Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is an endocrine condition which affects the ovaries, uterus, adrenal glands and liver. It can affect periods and fertility, hormone levels and appearance, as well as long-term health.

Polycystic ovary syndrome (PCOS) affects an estimated 8–13% of reproductive-aged women (World Health Organisation, 2023).

What are polycystic ovaries?

They are larger than normal ovaries and have twice the number of follicles than a normal ovary, however having polycystic ovaries does not indicate a diagnosis of polycystic ovarian syndrome.

Symptoms of PCOS

Symptoms can include:

• irregular or no periods
• hirsutism
• male pattern baldness
• being overweight
• oily skin/acne
• reduced fertility.

Causes of PCOS

The cause is unknown but it is known to be familial, and may be linked to fetal exposure to androgens. Symptoms are related to abnormal hormone levels. Testosterone levels may be slightly higher than normal and this can contribute to many of the symptoms. Women with PCOS can also have insulin resistance. This leads to higher levels of serum glucose which leads to more insulin production and can contribute to symptoms particularly weight gain, irregular periods and reduced fertility.

Diagnosis of PCOS

A diagnosis is made when two of the following are present:

• irregular, infrequent periods or no periods
• androgenic symptoms such as an increase in facial or body hair and/or blood tests showing raised testosterone levels
• polycystic ovaries seen on ultrasound.

Treatment of PCOS

There is no cure for PCOS but medical treatments and lifestyle changes can help reduce symptoms. Lifestyle changes such as weight loss and exercise can be as effective as medication in reducing symptoms.

Long term consequences

• Diabetes: There is an increased risk of developing gestational diabetes, and women should be screened for this at 24-28 weeks gestation. Women presenting with PCOS who are overweight (body mass index ≥ 25 kg/m2) and women with PCOS who are not overweight (BMI < 25 kg/m2), but who have additional risk factors should be screened for type II diabetes. 1-2 in every 10 women with PCOS will develop diabetes.
• High blood pressure: Women with PCOS tend to have high blood pressure.
• Endometrial cancer: There is a small risk of endometrial cancer in women who have less than three periods a year. This can be countered by taking a short course of progestogen tablets every three or four months, taking a contraceptive pill or using a mirena intrauterine system.
• Mood: PCOS can affect mood and self esteem.
• Snoring and fatigue: PCOS can lead to snoring and daytime drowsiness and fatigue due to sleep apnoea.

Nurses role in caring for women with PCOS

There is currently no specialist nurse role in PCOS however nurses working in general practice and gynaecology will often see women with this condition. They should have a general knowledge of the condition, to help with diagnosis and then to support women with starting and maintaining a healthy lifestyle, as well as putting them in touch with support groups such as Verity.