PCOS is one of the most commonest hormonal disturbances affecting women of reproductive age impacting around 1 in 10 women (8-13%). Despite affecting so many people PCOS is regularly overlooked and therefore left undertreated. Up to 70% of affected women remain undiagnosed. Those that are diagnosed will not always receive all the treatment they require. This is incredibly frustrating as it is the commonest cause of anovulation (ovary not releasing an egg each month) and a leading cause of infertility. Please note, this does not mean that everyone will have fertility challenges and does not mean that fertility challenges cannot be overcome.
What is PCOS?
It is a condition that can affect a women’s menstrual cycle, fertility, hormones and apearance as well as their physcial and emotional wellbeing. It tends to run in families, so when people come into the clinic we often ask about the health of mothers and sisters when doing assessments. Signs of it begin in adolescents with the start of puberty. However, it’s challenging to diagnose during this time.
Diagnosis
PCOS is diagnosed by the presence of at least 2 out of the following:
- signs or symptoms of high androgens (unwanted facial or bodily hair, loss of hair from the head, acne or an elevated blood level of testosterone) – after other causes for this have been excluded;
- irregular or absent menstrual periods – after other causes for this have been excluded; and
- polycystic ovaries on an ultrasound scan.
Please note that for some women periods can be long and heavy rather than absent and they can be irregular too and unpredictable. Women may also experience predictable but long cycles where they may not get many periods each year.
Blood tests
Blood tests are usually done during investigations and tell a story. Each blood test is a snapshop view of what is hapening at that time, so there may be differences between an individuals blood test results.
Women with PCOS may have high levels of
- testosterone or indications of high testosterone (SHBG and DHEA-S are also checked)
- luteinising hormone (LH is important for normal ovulation. It’s like the school bell which tells the mature egg it’s time for graduation and they can now leave);
- insulin (a hormone that manages blood sugar levels), HbA1c (average blood sugar), fasting blood sugar
- anti-müllerian hormone (AMH which is sometimes used to get an idea of egg count)
- CRP (inflammation)
- Liver function tests (LFTs)
- Cholesterol (Total, LDL, TG)
Disease risk
Women with PCOS have a higher risk of heart disease, impaired glucose tolerance (A.K.A. ‘prediabetes), type 2 diabetes and NAFLD (non alcoholic fatty liver disease or metabolic dysfunction-associated steatotic liver disease (MASLD) as its now called) – therefore dietary support and regular screening for these conditions is needed.
Things that are seen more often in women with PCOS include greater waist circumference, high blood pressure and raised cholesterol levels. Additionally, there may be increased risk of sleep disorders, endometrial cancer, depressive/ anxious symptoms and disordered eating.
- Regardless of age, the prevalence of gestational diabetes, imparied glucose tolerance and type 2 diabetes are significantly increased with PCOS (5 fold in Asia, 4 fold in Americans, 3 fold in Europe)
- By the fourth decade of life, 40% of women with PCOS will develop Insulin Glucose Tolerance or Type 2 Diabetes. 6.8 times higher prevalence T2DM at mid-life than general female population.
- Sleep apnea: Screening should only be considered to identify and alleviate related symptoms, such as snoring, waking unrefreshed from sleep, daytime sleepiness, and the potential for fatigue to contribute to mood disorders
- Endometrial cancer: 2 to 6 fold increased risk of endometrial cancer, which often presents before menopause; however absolute risk of endometrial cancer remains relatively low. Your doctor may recomend the Combined Oral Contraceptive Pill or progestin therapy if cycles are longer than 90 days, or if they deem it medically wise based on their expertise.
I hope this information helps you to help yourself. If you would like to book in to speak with a dietitian, we are here to help!
For information on how to manage your PCOS with diet, please click here.
