What is Polycystic Ovarian Syndrome (PCOS)?
Polycystic ovarian syndrome (PCOS) is a relatively common hormonal condition in women. ‘Polycystic’ literally means ‘many cysts’ refers to the many partially formed follicles on the ovaries, which each contain an egg. These rarely grow to maturity or produce eggs that can be fertilised.
PCOS affects 8 to 13 per cent of women of reproductive age (between late adolescence and menopause). Almost 70 per cent of these cases remain undiagnosed.
We don’t know exactly what causes PCOS, however family history and genetics, hormones and lifestyle play a role.
Women with PCOS commonly have high levels of insulin that don’t work effectively, or male hormones known as 'androgens', or both. Insulin resistance is present in up to four out of five women with PCOS.
What are the symptoms of PCOS?
Women who have PCOS experience symptoms related to the effects of their changing hormone levels. You don’t have to have all of these symptoms to have PCOS:
irregular periods – periods may be less or more frequent due to less frequent ovulation (release of an egg)
no periods (amenorrhoea) – some women with PCOS do not menstruate, in some cases for many years
excessive facial or body hair growth (or both) – hirsutism is common in women with PCOS
acne
scalp hair loss
reduced fertility – women with PCOS may have difficulty in becoming pregnant because they ovulate less or not at all
mood changes – including anxiety and depression
obesity
sleep apnoea
I have irregular periods, how do I know if I have PCOS?
Many different conditions may cause irregular periods. To be diagnosed with PCOS, women need to have two out of three of the following:
Irregular or absent periods
Acne, excess facial or body hair growth, scalp hair loss or high levels of androgens (testosterone and similar hormones) in the blood.
Polycystic ovaries – visible on an ultrasound
Up to a third of women may have many small cysts on the ovaries seen on an ultrasound, but they still don’t all have PCOS.
I am not overweight, can I still have PCOS?
Yes – women who are healthy or underweight can still have PCOS.
PCOS is linked to obesity, which means the condition can sometimes be overlooked in women who are not overweight. Symptoms like absent or irregular cycles can be considered ‘normal’ in women who are underweight. This means many women with PCOS are not diagnosed until they try to have a baby.
Are there treatments for PCOS?
There are treatments to help women who have PCOS.
Medications may help regulate your periods, relive symptoms and improve your fertility; while lifestyle changes can reduce your risk of related complications.
Regardless of your primary goal, PCOS should be treated because of the long-term health risks such as heart disease and endometrial cancer.
Your endocrinologist will suggest a combination of treatments to help you:
Lifestyle modifications – increasing your level of physical activity and eating a healthy diet can help to manage PCOS
Managing your weight – research has shown that even five to 10 per cent weight loss can provide significant health benefits so we can help you lose weight if needed
Medical treatment – medications to regulate your periods, balance your hormones, improve insulin resistance and improve fertility can form part of effective treatment for PCOS
Counselling – PCOS can be hard to cope with physically and emotionally – therefore counselling can be very helpful as part of treatment
Why is it important to treat PCOS?
Making changes to your daily habits can make a big difference if you have PCOS. It can make you feel better by improving symptoms and have an immediate and positive effect on your heath, for example, if your new lifestyle helps you lose weight.
PCOS is associated with many serious and long-term health risks. There is an increased risk of insulin resistance and developing diabetes, especially if women are overweight.
Women with PCOS are also at greater risk of cardiovascular disease (heart disease, heart attack and stroke) and endometrial cancer if there is long-standing thickening of the lining of the womb.
Can PCOS go away by itself?
PCOS does not go away on its own – even if you lose weight or have a baby. Even after menopause, women with PCOS often continue to have high levels of androgens as well as insulin resistance. However, insulin resistance is definitely a reversible factor with the right treatment, and our RECLAIM Program is designed to reverse insulin resistance.
If you have PCOS, you need to look after yourself by understanding and managing the health risks for the rest of your life.
Our team of endocrinologists, clinical psychologists and accredited practising dietitians are here to help. We understand how you feel and can help you manage the unique challenges of living with PCOS.
Polycystic Ovarian Syndrome (PCOS) & Hirsutism
What is hirsutism?
Hirsutism in women is when dark and coarse hair grows in areas where it doesn’t usually grow, such as the face and back. It affects about one in 10 women and in most cases is a symptom of polycystic ovarian syndrome (PCOS).
Dealing with hirsutism can be difficult but it’s important to seek help if you have any concerns about your body hair so any underlying cause can be explored, and you can seek treatment.
What causes hirsutism?
Hirsutism in women is usually caused by an abnormally high level of androgens.
Androgens are known as male sex hormones (including testosterone) and are the hormones responsible for characteristics like facial and coarse body hair. A woman’s ovaries and adrenal glands naturally make a small amount of androgens.
It’s important to understand that hairiness is not the same as hirsutism. Many women naturally have more body hair than others. Family and cultural background play an important role in hair colour, thickness and where it grows.
However, about nine in 10 women with hirsutism have polycystic ovary syndrome (PCOS), which is often associated with irregular menstrual cycles, acne, obesity, reduced fertility and an increased risk of diabetes and osteoporosis.
How do I know if my hirsutism is as a result of PCOS?
Hirsutism is diagnosed using a combination of tests and medical history. Your doctor will ask specific questions about your family and whether the hairiness has been gradual or sudden.
Tests to check if your hirsutism is as a result of underlying PCOS are very important due to the long-term health risks of undiagnosed PCOS. These include a physical examination, hormone blood tests and an ultrasound scan of the ovaries. In women with PCOS, multiple small follicles develop in the ovaries that appear as cysts.
What are the symptoms of hirsutism?
The symptoms of hirsutism depend on the underlying cause, but may include:
A sudden change in hair colour, rate of growth, thickness or distribution
Excessive body hair in typically ‘male’ areas of the body such as the face, back, abdomen, inner thighs and buttocks.
Other skin conditions such as acne
Irregular or absent periods
If other female family members have experienced excessive hair growth, you should watch for early signs of hirsutism in yourself and your children, especially during adolescence.
What is the treatment for hirsutism?
Your medical team will devise a treatment and management plan based on the underlying cause of your hirsutism (eg PCOS) and your long term health goals. Treatment options may include:
Medications to block the effects of androgens
Anti-androgen medications to reduce your body’s ability to make androgens
Medications to help block the manufacture of androgens in the ovaries, such as the oral contraceptive pill
Following medical treatment, cosmetic hair removal like laser treatment can be used to reduce or remove any remaining unwanted hair.
Looking after yourself
While you might feel self-conscious or embarrassed about excess hair or weight gain associated with PCOS and hirsutism, it’s important to remember that these are common problems experienced by many women and help is available.
Some practical things you can do include:
Understand your medications – talk to your doctor about side effects of any medication you are taking for your PCOS.
Make choices about your own body – if you decide to remove excess hair, talk to other women about treatments that have worked for them.
Look after your overall health – if you have PCOS, losing weight may help with associated symptoms like hirsutism because weight loss can naturally reduce the amount of androgens your body produces.
Seek more support – our dietitians and clinical psychologists can also support you with your health goals, including managing side effects of medication.
Be patient – it can take a while to see results of treatment and lifestyle changes so be patient and kind to yourself.