Understanding polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects how the ovaries work. It’s thought to be one of the most common female fertility problems, but the cause remains unknown. It can also go undetected so, while it’s estimated that PCOS affects 8 to 13% of reproductive-aged women worldwide, up to 70% of those affected remain undiagnosed.¹

There isn’t a cure for PCOS, but many of its symptoms can be managed or improved through treatment or lifestyle changes. We’ve put together this guide to provide an overview of the condition and help you understand the symptoms, risks and paths to diagnosis.

What is polycystic ovary syndrome?

In the UK, it’s thought that around 10% of reproductive-aged women are affected by PCOS,² but many of us don’t understand what it is or how it affects people.

Usually starting during adolescence, PCOS affects women of reproductive age. It causes the ovaries to become enlarged and full of fluid-filled sacs or follicles that surround the eggs.

Polycystic ovaries are often unable to release eggs as frequently as they should. This can result in irregular periods along with various other symptoms, which may fluctuate or change over time. It can also cause hormonal imbalances, including excess testosterone and high levels of insulin.

What are the symptoms?

Not everyone with polycystic ovary syndrome will experience the same symptoms, and some may not have any symptoms at all. For those that do experience symptoms, they usually become noticeable in the late teens or early twenties.

The nature and severity of symptoms will vary for everyone, but some of the main ones to look out for are:

• Missed, irregular or very light periods – caused by the ovaries not being able to release eggs (ovulate) regularly.
• Excess facial or body hair – particularly around the chest, stomach and back. This is caused by high levels of ‘male’ hormones in the body.
• Thinning hair or baldness – also caused by hormone imbalances.
• Weight gain – particularly around the abdomen. Being overweight can also impact PCOS symptoms and the overall risk of developing long-term health problems as a result of the condition.
• Skin issues – including skin tags, acne, oily skin and dark or thick patches of skin.
• Fertility issues – as PCOS interferes with ovulation, it can cause difficulties for people trying to get pregnant.
• Pregnancy risks – PCOS can also mean you’re at a higher risk of developing complications during pregnancy, including high blood pressure (hypertension), gestational diabetes and miscarriage.

What’s causes PCOS?

The exact cause is still unknown. It’s a hormonal condition, so it can be linked to certain factors that may play a role or increase the risk of developing PCOS. These include:

Resistance to insulin – insulin is a hormone that helps control blood sugar levels. When someone is resistant to insulin, the body has to produce extra. These higher levels of insulin can cause the ovaries to produce too much testosterone, which interferes with ovulation.

Hormone imbalances – as mentioned, raised levels of testosterone can be a factor in PCOS. Low levels of sex hormone-binding globulin – a protein in the blood that reduces the effects of testosterone – is also an imbalance found in women with PCOS. The condition can also be linked to raised levels of other hormones, including luteinising hormone, which stimulates ovulation, or prolactin, which is involved in the production of breast milk.

Genetics – in other cases, PCOS has been found to run in families, so there could be a genetic link. Specific genes associated with the condition haven’t yet been identified,³ but if a close relative has PCOS, such as your mother, sister or aunt, your risk of developing it may be increased.

Beyond the physical symptoms

The physical symptoms and hormonal factors associated with PCOS can have significant knock-on effects, particularly with regards to mental health.

Fertility challenges

PCOS is a leading cause of female infertility.¹ It can also cause miscarriage and other difficulties during pregnancy, all of which are very stressful if you’re trying to start a family.

In a 2022 study by Fertility Network UK and Middlesex University,⁴ which looked at the impact of fertility problems on mental health, 47% of respondents experienced feelings of depression often or all the time. And 83% of respondents often or always felt sad, frustrated or worried because of fertility problems / treatment.

Workplace challenges

Fertility issues can be all-consuming, which means they also have a profound impact on your work life.

Another Fertility Network UK survey, conducted alongside Fertifa in 2021, looked into the impact of fertility challenges on working life. It revealed that a staggering 90% of people struggled with their mental health while trying to balance fertility treatment with modern work life.⁵

And even if you aren’t experiencing fertility issues or you’re not trying to get pregnant, the symptoms of PCOS can still have a significant impact your workplace wellbeing. Period-related symptoms can make it difficult to focus or feel comfortable at work, and they’re also not always easy to talk about. Suffering in silence or having to make excuses for sick days can also lead to increased stress levels.

Social challenges

PCOS symptoms like acne, unwanted hair growth, weight gain or hair loss can also impact our self-esteem and overall confidence, which can affect social interactions and overall quality of life.

And, because PCOS often goes undiagnosed, many people experience symptoms for a long time without understanding what’s causing them. This can lead to further frustration and stress.

Diagnosing PCOS

To diagnose PCOS, your GP will assess the following three criteria:

1. Irregular or infrequent periods
2. High levels of male hormones, like testosterone, which they test for using blood tests
3. The presence of fluid-filled sacs in the ovaries, which involves an ultrasound scan

Diagnosis requires two of these three criteria to be met, so you may not have to go through the process of having each test before the condition is identified.

Treating PCOS

As mentioned, there is no cure for PCOS. However, the various symptoms and challenges can be relieved and carefully managed. Because symptoms are different for everyone, treatment paths and outcomes also vary.

You could be treated by your GP or referred to a specialist depending on the nature and severity of symptoms. So, while there’s not a one-size-fits-all approach, some of the main treatment options include:

• Lifestyle changes – as mentioned, the symptoms and overall risk of long-term health problems can be worse in overweight women. Weight loss of just 5% can significantly improve PCOS symptoms,⁶ so this is one of the first areas a doctor will look to address if relevant.
• Medicines – there are many possible symptoms of PCOS, and a lot of them can be eased or treated with medication. The contraceptive pill could be recommended to help with the regularity of periods. IVF or other medical interventions might be used to try and help with fertility issues. And creams or medicines can be prescribed to deal with skin conditions or hair removal.
• Surgery – there is also a minor surgical procedure called laparoscopic ovarian drilling (LOD), which could be an option for fertility problems.

You can find a more detailed overview of the main treatment options available for PCOS on the NHS website, here.

If you think you have any of the above listed PCOS symptoms, it’s important to speak to your GP as soon as possible. They’ll be able to help you identify and / or rule out PCOS or any other health condition that may present similar symptoms.

References

1. Polycystic ovary syndrome - World Health Organization
2. Overview – Polycystic ovary syndrome - NHS
3. Causes – Polycystic ovary syndrome - NHS
4. Fertility in the Workplace - Fertility Network UK
5. Fertifa & Fertility Network UK – June 2021 survey
6. Treatment – Polycystic ovary syndrome - NHS