- Hirsutism – male pattern hair growth / excessive female hair growth
- Polycystic ovaries
- Insulin resistance – weight gain
- Can also be caused by Cushings, and adrenal hyperplasia
- Very common!
- 5-20% of women aged 18-45
- Essentially unknown
- Possibly insulin resistance
- There is certainly a relationship between the two – hard to determine cause and effect
- Insulin resistance is also associated with obesity – and excess adipose tissue will result in the creation of excess oestrogen! A vicious cycles!
- Due to anovulation (irregular / absent ovulation)
- The anovulation can also result in reduced fertility
Weight gain / insulin resistance
- May be visible by dark patches of skin, particularly on the neck and in skin folds
Masculinisation – due to excessive testosterone production
- E.g. Hirsutism – excessive hair growth on females. Common during puberty as the hormonal axis matures, and usually transient. If persistent, or presents later in life, suspect another cause (e.g. PCOS)
- Excessive body hair
Infertility may occur
Symptoms usually begin around the time of puberty, and worsen at the patient gets older.
- PCOS is unlikely if regular periods have been established before amenorrhoea.
- The cysts seen on USS are actually immature follicles and not true cysts
- Cysts are about 2-6mm in size
- ↑ LH
- ↓ E2 (estradiol)
- ↑ Testosterone
- ↑ Prolactin
- ↑ oestrogen – which ultimately results in increased risk of endometrial hyperplasia / endometrial cancer
- TFTs – for hyperthyroidism:
- Shows >5 follicles per ovary
- Sometimes said to look like a string of pearls
- May show excessive cervical mucus – consistent with excess oestrogen
Risks / complications
- Insulin resistance and possibly later, Type II diabetes
- Cardiovascular disease
- Including MI and stroke
- Dyslipiaemia – disorders of lipid metabolism
- Weight gain
- Autoimmune thyroid disease
- Acanothosis nigricans – patches of dark skin, typically under the arms and on the back of the neck
- Increased risk of endometrial cancer due to unopposed oestrogens.
- Advise increased exercise
- Often Metformin is helpful. Can not only improve diabetic symptoms, but can also help menstrual problems (amenorrhoea / oligomenorrhoea), and can help ovulation
- Metformin recommended by NICE in those trying to conceive
Oral contraceptives – should be progesterone containing, usually POP (so not as to add more oestrogen !) Help to reduce endometrial cancer risk, and reduces circulating androgens. Usually with 3-monthly withdrawal bleeds.
Treatment of hirsutism – if a problem, consider cosmetic treatments (hair removal) or an anti-androgen e.g. cyproterone.
- Spironolactone and finasteride – are also antiandrogenic, but is teratogenic, so avoid pregnancy!
- Clomifene – usually used in conjunction with metformin, will help ovulation.
- Increases the riks of multiple pregnancy and ovarian cancer
- Monitor effect with USS in at least the first cycle
- Ovarian drilling – is recommended as second line if clomiphene is not working. Helps to reduce steroid production.
- COC – may help provide regular bleeding, and will reduces the risk of endometrial cancer