Polycystic Ovarian Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects young women in their reproductive years. It affects the ovaries which are responsible for the production of oestrogen, progesterone, and a small amount of androgen. 

Oestrogen and progesterone are the hormones that regulate the menstrual cycle and androgen is the male hormone responsible for reproductive health and development of the body. 

Women with PCOS have an excess of androgen which results in a hormonal imbalance of the reproductive hormones (progesterone and oestrogen). This prevents ovulation from taking place and hence is one of the main causes of infertility in females. If ovulation does not happen, the ovaries may begin to develop small cysts which can also produce androgen. 

This excess androgen contributes to the already high levels of androgen produced by the ovaries, further disrupting ovulation and the menstrual cycle, and thus resulting in the many symptoms associated with PCOS.

What causes polycystic ovary syndrome?

The main cause of PCOS is still unknown and there are a number of factors associated with it, these are:

• Insulin resistance: PCOS is a hormonal condition and other than the reproductive hormones, it has also been known to be related to insulin – the hormone released by the pancreas to help the body convert sugar/glucose into energy. In some individuals, they become insulin resistant and can no longer use insulin to convert sugar into energy. This causes sugar to build up in the blood which triggers your pancreas to make more insulin which does not get used. Together with sugar, insulin also builds up which then causes your body to produce more androgen.
• Excess androgen: too much androgen in the body prevents ovulation and disrupts the menstrual cycle.
• Genetics: PCOS sometimes runs in families, but it can also appear in individuals with no family history of the condition. 

Inflammation: studies have shown that low-grade, long-term inflammation is linked to higher levels of androgen [1,2].

What are the symptoms and signs of polycystic ovary syndrome?

For some women, symptoms appear when they get their first period but for others, they may only develop symptoms later in life. 

The symptoms of PCOS are:

• Irregular menstrual cycle: women with PCOS often experience irregular periods, some get less than eight periods a year while others experience none at all.
• Heavy periods: due to all the missed periods, the uterine lining builds up and accumulates. So, when women with PCOS eventually get their periods, they can experience heavy bleeding.
• Polycystic ovaries: some women have larger ovaries and develop numerous small cysts (fluid-filled sac) within their ovaries.
• Acne: excess androgen causes oily skin and may result in acne on various parts of the body.
• Weight gain: a vast majority of women with PCOS are overweight or obese.
• Dark patches of skin: women with PCOS often develop dark patches of skin at the neck, armpit, groin, or under their breasts.
• Headaches: hormonal changes can cause headaches.
• Hair growth: most women with PCOS develop excess hair on various parts of their body.
• Male pattern baldness or thinning hair: androgen is the hormone responsible for hair loss. Therefore, an excess of androgen will cause male pattern baldness where hair thins on the crown of the head.

Skin tags: some women develop skin tags on their necks or armpits.

Who is at risk of polycystic ovary syndrome?

There are some factors that may increase your risk of PCOS, these are:

• Family history: if you have a mother or sister with PCOS, your risk increases.
• Weight: if you are overweight or obese, your risk increases.
• Insulin resistance: if you have insulin resistance, your risk increases.

How is polycystic ovary syndrome diagnosed?

Your medical history and symptoms will be assessed followed during a physical examination. 

The following tests help with the diagnosis of PCOS:

• Blood tests: check your hormonal and blood glucose levels.
• Ultrasound: checks your ovaries to see if cysts are present and checks the thickness of the uterus (endometrium) lining for signs of PCOS.

If you have been diagnosed with PCOS, you will be monitored for other complications such as sleep apnoea, depression, high blood pressure, prediabetes or diabetes, and high triglycerides and cholesterol levels.

What are the treatment options for polycystic ovary syndrome in Singapore?

The treatment for PCOS depends on whether you plan on becoming pregnant or not. 

If you plan on becoming pregnant, your treatment options are:

• Lifestyle changes: eating healthy, exercising, and losing weight will help alleviate your PCOS symptoms.
• Ovulation medications: these help you to ovulate thus increasing your chances of getting pregnant.

If you do not plan on becoming pregnant, your treatment options are:

• Birth control pills: birth control pills help regulate your menstrual cycle, reduce acne, and lower androgen levels.

• Lifestyle changes: eating healthy, exercising, and losing weight will help alleviate your PCOS symptoms.

Diabetes medication: used to lower insulin resistance and helps control blood glucose levels.