Understanding PCOS: what does it mean for you?

Acne, weight gain, excess body hair, irregular periods, depression, infertility are just some of the frustrating symptoms of polycystic ovarian syndrome (PCOS).

It’s estimated that 12 to 18 per cent of women at child-bearing aged experience PCOS, and up to 21 per cent in high-risk groups such as Indigenous women. It’s also the most common reproductive disorder in females, but what exactly is it?

At the crux of PCOS is hormone imbalance. Most symptoms are caused by high levels of androgens (male hormones) circulating throughout the body. These high levels of androgens (often testosterone) can prevent ovulation and also affect your menstrual cycle.

The name polycystic suggests multiple cysts on the ovaries, but that’s not always the case. According to health organisation Jean Hailes for Women’s Health, ‘Not all women who have PCOS have multiple ‘cysts’ and not all women who have multiple ‘cysts’ have PCOS. The term ‘cyst’ is a bit misleading. The cysts are actually not cysts but partially formed follicles which contain an egg.’

If left untreated, PCOS may affect a woman’s appearance, mood and overall wellbeing. It’s a disorder that’s difficult to diagnose and largely misunderstood, so here’s what you need to know. 

PCOS looks different to different women
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Excess facial or body hair growth, acne, irregular periods, weight excess, fertility issues and scalp hair loss are some common signals of the disorder. Women with PCOS can experience a wide range of symptoms, and not all sufferers meet the same diagnosis criteria.

According to Jean Hailes endocrinologist Dr Sonia Davison, women may have some, but not all, of the typical symptoms of PCOS, "hence further testing and careful assessment is needed to diagnose some women.” To be diagnosed with PCOS, patients meet two out of three diagnostic criteria:

1. The ovaries are ‘polycystic’ because they are enlarged or have 12 or more follicles visible.

2. There are high levels of male hormones in the blood and symptoms such as excess hair growth and acne.

3. There is menstrual dysfunction and lack of ovulation.

According to Jean Hailes, PCOS can be more prevalent in certain groups, such as Indigenous women. “We don’t know why some women are at an increased risk, but there are thought to be genetic and ethnic influences which are yet to be identified,” says Dr Davison. 

Untreated PCOS can lead to health complications in the future
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Up to 75 per cent of women with PCOS are overweight or obese, with weight more likely to be located around the middle. This excess visceral fat leaves women at risk of other health issues including pre-diabetes and type-2 diabetes, metabolic disorder and cardiovascular disease.

Women with PCOS are more likely to suffer insulin resistance, making them up to seven times more likely to develop pre-diabetes and type-2 diabetes and more likely to do it earlier, in their 30s and 40s.

It's also worth mentioning that there's an increased endometrial cancer risk in untreated PCOS. However, that is not caused by having PCOS, rather than the lack of menstruation that comes an irregular cycle. 

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Lifestyle changes everything
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Taking your health into your own hands is essential to treating PCOS. “Lifestyle is crucial,” says Dr Davison. While metabolic factors such as high insulin resistance can make it difficult for women with PCOS to lose weight, “studies have shown that even a five to 10 per cent weight loss can help with the hormonal abnormalities in PCOS and improve fertility.”

Medical therapies (such as the oral contraceptive pill) will depend on individual symptoms but “from a clinician’s perspective, maintaining a healthy weight for height is the most effective strategy in those women with PCOS who are overweight,” says Dr Davison.

“A healthy, balanced diet that contains fruit, vegetables, lean meat and low GI carbohydrates is ideal, but no one strategy works in terms of losing weight in women with PCOS.” But she adds, “lowering the number of calories consumed, reducing carbohydrate consumption, and reducing the amount of overall fat content in the diet” is a good place to start.  

You can have PCOS and fall pregnant
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Before you think all hopes of natural conception are dashed, know this: 60 per cent of women with PCOS become pregnant without medical help.

The first step? Managing your weight and, in turn, your menstrual cycle. “Women with PCOS will have a higher chance of conceiving if they have regular periods and a healthy weight for height,” says Dr Davison. “These can be achieved through a combination of diet and exercise.” Or speak to a fertility specialist about improving ovulation through medication, surgery or assisted technologies like IVF.