can be reduced by a healthy lifestyle. And importantly, any potential problems can be identified and addressed early with regular health checks.
“Check in regularly with your GP for diabetes screening, as well as blood pressure and cholesterol checks,” advises Dr Rassie.
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