Polycystic Ovarian Syndrome (PCOS) is a condition which affects a huge 8-13% of women of reproductive age & research suggests up to 70% of women who are affected remained undiagnosed (1,2). Ladies, if you have or think you may have PCOS, you’re not alone, around 1 in 8 women of reproductive age are with you!

What is PCOS?

It is essentially a hormonal imbalance, the main drivers are insulin and androgens (male sex hormones-it’s ok all females have them too, but obviously we have far less than males). Generally when one this is out of whack, it has a snowball effect on other areas of the body & this hormone imbalance, increases your risk of cardiometabolic conditions such as heart disease, metabolic syndrome and diabetes (including gestational diabetes), which sounds scary but you can definitely prevent these from occurring-effective management is key!

Did you know...

You don't actually have to have cysts on your ovaries to have PCOS so it is kind of misleading! I am not a fan of the name because these 'cysts' are partially formed follicles that each contain eggs, not cysts at all.

What symptoms may I have?

• Irregular or missing periods

• Fertility problems

• Excess hair on face, chest, stomach and back (known as hirsutism)

• Acne

• Darkened skin patches

• Thinning of scalp hair

• Low mood/depression/anxiety

• Poor body image

• Weight gain (difficulty losing weight)

• Sleep Apnoea

It can be tricking to diagnose because you may have some or all of these symptoms, every women is different! How your PCOS is treated is based on your symptoms, and this ia why I recommend getting the best testing which fits within your budget (see here for testing) & your journey will be different to the woman sitting next to you. Managing your condition can reduce symptoms and prevent further complications later on.

How do I know if I have PCOS?

PCOS is diagnosed using the Rotterdam Criteria (3). You must have at least 2 of the following to be diagnosed with PCOS:

1. Oligo- or anovulation which means you either don’t ovulate, or you ovulate at a different time in your menstrual cycle & therefore have a period less than every 21 days or more than 35 days

2. Clinical (acne, excess hair on your face, back, chest or stomach) and/or biochemical hyperandrogenism (blood results showing high levels of androgen hormones)

3. Polycystic ovaries on an ultrasound

All other potential conditions must be excluded first. Please note ultrasounds are unnecassary if you have 1. & 2. and for females under 20 years. Which is why you can actually have PCOS without having any polycystic ovaries.

What causes PCOS?

We don’t know the exact blanket reason women develop PCOS, however, we know genetics, a family history, increased hormones during pregnancy and lifestyle (4). But let's not focus on this, let's focus on making you feel amazing!

What are Androgens?

Androgens are male hormones. Testosterone is the main hormone which may show up higher than normal on your blood results. Before it freaks you out that you are producing testosterone-every female produces testosterone, it is perfectly normal! The problem lies when we have too much, because that is when it starts to interfere with our menstrual cycle and ovulation-making it harder to fall pregnant.

I have excess hair in places I shouldn’t-help!

Up to 60% of females with PCOS have excess facial &/or body hair (6). So, you are not alone. I get it, you feel awkward but don't worry, you can try laser, IPL or other forms of hair removal. Removing the hair doesn't mean you don't have PCOS anymore, it manages your symptoms. I recommend finding out WHY you have the excess hair and treating that, plus definitely some laser work to help you feel more confident and better about yourself.

Will it be harder to fall pregnant?

About 70% of women with PCOS have difficulty falling pregnant. This is because eggs are not released regularly and therefore no ovulation (or at random times) takes place so conception can be hard-but not impossible, most women go on to have the family they dream of!

Ideally you will want to make sure you have everything under control before falling pregnant, particularly having a regular period (and ovulating!). Also, for those who are losing weight to manage their condition be where you want to be prior to trying to fall pregnant because weight loss is not advised during pregnancy.

Prepare your body for a healthy pregnancy (this includes taking a folate supplement!). If you are overweight, losing 5-10% of your body weight has been shown to improve fertility (7).

Can PCOS go away?

It doesn't 'go away' but your symptoms may be reduced. As you get closer to menopause you may find your period may be a more regular cycle. However, metabolically, as you age (I know ladies-why?!) our risk of heart disease and diabetes increases-which is why it is important to learn manage our hormone imbalance to to prevent this from happening.

How can a Dietitian help with PCOS?

A dietitian should always be involved in your care team. We will provide you with the skills, tools and knowledge to manage your condition, get a regular period, lose weight (if needed), reduce your risk of developing other conditions.

And remember, your PCOS journey will be different to the next person, find what is right for you!

You can read more about expected weight changes in pregnancy here

If you think you have PCOS, see your doctor before making any dietary changes and ask for a referral to a dietitian. You may qualify for a care plan which means you can claim some of your appointment back from Medicare. As always, I am here to answer your questions or can point you in the direction to your closest dietitian.

If you know someone who is or thinks they may have PCOS, feel free to share this with them,

Kindest,

Sarah

References

1. Bozdag G, Mumusoglu S, Zengin D, et al. The prevalence and phenotypic features of polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod 2016; 31: 2841-2855.

2. Boyle JA, Cunningham J, O’Dea K, et al. Prevalence of polycystic ovary syndrome in a sample of Indigenous women in Darwin, Australia. Med J Aust 2012; 196: 62-66.

3. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Hum Reprod 2004; 19: 41-47.

4. Tata B, Mimouni NEH, Barbotin A-L, et al. Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood. Nat Med 2018; 24: 834-846.

5. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012; 33: 981-1030.

6. Fauser B, Tarlatzis B et al. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertility Sterility. 2012;97(1):28-38.

7. Clark, A., et al., Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Human Reproduction, 1998. 13(6): 1502 - 1505.

Helpful sites

Jean Hailes

Monash University PCOS