Polycystic ovarian syndrome

What it is

Polycystic ovary syndrome, or PCOS, is a condition in which the ovaries produce an abnormal amount of androgens — male sex hormones that are usually present in women in small amounts. Estimates of how many women it affects vary widely, from 2 to 26 in every 100. Polycystic ovaries are slightly larger than normal and have twice the number of follicles, the spaces within the ovary that release the eggs.

PCOS very often shows itself first on the skin. Suspect it if you develop very oily skin; moderate to severe recurrent acne that does not respond to treatment; irregular, delayed or absent periods; difficulty conceiving; increased facial or body hair; loss of hair on the scalp; moderate to severe dandruff; weight gain; brownish-black discolouration on the neck, underarms, knuckles and elbows; or skin tags on the neck and armpits. Type 2 diabetes, high blood pressure, raised lipids, cardiac problems, non-alcoholic liver disease and sleep apnoea are long-term risks. Symptoms vary a great deal from woman to woman.

What causes it

The cause is not yet known, but it often runs in families. Women with PCOS have higher than normal levels of testosterone, which accounts for many of the symptoms. The body may also not respond properly to insulin, so blood glucose rises and the body produces even more insulin; high insulin leads to weight gain, irregular periods, fertility problems and higher testosterone.

How we diagnose it

A pelvic ultrasound scan looks at the ovaries, hormonal tests are done, and your doctor may advise others.

How we treat it

Treatment starts with lifestyle: a low-glycaemic balanced diet, low in carbohydrate and rich in fibre, with less sugar, salt and caffeine; regular exercise, at least 30 minutes three times a week, and yoga. Aim to keep your body mass index between 19 and 23. Diet, exercise and weight loss on their own can often reduce the symptoms of PCOS.

Beyond that, PCOS is assessed and managed together by your dermatologist, your gynaecologist and an endocrinologist, because it affects the skin, the periods and the hormones at the same time. What is advised depends on which symptoms affect you most, and any medicine is decided and prescribed by the appropriate specialist after that assessment.