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PCOS is a condition that can affect your periods, fertility, hormones and aspects of your appearance. It can also affect your long-term health. Estimates of how many women it affects vary widely from 2 to 26 in every 100 women.
Polycystic ovaries are slightly larger than normal ovaries and have twice the number of follicles (fluid-filled spaces within the ovary that release the eggs when you ovulate). Having polycystic ovaries does not necessarily mean that you have PCOS. Women with PCOS have symptoms as well as polycystic ovaries.
The symptoms of PCOS include:
Depression and psychological problems can also result from having PCOS. The symptoms vary from woman to woman. Some women have very few mild symptoms, while others are affected more severely by a wider range of symptoms. PCOS is a cause of fertility problems in women.
The cause of PCOS is not yet known but it often runs in families. If any of your relatives (mother, aunts, sisters) are affected with PCOS, your risk of developing PCOS may be increased.
The symptoms are related to abnormal hormone levels:
Testosterone is a hormone that is produced in small amounts by the ovaries in all women. Women with PCOS have slightly higher than normal levels of testosterone and this is associated with many of the symptoms of the condition.
Insulin is a hormone that controls the level of glucose (a type of sugar) in the blood. If you have PCOS, your body may not respond to insulin (this is known as insulin resistance), so the level of glucose is higher. To try to prevent the glucose levels becoming higher, your body produces even more insulin. High levels of insulin can lead to weight gain, irregular periods, fertility problems and higher levels of testosterone.
Having polycystic ovaries does not mean you have PCOS. Women with PCOS often have symptoms that come and go, particularly if their weight goes up and down. This can make it a difficult condition to diagnose, which means it may take a while to get a diagnosis.
A diagnosis is made when you have any two of the following:
If you have PCOS, you are at greater risk of developing the long-term health problems discussed below.
If your blood glucose does not stay normal, this can lead to diabetes. One or two in every ten women with PCOS go on to develop diabetes at some point. If the diabetes is untreated, this can cause damage to organs in the body. If you have PCOS, your risk of developing diabetes is increased further if you:
Women with PCOS tend to have high blood pressure, which is likely to be related to insulin resistance and to being overweight rather than to the PCOS itself. High blood pressure can lead to heart problems and should be treated.
If you have fewer than three periods a year, the lining of the womb (endometrium) can thicken and this may lead to endometrial cancer in a small number of women. There are various ways to protect the lining of the womb using the hormone progestogen. Your doctor will discuss the options with you. This may include a five-day course of progestogen tablets used every three or four months, taking a contraceptive pill or using the intrauterine contraceptive system (Mirena®). The options will depend on whether you are trying for a baby. PCOS does not increase your chance of breast or ovarian cancer.
The symptoms of PCOS may affect how you see yourself and how you think others see you. It can lower your self-esteem. Snoring and daytime drowsiness PCOS can lead to fatigue or sleepiness during the day. It is also associated with snoring.
The main ways to reduce your overall risk of long-term health problems are to:
Your doctor can provide you with full information on eating a healthy diet and exercise. You should aim to keep your weight to a level that is normal. BMI is the measurement of weight in relation to height and you should aim to keep your BMI between 19 and 25. To calculate your BMI, follow this link: www.nhs.uk/Tools/Pages/Healthyweightcalculator.aspx. If you are overweight, it would be helpful to lose weight and maintain your weight at this new level. If your BMI is more than 30, discuss ways of losing weight, including weight-reducing drugs, with your GP or pharmacist.
The benefits of losing weight include:
You only have to lose a small amount of weight to make a difference to your symptoms and your health. There is no strong evidence that PCOS by itself can cause you to gain weight or makes losing weight difficult.
Once you have a diagnosis of PCOS, you will be monitored to check for any early signs of health problems:
Diabetes: Women with PCOS over the age of 40 should be offered a blood sugar test once a year to check for signs of diabetes. If your BMI is 30 or over or you have a family history of diabetes, you may be offered testing for diabetes earlier than age 40.
Cancer of the womb: If you have not had a period for a long time (over 4 months) or have irregular bleeding, it is advisable to see your doctor. You may be offered a referral for further tests that may include an ultrasound scan of your womb (uterus) or treatment to make you have a period if they are very irregular.
High blood pressure: Discuss with your doctor how often you should have your blood pressure checked and whether you should have blood tests to check your cholesterol levels.
Depression and psychological problems: You can be referred to a counsellor or trained specialist if necessary.
There is no cure for PCOS. Medical treatments aim to manage and reduce the symptoms or consequences of having PCOS. Medication alone has not been shown to be any better than healthy lifestyle changes (weight loss and exercise). Many women with PCOS successfully manage their symptoms and long-term health risks without medical intervention. They do this by eating a healthy diet, exercising regularly and maintaining a healthy lifestyle.
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