Polycystic Ovarian Syndrome

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One lesson I have learned since starting work as a GP is that women worry about their periods. A lot. They worry about them being too heavy, long, light, short (trust me, some women actually see those two as a problem!) frequent, infrequent, irregular, painful and a whole host of other issues besides, and I consequently spend a major chunk of my working life listening to blow by blow accounts of monthly misery. Some are tales of true horror with endless agonising sleepless nights of haemorrhage, while at the other end of the scale I meet people who are desperately worried because their reassuringly regular, light and painless bleeds have shortened from 7 days to 5 days – I generally send those on their way with a light-hearted ‘Lucky you!’ – and it seems that most women want the whole process to just go away, however I have also learned from a different group of patients that the menopause thing isn’t much fun either, but that’s a different article entirely!

I have also learned that one of the main things women want to discuss if they have any concerns about their periods is the possibility of polycystic ovarian syndrome (PCOS), which is a perfectly reasonable question to ask given that about 10% of women are affected by it. PCOS is a condition which usually, but not always, involves having large numbers of harmless, small cysts on the ovaries with a list of other possible symptoms including irregular periods, infertility, increased facial and body hair, acne and (the reason I am writing about it here!) gain in weight that is more difficult to lose than usual because of the associated hormone changes.

We still do not know what causes PCOS, although we know that it tends to run in families, and as we do not know the cause it is difficult to write about how to prevent PCOS; however there are various treatments available, so if you have any of the above symptoms then it is worth asking your doctor about it. They will want to ask you about all of the possible symptoms and probably arrange blood tests to check the levels of hormones in your blood that are related to your ovaries. They will also probably suggest an ultrasound scan of your womb and ovaries, although it is possible to have the overall syndrome known as PCOS without actually having the cysts on your ovaries. It is important to check your symptoms out as they could be caused by other conditions including thyroid problems.

The diagnosis would be made based on your overall condition – if you have many of the symptoms of PCOS and blood test results that look a lot like PCOS then that is enough to make the diagnosis, equally if you happen to have your bloods done on a particular day when your hormone levels do not look typical of PCOS but your scan shows lots of small cysts on your ovaries then this would suggest that you probably do have the condition.

If you do have PCOS then there are a number of effective treatments available. One of the most important things to consider is keeping your weight normal, which can be a particular challenge if you have PCOS. Part of the problem with PCOS is that it changes the way that your body handles sugar and insulin, in much the same way as type 2 diabetes does, and people with PCOS tend to be ‘insulin resistant’ – when they eat significant quantities of carbohydrate, particularly refined carbohydrate like sugar and white pasta, their pancreas (where insulin comes from) makes more insulin to try and use that sugar effectively, but their body does not respond well to it, making the whole situation worse and weight loss less likely. So one of the key changes to make if you have PCOS is to eat a diet that is low in refined carbohydrates, a so-called low GI diet. This will keep your insulin levels nice and stable which should help with weight loss and reduce hunger and mood swings if you have them. It is also important to keep an eye on your blood pressure and cholesterol – insulin resistance can increase your chances of having problems in these areas too.

There are various drug treatments available for PCOS. Because it is closely related to diabetes, metformin (a standard diabetes medication) can be very helpful – it can help you to lose weight, has been shown to get periods started again in most women with PCOS who take it, and is good for balancing the hormones. Orlistat is the only weight loss medication currently available on prescription in the UK, and while I would not normally recommend weight loss medication, it can be helpful to people with PCOS in the initial stages because the weight is so difficult to lose. Once the weight has started to reduce and hormones return to normal then a generally healthy diet governed by a Spirit controlled appetite would be all that is needed. Lastly, if facial hair, or unwanted hair anywhere else is a problem, then certain types of the contraceptive pill can be very effective at reducing this and any associated acne – it also provides control over periods and many women are actually relieved to be able to have a regular, predictable monthly bleed again.

If your fertility is affected by PCOS then do not despair! Many people, particularly Christians, have concerns about some of the ethical issues surrounding fertility treatments, but if you are one of the people with PCOS who is having trouble conceiving then this is most likely to be a problem with ovulation which is often easily sorted out with medication such as clomiphene, following which you can conceive naturally – no ethical problems there!

So the message for those of you with PCOS is the same as for so many other conditions: it is worth making the lifestyle changes you need in order to improve your symptoms, and taking any medication recommended by your doctor who knows your case in detail – you will have a better quality of life in the short term and reduce your chances of blood pressure and cholesterol related problems later on. Win-win!


  1. There is another interesting piece of information about the link between diet and PCOS. According to research, eating a big breakfast and a small dinner can cause a drop in testosterone levels and insulin resistance by at least 50%. Of course you need to do it consistently. Just try to eat the majority of your calories early in the day.

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