I’m going to blow your mind – polycystic ovarian syndrome (PCOS) has little to do with the ovaries.
PCOS is a common, but often misunderstood condition. 12–21% of women of reproductive age will suffer from it and despite the small acronym the diagnosis has many implications.
The syndrome, despite the name, is more about the body’s metabolism and how it deals with insulin as opposed to the ovaries. Whilst most people’s minds jump to overweight women with excessive hair growth when they think of PCOS, take a look at Victoria Beckham – a very slender woman who has struggled with the condition. There may be friends or family members who have the condition that you are not aware of – remember how they said to never judge a book by its cover?
Here are the main things you should know.
The disorder has 3 characteristic features and you only need 2 to be diagnosed. Irregularities of menstrual cycle, high levels of testosterone (with features like excessive hair growth or elevated levels on a blood test) and characteristic features of the ovaries on ultrasound are the 3 criteria. The ovaries are not essential to diagnosis, so everyone harping on about them can be very misleading! You can be diagnosed with the condition and have perfectly normal ovaries on an ultrasound.
The ‘cysts’ everyone refers to are actually follicles in the ovary. A follicle is where the eggs are made and when a woman ovulates there is one lucky follicle (usually!) that gets to release an egg. People often ask me “what will happen to the cysts? Do they get surgically removed or burst?” The image that many of my patients have in their mind of a huge ovary with pimples all over it isn’t necessarily correct – and the follicles don’t need removal.
Insulin resistance is the main issue in PCOS. This means that the body needs more insulin to keep the blood sugar levels normal. It is the high levels of insulin that cause a lot of the problems in PCOS. It is the reason why patients have a much higher risk of both type 2 and gestational diabetes. The higher insulin levels also stimulate more testosterone production which can cause the excessive hair growth and acne that many PCOS patients struggle with. Ongoing monitoring for diabetes in patients every 2-5 years is recommended and for women with PCOS who are pregnant, we screen for gestational diabetes earlier on.
Before we can diagnose you with PCOS we need to do blood tests to exclude other conditions like thyroid disease. If you meet the criteria for diagnosis (for instance you have excessive hair growth on the lip or tummy and long menstrual cycles) you don’t always need an ultrasound. Remember you only need 2 out of the 3 criteria to be diagnosed. Having said that, most of my patients who meet the criteria still want the ultrasound for peace of mind and to know exactly what they are dealing with – and that’s fine too.