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In the first of a series of new fertility treatment articles, Dr Anthony Cheung explains Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a condition in women that covers a spectrum of variable features, but is typically characterized by increased male hormones (androgens) and irregular periods, hence, lack of regular ovulation. Doctors may suspect increased androgens because of physical changes such as excessive hair growth, or the increased androgens may be discovered by blood tests. The diagnosis of PCOS is on the proviso that other causes of irregular menstrual periods and elevated androgens have been excluded. Using this definition, PCOS is estimated to affect 6-7% of women in the reproductive age.

More recent diagnostic criteria have broadened the definition to include at least two of the following three features:

  • Increased production of androgens, or the presence of physical effects of the latter
  • Continual lack of ovulation
  • Ultrasound changes showing multiple, round fluid-filled “cysts” usually less than 8 mm in diameter, in the ovary, giving a “polycystic” appearance

*(These “cysts” are similar to the physiological cysts or “follicles” seen in the normal ovary. However, in PCOS, they are present in larger numbers and are found, typically, around the periphery of the ovary. They fail to undergo the normal growth and development that leads to ovulation in the normal menstrual cycle).

Note that some androgens are normally present in women, but when androgen levels rise too high, this upsets the normal female hormone balance and interferes with ovulation, which causes infrequent menstrual periods. Excessive weight and/or fat distribution around the waist (leading to an increased waist-to-hip ratio) as well pre-diabetic metabolic changes are also features in some women with PCOS and can also disturb hormone signals that regulate the menstrual cycle, resulting in no or infrequent ovulation.

However, using the above broadened criteria, women can be classified as having PCOS with just irregular cycles and ultrasound appearance of polycystic ovaries but without features related to increased androgens or altered fat distribution, obesity and pre-diabetic metabolic changes. This has generated an ongoing debate on what characteristics should be included in the diagnosis of PCOS.

Because excessive weight, altered fat distribution in the waist and hip and/or pre-diabetic metabolic changes are considered long-term health risks, it has recently been suggested, that a new name be created for this group so that a definitive “diagnosis” can be made early for appropriate health promotion and preventive measures, while the name “PCOS” continues to be applied to those related to reproduction (with footnotes categorizing the specific features).

Ultrasound image of a polycystic ovary