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Complications of Diabetes

Polycystic Ovarian Syndrome (PCOS)

What is Polycyctic Ovarian Syndrome?

Polycystic ovarian Syndrom (PCOS) is also known as Stein Leventhal syndrome after Stein and Leventhal who first described the condition. They described an association between the presence of multiple cysts in the ovaries, menstrual disturbances, hirsutism (excess hair growth) and obesity.

How common is PCOS?

It is estimated that upto 10% of pre-menopausal women have PCOS.

What causes PCOS?

It is thought to be due to a hormonal imbalance. The ovaries and adrenal glands of women with PCOS produce more androgens (male hormones) such as testosterone. Cysts develop in the ovarian follicles which produce eggs. These cysts when multiple can cause damage ot the ovaries. It is thought that high levels of insulin (hyperinsulinaemia) stimulate the ovaries to increase production of androgens.

What are the symptoms?

  • irregular menstruation
  • obesity (as many as 50% of people with PCOS are overweight)
  • acne
  • hirsutism (hair growth on the face, chest and back)
  • subfertility (difficulty in conceiving)

What are the menstrual irregularities?

  • infrequent periods (oligomenorrhoea)
  • Amenorrhoea (no menstrual periods for 3 or months or more)

I am not overweight – can I have PCOS?

Yes. You can be slim and have PCOS. You can also develop insulin resistance in the absence of obesity.

I have noticed increased hair growth – am I likely to have PCOS?

There are other causes of hirsutism as well. Idiopathic hirsutism (hair growth without an obvious cause) and PCOS together make up over 95% of all cases.

What is the link with diabetes?

PCOS is associated with insulin resistance and high levels of circulating insulin. Obesity adds to these problems. It is estimated that as many as 10% of women who are obese and have PCOS develop type 2 diabetes by the age of 40 years. A higher proportion have developed impaired glucose tolerance by this age.

What is the significance of finding Polycystic ovaries on ultrasound?

  • Most women with PCOS have polycysitc ovaries, however the diagnosis of PCOS does not require the demonstration of polycystic ovaries.
  • About 20-30% of otherwise normal women have polycystic ovaries on ultrasound.

How is PCOS diagnosed?

Three key features are necessary:

  1. infrequent periods (oligomenorrhoea)
  2. hyperandrogenism – increased male hormone
  3. absence of other endocrine disorders

What are the long term problems with PCOS?

  • infertility
  • Type 2 diabetes
  • high blood pressure
  • greater risk of heart disease

How is this condition treated?

The treatment of this condition often depends on whether you wish to conceive or not. Your doctor will discuss these issues further with you.

  1. Diet and exercise – there is good evidence that weight loss results in a significant improvement of the metabolic abnormalities associated with PCOS. A reduction in hair growth and sometimes a return to ovulatory cycles may occur. Weight loss alone may restore ovulation and menstruation.
  2. Stimulation of ovulation with Clomiphene – Polycystic ovaries are very sensitive to stimulation and this treatment needs to be carefully monitored. Ovarian hyperstimulation and multiples pregnancies may result.
  3. Surgery – ovarian drilling or wedge resection.

What is the place of drugs which increase insulin sensitivity?

There are two groups of drugs currently used to increase insulin sensitivity

  1. Metformin
  2. Thiazolidenediones – Rosiglitazone and Pioglitazone

What benefits have been shown with Metformin?

  1. Decrease in body mass index in the region of 4%
  2. Decrease in androgen (male hormone) activity fo around 20%
  3. Increase in ovulatory cycles – normal menstrual cycles achieved within 3 months of starting treatment in some groups of patients
  4. Increased rates of pregnancy reported in several trials

What is the impact of Metformin on hair growth and acne?

Currently the evidence does not suggest that metformnin has a significant effect on hirsutism and acne. No recomendation can be made for its use.

Are Thiazolidenediones effective?

These drugs have been shown to result in higher ovulation rates.

What treatments are effective for hair growth?

  • removal of hair by shaving, electrolysis, laser treatment etc
  • oral contraceptives
  • anti-androgens eg Spironolactone

Where can I get more information/support?

www.pcos-support.org

Medifocus Guide

 

Dr Nishan Wijenaike, Consultant Physician
West Suffolk Diabetes Service
September 2003