EDP column by Professor Ketan Dhatariya
Polycystic ovarian syndrome is extremely common with anything up to 7 or 8% of the female population having this disorder. It is usually comes to light with any one of several seemingly unrelated problems. These tend to be being overweight, having period problems (usually irregular, or they may even be absent for several months), having excessive hair growth in places where men usually have hair but women don’t – that is on the upper lip, on the chin and neck, between the breasts, on the back and underneath the belly button.
The diagnosis can be made using a combination of three factors, the story you tell your doctor, some blood tests, and an ultrasound of the ovaries. If you have two out of the three, then it is very possible that you have the condition.
The hair growth and period problems are often due to having too much of the male hormones, the androgens. In health, men and women have both male and female hormones, but in different quantities in each gender, female hormones being higher in women, and male hormone levels higher in men.
The underlying problem that causes this condition is unknown, but it is associated with several other conditions including high blood pressure, high cholesterol and diabetes. Together, they are known as the metabolic syndrome. This usually runs in families, and it may be that one family member has one element of the metabolic syndrome, and another family member has something else. However, they are often found together. Also, if you have one element of the syndrome, your doctor may test you for any of the others.
There are several different treatments available depending on the main concern. If it is the periods, then treatment depends on whether there is a wish to become pregnant in the near future. If pregnancy is not planned, then it may be a form of the oral contraceptive pill, if pregnancy is planned, then it will be drugs to help you lose weight and reduce the levels of the male hormones.
If the main concern is the hair growth, then again, the treatment depends on how soon in the future pregnancy is. If it is not an issue, then treatment is based on using the side effects of other drugs that have ‘anti-androgenic’ properties, that is, they block the actions of the male hormones. In addition, losing weight is very important and your doctor will probably ask you to go on a diet as well as be more active.
Infertility is an issue in this condition, because if levels of the male hormones remain high, then the ovaries do not produce eggs regularly, and so this may lead to reduced fertility. It is important, therefore to keep your weight normal and take regular exercise.