SEPTEMBER is PCOS Awareness Month, used to bring awareness to polycystic ovary syndrome, the most common cause of menstrual irregularities and infertility in women.

PCOS has been described in medical literature from as far back as the early 1800s; however, doctors weren’t able to get a formal way of diagnosing it until the early 1990s.

Here is some interesting PCOS information shared previously by Dr Ryan Halsall, a consultant obstetrician-gynaecologist who operates at ILAP Medical.

1. PCOS is not a specific disease. Specific diseases are straightforward, can be defined, and the causes and treatment can be determined. PCOS is a syndrome rather than a specific disease. That means it’s a bunch of signs and symptoms grouped together that sounds like it could be something, but we are not really sure what causes it.

2. Classically, this syndrome is characterised by three things — irregular periods, excess male hormones, and specific ultrasound ovarian features. These irregular periods involve missed periods or cycles longer than 35 days. The excess male hormones can either be diagnosed via blood tests or by symptoms, such as acne and facial/chest hairs. The ultrasound features can involve an ovary (or both ovaries) having the classic polycystic appearance, or it could just be a large ovary.

3. The most common criteria for diagnosis states that a woman only needs to have two out of the three to have PCOS. This means that PCOS, the most common cause of irregular periods, can be diagnosed in someone with regular periods. This also means that the ultrasound can be completely normal with no polycystic ovaries, and you still have PCOS. If that’s not confusing enough, adolescents often have irregular periods and male hormone level fluctuations. Even in adults, the diagnosis isn’t straightforward. Many other conditions can mimic what PCOS looks like. If you have abnormal thyroid function, high prolactin levels or a tumour producing excess male hormones, you may present with the same symptoms. There’s also another diagnostic criteria that states you must have excess male hormones to diagnose PCOS. This wide variability causes PCOS to be both over and under diagnosed, often frustrating patients.

4. The exact cause is unknown. Genetics, in utero nutrition, and lifestyle all play a role in developing PCOS. In 90 per cent of PCOS patients, the ovary is overproducing male hormones, and over half of patients have some form of insulin resistance. For those with insulin resistance, this results in higher than normal insulin levels which, in turn, stimulates the ovary to produce even more male hormones. Obesity is a known contributor because excess body fat increases insulin resistance.

5. The knowledge of what happens in PCOS patients is what directs treatment, and it also explains why not everyone receives the same treatment. If you have excess body fat, then weight loss with dietary modifications and exercise is a good starting point. If your body fat percentage is normal, then medication to suppress the excess male hormones may be right for you. Many patients will benefit from medication to help reduce insulin resistance such as Metformin. Contraceptive pills can be used to regularise your cycle, especially if you need some form of birth control as well. Some contraceptives can directly reduce male hormone levels and provide relief of not only irregular periods but also the acne and male hair distribution. So while doctors can’t exactly tell you what it is or what caused it, they know a lot about what happens within PCOS patients. It has a wide array of presentations and underlying causes, so it’s important for you and your physician to understand “your type of PCOS” so that your investigations and treatments can be tailored to suit your specific needs.